Skin-interfaced systems for sweat collection and analytics

Micro-Nano Hierarchical Structure Enhanced Strong Wet Friction Surface Inspired by Tree Frogs

Superior wet attachment and friction performance without the need of special external or preloaded normal force, similar to the tree frog's toe pad, is highly essential for biomedical engineering, wearable flexible electronics, etc. Although various pillar surfaces are proposed to enhance wet adhesion or friction, their mechanisms remain on micropillar arrays to extrude interfacial liquid via an external force. Here, two-level micropillar arrays with nanocavities on top are discovered on the toe pads of a tree frog, and they exhibit strong boundary friction ≈20 times higher than dry and wet friction without the need of a special external or preloaded normal force. Microscale in situ observations show that the specific micro-nano hierarchical pillars in turn trigger three-level liquid adjusting phenomena, including two-level liquid self-splitting and liquid self-sucking effects. Under these effects, uniform nanometer-thick liquid bridges form spontaneously on all pillars to generate strong boundary friction, which can be ≈2 times higher than for single-level pillar surfaces and ≈3.5 times higher than for smooth surfaces. Finally, theoretical models of boundary friction in terms of self-splitting and self-sucking are built to reveal the importance of liquid behavior induced by micro-nano hierarchical structure.

Minimally Invasive Platforms in Biosensing

The interaction of sensing components with body fluids is a basic requirement for clinical diagnostics; a variety of novel platforms have recently been developed for invasive and non-invasive sensing. In this manuscript, recent advancements related to minimally invasive platform for biosensing are reviewed. Many approaches have been utilized for generating minimally invasive platforms that require a small volume of body fluid; for example, the use of small-scale needles known as microneedles for minimally invasive detection has been demonstrated. The use of capillary action in microneedle-assisted biosensing may facilitate the detection of analytes in body fluids. This review considers recent innovations in the structure and performance of minimally invasive sensos.

Wearable Electrochemical Sensors for the Monitoring and Screening of Drugs

Wearable electrochemical sensors capable of noninvasive monitoring of chemical markers represent a rapidly emerging digital-health technology. Recent advances toward wearable continuous glucose monitoring (CGM) systems have ignited tremendous interest in expanding such sensor technology to other important fields. This article reviews for the first time wearable electrochemical sensors for monitoring therapeutic drugs and drugs of abuse. This rapidly emerging class of drug-sensing wearable devices addresses the growing demand for personalized medicine, toward improved therapeutic outcomes while minimizing the side effects of drugs and the related medical expenses. Continuous, noninvasive monitoring of therapeutic drugs within bodily fluids empowers clinicians and patients to correlate the pharmacokinetic properties with optimal outcomes by realizing patient-specific dose regulation and tracking dynamic changes in pharmacokinetics behavior while assuring the medication adherence of patients. Furthermore, wearable electrochemical drug monitoring devices can also serve as powerful screening tools in the hands of law enforcement agents to combat drug trafficking and support on-site forensic investigations. The review covers various wearable form factors developed for noninvasive monitoring of therapeutic drugs in different body fluids and toward on-site screening of drugs of abuse. The future prospects of such wearable drug monitoring devices are presented with the ultimate goals of introducing accurate real-time drug monitoring protocols and autonomous closed-loop platforms toward precise dose regulation and optimal therapeutic outcomes. Finally, current unmet challenges and existing gaps are discussed for motivating future technological innovations regarding personalized therapy. The current pace of developments and the tremendous market opportunities for such wearable drug monitoring platforms are expected to drive intense future research and commercialization efforts.

Wireless battery-free wearable sweat sensor powered by human motion

Wireless wearable sweat biosensors have gained huge traction due to their potential for noninvasive health monitoring. As high energy consumption is a crucial challenge in this field, efficient energy harvesting from human motion represents an attractive approach to sustainably power future wearables. Despite intensive research activities, most wearable energy harvesters suffer from complex fabrication procedures, poor robustness, and low power density, making them unsuitable for continuous biosensing. Here, we propose a highly robust, mass-producible, and battery-free wearable platform that efficiently extracts power from body motion through a flexible printed circuit board (FPCB)-based freestanding triboelectric nanogenerator (FTENG). The judiciously engineered FTENG displays a high power output of ~416 mW m^-2 Through seamless system integration and efficient power management, we demonstrate a battery-free triboelectrically driven system that is able to power multiplexed sweat biosensors and wirelessly transmit data to the user interfaces through Bluetooth during on-body human trials.

Ultrathin Ion-Sensitive Field-Effect Transistor Chips with Bending-Induced Performance Enhancement

Flexible multifunctional sensors on skin or wearables are considered highly suitable for next-generation noninvasive health care devices. In this regard, the field-effect transistor (FET)-based chemical sensors such as ion-sensitive FETs (ISFETs) are attractive as, with the ultrathin complementary metal oxide semiconductor technology, they can enable a flexible or bendable sensor system. However, the bending-related stress or strain could change the output of devices on ultrathin chips (UTCs), and this has been argued as a major challenge hindering the advancement and use of this technology in applications such as wearables. This may not be always true, as with drift-free ISFETs, we show that bending could also enhance the performance of UTCs. Through fine control of bending radius in the micrometer scale, the mechanically flexible RuO₂-based ISFETs on UTCs (44.76 μm thickness) are shown to reproducibly enhance the performance even after 1000 bending cycles. The 1.3 orders of magnitude improved stability (the drift rate changed from -557 nA/min to -28 ± 0.16 nA/min) is observed over a time period of 417.3 s (∼7 min) at fixed biasing and temperature conditions and under different pH conditions. Finally, a compact macromodel is developed to capture the bending-induced improvements in flexible ISFETs. The performance enhancement by controlled bending of devices could generally benefit the rapidly growing field of flexible electronics.

Advances in Sweat Wearables: Sample Extraction, Real-Time Biosensing, and Flexible Platforms

Wearable biosensors for sweat-based analysis are gaining wide attention due to their potential use in personal health monitoring. Flexible wearable devices enable sweat analysis at the molecular level, facilitating noninvasive monitoring of physiological states via real-time monitoring of chemical biomarkers. Advances in sweat extraction technology, real-time biosensors, stretchable materials, device integration, and wireless digital technologies have led to the development of wearable sweat-biosensing devices that are light, flexible, comfortable, aesthetic, affordable, and informative. Herein, we summarize recent advances of sweat wearables from the aspects of sweat extraction, fabrication of stretchable biomaterials, and design of biosensing modules to enable continuous biochemical monitoring, which are essential for a biosensing device. Key chemical components of sweat, sweat capture methodologies, and considerations of flexible substrates for integrating real-time biosensors with electronics to bring innovations in the art of wearables are elaborated. The strategies and challenges involved in improving the wearable biosensing performance and the perspectives for designing sweat-based wearable biosensing devices are discussed.

Trisk 95 as a novel skin mirror for normal and diabetic systemic glucose level

Developing trustworthy, cost effective, minimally or non-invasive glucose sensing strategies is of great need for diabetic patients. In this study, we used an experimental type I diabetic mouse model to examine whether the skin would provide novel means for identifying biomarkers associated with blood glucose level. We first showed that skin glucose levels are rapidly influenced by blood glucose concentrations. We then conducted a proteomic screen of murine skin using an experimental in vivo model of type I diabetes and wild-type controls. Among the proteins that increased expression in response to high blood glucose, Trisk 95 expression was significantly induced independently of insulin signalling. A luciferase reporter assay demonstrated that the induction of Trisk 95 expression occurs at a transcriptional level and is associated with a marked elevation in the Fluo-4AM signal, suggesting a role for intracellular calcium changes in the signalling cascade. Strikingly, these changes lead concurrently to fragmentation of the mitochondria. Moreover, Trisk 95 knockout abolishes both the calcium flux and the mitochondrial phenotype changes indicating dependency of glucose flux in the skin on Trisk 95 function. The data demonstrate that the skin reacts robustly to systemic blood changes, and that Trisk 95 is a promising biomarker for a glucose monitoring assembly.

On interfacial viscosity in nanochannels

Capillary driven transport of liquids in nanoscopic channels is an omnipresent phenomenon in nature and technology including fluid flow in the human body and plants, drug delivery, nanofluidic devices, and energy/water systems. However, the kinetics of this mass transport mechanism remains in question as the well-known Lucas-Washburn (LW) model predicts significantly faster flow rates compared to the experimental observations. We here showed the role of interfacial viscosity in capillary motion slowdown in nanochannels through a combination of experimental, analytical and molecular dynamics techniques. We showed that the slower liquid flow is due to the formation of a thin liquid layer adjacent to the channel walls with a viscosity substantially greater than the bulk liquid. By incorporating the effect of the interfacial layer, we presented a theoretical model that accurately predicts the capillarity kinetics in nanochannels of different heights. Non-equilibrium molecular dynamics simulation confirmed the obtained interfacial viscosities. The viscosities of isopropanol and ethanol within the interfacial layer were 9.048 mPa s and 4.405 mPa s, respectively (i.e. 279% and 276% greater than their bulk values). We also showed that the interfacial layers are 6.4 nm- and 5.3 nm-thick for isopropanol and ethanol, respectively.

Skin-Integrated Wearable Systems and Implantable Biosensors: A Comprehensive Review

Biosensors devices have attracted the attention of many researchers across the world. They have the capability to solve a large number of analytical problems and challenges. They are future ubiquitous devices for disease diagnosis, monitoring, treatment and health management. This review presents an overview of the biosensors field, highlighting the current research and development of bio-integrated and implanted biosensors. These devices are micro- and nano-fabricated, according to numerous techniques that are adapted in order to offer a suitable mechanical match of the biosensor to the surrounding tissue, and therefore decrease the body’s biological response. For this, most of the skin-integrated and implanted biosensors use a polymer layer as a versatile and flexible structural support, combined with a functional/active material, to generate, transmit and process the obtained signal. A few challenging issues of implantable biosensor devices, as well as strategies to overcome them, are also discussed in this review, including biological response, power supply, and data communication.

Integrated Smart Janus Textile Bands for Self-Pumping Sweat Sampling and Analysis

Wearable sweat sensors have spearheaded the thrust toward personalized health monitoring with continuous, real-time, and molecular-level insight in a noninvasive manner. However, effective sweat sampling still remains a huge challenge. Here, we introduce an intelligent Janus textile band that bridges the gap between self-pumping sweat collection, comfortable epidemic microclimate, and sensitive electrochemical biosensing via an integrated wearable platform. The dominant sweat sampling configuration is a textile with Janus wettability, which is fabricated by electrospinning a hydrophobic polyurethane (PU) nanofiber array onto superhydrophilic gauze. Based on a contact-pumping model, the Janus textile can unidirectionally and thoroughly transport sweat from skin (hydrophobic side) to embedded electrode surface (hydrophilic side) with epidemic comfort. On-body experimentation reveals that the sensitive detection of multiple biomarkers including glucose, lactate, K⁺, and Na⁺ is achieved in the pumped sweat. Such smart Janus textile bands can effectively drain epidermal sweat to targeted assay sites via interface modifications, representing a reinforced and controlled biofluids analysis pathway with physiological comfort.

Water and microbial monitoring technologies towards the near future space exploration

Space exploration is demanding longer lasting human missions and water resupply from Earth will become increasingly unrealistic. In a near future, the spacecraft water monitoring systems will require technological advances to promptly identify and counteract contingent events of waterborne microbial contamination, posing health risks to astronauts with lowered immune responsiveness. The search for bio-analytical approaches, alternative to those applied on Earth by cultivation-dependent methods, is pushed by the compelling need to limit waste disposal and avoid microbial regrowth from analytical carryovers. Prospective technologies will be selected only if first validated in a flight-like environment, by following basic principles, advantages, and limitations beyond their current applications on Earth. Starting from the water monitoring activities applied on the International Space Station, we provide a critical overview of the nucleic acid amplification-based approaches (i.e., loop-mediated isothermal amplification, quantitative PCR, and high-throughput sequencing) and early-warning methods for total microbial load assessments (i.e., ATP-metry, flow cytometry), already used at a high readiness level aboard crewed space vehicles. Our findings suggest that the forthcoming space applications of mature technologies will be necessarily bounded by a compromise between analytical performances (e.g., speed to results, identification depth, reproducibility, multiparametricity) and detrimental technical requirements (e.g., reagent usage, waste production, operator skills, crew time). As space exploration progresses toward extended missions to Moon and Mars, miniaturized systems that also minimize crew involvement in their end-to-end operation are likely applicable on the long-term and suitable for the in-flight water and microbiological research.

3D Printed, Customizable, and Multifunctional Smart Electronic Eyeglasses for Wearable Healthcare Systems and Human-Machine Interfaces

Personal accessories such as glasses and watches that we usually carry in our daily life can yield useful information from the human body, yet most of them are limited to exercise-related parameters or simple heart rates. Since these restricted characteristics might arise from interfaces between the body and items as one of the main reasons, an interface design considering such a factor can provide us with biologically meaningful data. Here, we describe three-dimensional-printed, personalized, multifunctional electronic eyeglasses (E-glasses), not only to monitor various biological phenomena but also to propose a strategy to coordinate the recorded data for active commands and game operations for human-machine interaction (HMI) applications. Soft, highly conductive composite electrodes embedded in the E-glasses enable us to achieve reliable, continuous recordings of physiological activities. UV-responsive, color-tunable lenses using an electrochromic ionic gel offer the functionality of both eyeglass and sunglass modes, and accelerometers provide the capability of tracking precise human postures and behaviors. Detailed studies of electrophysiological signals including electroencephalogram and electrooculogram demonstrate the feasibility of smart electronic glasses for practical use as a platform for future HMI systems.

Sweat monitoring beneath garments using passive, wireless resonant sensors interfaced with laser-ablated microfluidics

Sweat loss can help determine hydration status of individuals working in harsh conditions, which is especially relevant to those who wear thick personal protective equipment (PPE) such as firefighters. A wireless, passive, conformable sweat sensor sticker is described here that can be worn under and interrogated through thick clothing to simultaneously measure sweat loss volume and conductivity. The sticker consists of a laser-ablated, microfluidic channel and a resonant sensor transducer. The resonant sensor is wirelessly read with a handheld vector network analyzer coupled to two, co-planar, interrogation antennas that measure the transmission loss. A sweat proxy is used to fill the channels and it is determined that the sensor can orthogonally determine the sweat conductivity and volume filled in the channel via peak transmission loss magnitude and frequency respectively. A four-person study is then used to determine level of sensor variance caused by local tissue dielectric heterogeneity and sensor-reader orientation.

Microfabricated electrochemical sensing devices

Electrochemistry provides possibilities to realize smart microdevices of the next generation with high functionalities. Electrodes, which constitute major components of electrochemical devices, can be formed by various microfabrication techniques, and integration of the same (or different) components for that purpose is not difficult. Merging this technique with microfluidics can further expand the areas of application of the resultant devices. To augment the development of next generation devices, it will be beneficial to review recent technological trends in this field and clarify the directions required for moving forward. Even when limiting the discussion to electrochemical microdevices, a variety of useful techniques should be considered. Therefore, in this review, we attempted to provide an overview of all relevant techniques in this context in the hope that it can provide useful comprehensive information.

Recent advances of biosensors for hypertension and nephrology

PURPOSE OF REVIEW

Hypertension (HTN) and chronic kidney disease (CKD) are significant problems. With recent advances in technologies, biosensors have shown a great potential to provide better home monitoring in hypertension (HTN), medication compliance, diagnostic device for kidney disease, CKD/end-stage renal disease (ESRD) care, and post kidney transplant management.

RECENT FINDINGS

Multiple devices/biosensors have been developed related to HTN, kidney function including real-time glomerular filtration rate, CKD/end-stage renal disease, and transplant care. In recent advances in wearable biosensors, point of care monitoring system could provide more integrated care to the patients via telenephrology.

SUMMARY

This review focuses on the recent advances in biosensors which may be useful for HTN and nephrology. We will discuss future potential clinical implication of these biosensors.

Flexible Electrochemical Bioelectronics: The Rise of In Situ Bioanalysis

The amalgamation of flexible electronics in biological systems has shaped the way health and medicine are administered. The growing field of flexible electrochemical bioelectronics enables the in situ quantification of a variety of chemical constituents present in the human body and holds great promise for personalized health monitoring owing to its unique advantages such as inherent wearability, high sensitivity, high selectivity, and low cost. It represents a promising alternative to probe biomarkers in the human body in a simpler method compared to conventional instrumental analytical techniques. Various bioanalytical technologies are employed in flexible electrochemical bioelectronics, including ion-selective potentiometry, enzymatic amperometry, potential sweep voltammetry, field-effect transistors, affinity-based biosensing, as well as biofuel cells. Recent key innovations in flexible electrochemical bioelectronics from electrochemical sensing modalities, materials, systems, fabrication, to applications are summarized and highlighted. The challenges and opportunities in this field moving forward toward future preventive and personalized medicine devices are also discussed.

Nanomaterial-Enabled Flexible and Stretchable Sensing Systems: Processing, Integration, and Applications

Nanomaterial-enabled flexible and stretchable electronics have seen tremendous progress in recent years, evolving from single sensors to integrated sensing systems. Compared with nanomaterial-enabled sensors with a single function, integration of multiple sensors is conducive to comprehensive monitoring of personal health and environment, intelligent human-machine interfaces, and realistic imitation of human skin in robotics and prosthetics. Integration of sensors with other functional components promotes real-world applications of the sensing systems. Here, an overview of the design and integration strategies and manufacturing techniques for such sensing systems is given. Then, representative nanomaterial-enabled flexible and stretchable sensing systems are presented. Following that, representative applications in personal health, fitness tracking, electronic skins, artificial nervous systems, and human-machine interactions are provided. To conclude, perspectives on the challenges and opportunities in this burgeoning field are considered.

Advanced Soft Materials, Sensor Integrations, and Applications of Wearable Flexible Hybrid Electronics in Healthcare, Energy, and Environment

Recent advances in soft materials and system integration technologies have provided a unique opportunity to design various types of wearable flexible hybrid electronics (WFHE) for advanced human healthcare and human-machine interfaces. The hybrid integration of soft and biocompatible materials with miniaturized wireless wearable systems is undoubtedly an attractive prospect in the sense that the successful device performance requires high degrees of mechanical flexibility, sensing capability, and user-friendly simplicity. Here, the most up-to-date materials, sensors, and system-packaging technologies to develop advanced WFHE are provided. Details of mechanical, electrical, physicochemical, and biocompatible properties are discussed with integrated sensor applications in healthcare, energy, and environment. In addition, limitations of the current materials are discussed, as well as key challenges and the future direction of WFHE. Collectively, an all-inclusive review of the newly developed WFHE along with a summary of imperative requirements of material properties, sensor capabilities, electronics performance, and skin integrations is provided.

A wearable lab-on-a-patch platform with stretchable nanostructured biosensor for non-invasive immunodetection of biomarker in sweat

Conformable, wearable biosensor-integrated systems are a promising approach to non-invasive and quantitative on-body detection of biomarkers in body fluids. However, realizing such a system has been slowed by the difficulty of fabricating a soft affinity-based biosensor patch capable of precise on-body fluid handling with minimal wearer intervention and a simple measurement protocol. Herein, we demonstrate a conformable, wearable lab-on-a-patch (LOP) platform composed of a stretchable, label-free, impedimetric biosensor and a stretchable microfluidic device for on-body detection of the hormone biomarker, cortisol. The all-in-one, stretchable microfluidic device can precisely collect and deliver sweat for cortisol quantitation and offers one-touch operation of reagent delivery for simultaneous electrochemical signal generation and washing. Three-dimensional nanostructuring of the Au working electrode enables the high sensitivity required to detect the pM-levels of cortisol in sweat. Our integrated LOP detected sweat cortisol quantitatively and accurately during exercise. This LOP will open a new horizon for non-invasive, highly sensitive, and quantitative on-body immunodetection for wearable personal diagnostics.

Cyber-Physiochemical Interfaces

Living things rely on various physical, chemical, and biological interfaces, e.g., somatosensation, olfactory/gustatory perception, and nervous system response. They help organisms to perceive the world, adapt to their surroundings, and maintain internal and external balance. Interfacial information exchanges are complicated but efficient, delicate but precise, and multimodal but unisonous, which has driven researchers to study the science of such interfaces and develop techniques with potential applications in health monitoring, smart robotics, future wearable devices, and cyber physical/human systems. To understand better the issues in these interfaces, a cyber-physiochemical interface (CPI) that is capable of extracting biophysical and biochemical signals, and closely relating them to electronic, communication, and computing technology, to provide the core for aforementioned applications, is proposed. The scientific and technical progress in CPI is summarized, and the challenges to and strategies for building stable interfaces, including materials, sensor development, system integration, and data processing techniques are discussed. It is hoped that this will result in an unprecedented multi-disciplinary network of scientific collaboration in CPI to explore much uncharted territory for progress, providing technical inspiration-to the development of the next-generation personal healthcare technology, smart sports-technology, adaptive prosthetics and augmentation of human capability, etc.

The role of sampling in wearable sweat sensors

Wearable sweat sensors demonstrate outstanding performance in non-invasive, real-time monitoring of vital biomarkers in sweat, which offer an opportunity for individuals to achieve dynamic monitoring their own physiology in molecular-level. As a key step in sweat analysis that impact the accuracy of results, frequently-used sweat sampling methods are introduced in this review, and the emphasis is sweat sampling in wearable sensors including absorbent materials, superhydrophobic/superhydrophilic surface, sweat guidance and epidermal microfluidic systems. In the end, we also propose the remaining challenges in the practical, large-scale application of wearable sweat sensors and provide personal prospects on the future development.

Flexible molecularly imprinted electrochemical sensor for cortisol monitoring in sweat

A selective cortisol sensor based on molecularly imprinted poly(glycidylmethacrylate-co ethylene glycol dimethacrylate) (poly(GMA-co-EGDMA)) has been demonstrated for detection of cortisol in human sweat. The non-enzymatic biomimetric flexible sweat sensor was fabricated inexpensively by layer by layer (LbL) assembly. The sensor layers comprised a stretchable polydimethylsiloxane (PDMS) base with carbon nanotubes-cellulose nanocrystals (CNC/CNT) conductive nanoporous nanofilms. The imprinted (MIP) poly(GMA-co-EGDMA) deposited on the CNC/CNT was the cortisol biomimetric receptor. Rapid in analyte response (3 min), the cortisol MIP sensor demonstrated excellent performance. The sensor has a limit of detection (LOD) of 2.0 ng/mL ± 0.4 ng/mL, dynamic range of 10-66 ng/mL, and a sensor reproducibility of 2.6% relative standard deviation (RSD). The MIP sensor also had high cortisol specificity and was inherently blind to selected interfering species including glucose, epinephrine, β-estradiol, and methoxyprogestrone. The MIP was four orders of magnitude more sensitive than its non-imprinted (NIP) counterpart. The MIP sensor remains stable over time, responding proportionately to doses of cortisol in human sweat. Graphical abstract.

Recent Progress and Perspectives of Thermally Drawn Multimaterial Fiber Electronics

Fibers are the building blocks of a broad spectrum of products from textiles to composites, and waveguides to wound dressings. While ubiquitous, the capabilities of fibers have not rapidly increased compared to semiconductor chip technology, for example. Recognizing that fibers lack the composition, geometry, and feature sizes for more functions, exploration of the boundaries of fiber functionality began some years ago. The approach focuses on a particular form of fiber production, thermal-drawing from a preform. This process has been used for producing single material fibers, but by combining metals, insulators, and semiconductors all within a single strand of fiber, an entire world of functionality in fibers has emerged. Fibers with optical, electrical, acoustic, or optoelectronic functionalities can be produced at scale from relatively easy-to-assemble macroscopic preforms. Two significant opportunities now present themselves. First, can one expect that fiber functions escalate in a predictable manner, creating the context for a "Moore's Law" analog in fibers? Second, as fabrics occupy an enormous surface around the body, could fabrics offer a valuable service to augment the human body? Toward answering these questions, the materials, performance, and limitations of thermally drawn fibers in different electronic applications are detailed and their potential in new fields is envisioned.

Recent advances of tissue-interfaced chemical biosensors

This review discusses recent advances of tissue interfaced chemical biosensors, highlights current challenges and gives an outlook on future possibilities.

Microfluidics for interrogating live intact tissues

The intricate microarchitecture of tissues - the "tissue microenvironment" - is a strong determinant of tissue function. Microfluidics offers an invaluable tool to precisely stimulate, manipulate, and analyze the tissue microenvironment in live tissues and engineer mass transport around and into small tissue volumes. Such control is critical in clinical studies, especially where tissue samples are scarce, in analytical sensors, where testing smaller amounts of analytes results in faster, more portable sensors, and in biological experiments, where accurate control of the cellular microenvironment is needed. Microfluidics also provides inexpensive multiplexing strategies to address the pressing need to test large quantities of drugs and reagents on a single biopsy specimen, increasing testing accuracy, relevance, and speed while reducing overall diagnostic cost. Here, we review the use of microfluidics to study the physiology and pathophysiology of intact live tissues at sub-millimeter scales. We categorize uses as either in vitro studies - where a piece of an organism must be excised and introduced into the microfluidic device - or in vivo studies - where whole organisms are small enough to be introduced into microchannels or where a microfluidic device is interfaced with a live tissue surface (e.g. the skin or inside an internal organ or tumor) that forms part of an animal larger than the device. These microfluidic systems promise to deliver functional measurements obtained directly on intact tissue - such as the response of tissue to drugs or the analysis of tissue secretions - that cannot be obtained otherwise.

Non-invasive Biodiversified Sensors: A Modernized Screening Technology for Cancer

Background:

Biological sensors revolutionize the method of diagnoses of diseases from early to final stages using the biomarkers present in the body. Biosensors are advantageous due to the involvement of minimal sample collection with improved specificity and sensitivity for the detection of biomarkers.

Methods:

Conventional biopsies restrict problems like patient non-compliance, cross-infection and high cost and to overcome these issues biological samples like saliva, sweat, urine, tears and sputum progress into clinical and diagnostic research for the development of non-invasive biosensors. This article covers various non-invasive measurements of biological samples, optical-based, mass-based, wearable and smartphone-based biosensors for the detection of cancer.

Results:

The demand for non-invasive, rapid and economic analysis techniques escalated due to the modernization of the introduction of self-diagnostics and miniature forms of devices. Biosensors have high sensitivity and specificity for whole cells, microorganisms, enzymes, antibodies, and genetic materials.

Conclusion:

Biosensors provide a reliable early diagnosis of cancer, which results in faster therapeutic outcomes with in-depth fundamental understanding of the disease progression.

Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring

BACKGROUND

Conventional diet assessment approaches such as the 24-hour self-reported recall are burdensome, suffer from recall bias, and are inaccurate in estimating energy intake. Wearable sensor technology, coupled with advanced algorithms, is increasingly showing promise in its ability to capture behaviors that provide useful information for estimating calorie and macronutrient intake.

OBJECTIVE

This paper aimed to summarize current technological approaches to monitoring energy intake on the basis of expert opinion from a workshop panel and to make recommendations to advance technology and algorithms to improve estimation of energy expenditure.

METHODS

A 1-day invitational workshop sponsored by the National Science Foundation was held at Northwestern University. A total of 30 participants, including population health researchers, engineers, and intervention developers, from 6 universities and the National Institutes of Health participated in a panel discussing the state of evidence with regard to monitoring calorie intake and eating behaviors.

RESULTS

Calorie monitoring using technological approaches can be characterized into 3 domains: (1) image-based sensing (eg, wearable and smartphone-based cameras combined with machine learning algorithms); (2) eating action unit (EAU) sensors (eg, to measure feeding gesture and chewing rate); and (3) biochemical measures (eg, serum and plasma metabolite concentrations). We discussed how each domain functions, provided examples of promising solutions, and highlighted potential challenges and opportunities in each domain. Image-based sensor research requires improved ground truth (context and known information about the foods), accurate food image segmentation and recognition algorithms, and reliable methods of estimating portion size. EAU-based domain research is limited by the understanding of when their systems (device and inference algorithm) succeed and fail, need for privacy-protecting methods of capturing ground truth, and uncertainty in food categorization. Although an exciting novel technology, the challenges of biochemical sensing range from a lack of adaptability to environmental effects (eg, temperature change) and mechanical impact, instability of wearable sensor performance over time, and single-use design.

CONCLUSIONS

Conventional approaches to calorie monitoring rely predominantly on self-reports. These approaches can gain contextual information from image-based and EAU-based domains that can map automatically captured food images to a food database and detect proxies that correlate with food volume and caloric intake. Although the continued development of advanced machine learning techniques will advance the accuracy of such wearables, biochemical sensing provides an electrochemical analysis of sweat using soft bioelectronics on human skin, enabling noninvasive measures of chemical compounds that provide insight into the digestive and endocrine systems. Future computing-based researchers should focus on reducing the burden of wearable sensors, aligning data across multiple devices, automating methods of data annotation, increasing rigor in studying system acceptability, increasing battery lifetime, and rigorously testing validity of the measure. Such research requires moving promising technological solutions from the controlled laboratory setting to the field.

Resettable skin interfaced microfluidic sweat collection devices with chemesthetic hydration feedback

Recently introduced classes of thin, soft, skin-mounted microfluidic systems offer powerful capabilities for continuous, real-time monitoring of total sweat loss, sweat rate and sweat biomarkers. Although these technologies operate without the cost, complexity, size, and weight associated with active components or power sources, rehydration events can render previous measurements irrelevant and detection of anomalous physiological events, such as high sweat loss, requires user engagement to observe colorimetric responses. Here we address these limitations through monolithic systems of pinch valves and suction pumps for purging of sweat as a reset mechanism to coincide with hydration events, microstructural optics for reversible readout of sweat loss, and effervescent pumps and chemesthetic agents for automated delivery of sensory warnings of excessive sweat loss. Human subject trials demonstrate the ability of these systems to alert users to the potential for dehydration via skin sensations initiated by sweat-triggered ejection of menthol and capsaicin.

Wearable and Implantable Electronics: Moving toward Precision Therapy

Soft wearable and implantable electronic systems have attracted tremendous attention due to their flexibility, conformability, and biocompatibility. Such favorable features are critical for reliably monitoring key biomedical and physiological information (including both biophysical and biochemical signals) and effective treatment and management of specific chronic diseases. Miniaturized, fully integrated self-powered bioelectronic devices that can harvest energy from the human body represent promising and emerging solutions for long-term, intimate, and personalized therapies. In this Perspective, we offer a brief overview of recent advances in wearable/implantable soft electronic devices and their therapeutic applications ranging from drug delivery to tissue regeneration. We also discuss the key opportunities, challenges, and future directions in this important area needed to fulfill the vision of personalized medicine.

Recent Advances in Skin Chemical Sensors

This review summarizes the latest developments in the field of skin chemical sensors, in particular wearable ones. Five major applications are covered in the present work: (i) sweat analysis, (ii) skin hydration, (iii) skin wounds, (iv) perspiration of volatile organic compounds, and (v) general skin conditions. For each application, the detection of the most relevant analytes is described in terms of transduction principles and sensor performances. Special attention is paid to the biological fluid collection and storage and devices are also analyzed in terms of reusability and lifetime. This review highlights the existing gaps between current performances and those needed to promote effective commercialization of sensors; future developments are also proposed.

A versatile, cost-effective, and flexible wearable biosensor for in situ and ex situ sweat analysis, and personalized nutrition assessment

Point-of-care (POC) diagnostics have shown excellent potential in rapid biological analysis and health/disease monitoring. Here, we introduce a versatile, cost-effective, flexible, and wearable POC biomarker patch for effective sweat collection and health monitoring. We design and fabricate channels/patterns on filter paper using wax printing technology, which can direct sweat to collection and biomarker detection zones on the proposed platform. The detection zones are designed to measure the amount of collected sweat, in addition to measuring the sweat pH, and glucose (a potential diabetic biomarker), and lactate concentrations. It is significantly challenging to measure glucose in human sweat by colorimetric methods due to the extremely low glucose levels found in this medium. However, we overcame this issue by effectively engineering our wearable biosensor for optimal intake, storage, and evaporation of sweat. Our design concentrates the colorant (indicator) into a small detection zone and significantly increases the sensitivity for the sweat glucose sensing reactions. The device can thus detect glucose in physiological glucose concentration range of 50-300 μM. This cost-effective and wearable biosensor can provide instant in situ quantitative results for targets of interest, such as glucose, pH, and lactate, when coupled with the imaging and computing functionalities of smartphones. Meanwhile, it is also feasible to extract the air-dried sweat from the storage zone for further ex situ measurements of a broader portfolio of biomarkers, leading to applications of our wearable biosensor in personalized nutrition and medicine.

Dry sweat as sample for metabolomics analysis

Sweat is gaining popularity in clinical metabolomics as this biofluid is non-invasively sampled and its composition is modified by several pathologies. There is a lack of standardized strategies for collection of human sweat. Most studies have been carried out with fresh sweat collected after stimulation. A promising and simple alternative is sampling dry sweat by a solid support impregnated with a suited solvent. This research was aimed at comparing the metabolomics coverage provided by dry sweat collected by two solid supports (gauzes and filter papers) impregnated with different solvents. The dissolved dry sweat was analyzed by a dual approach: gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Among the tested sampling strategies, filter paper impregnated with 1:1 (v/v) ethanol‒phosphate buffer resulted the combination providing the highest metabolomics coverage (tentative identification of one hundred seventy-five compounds). Dry and fresh sweat were compared by using pools from the same individuals to evaluate compositional differences. Families of metabolites such as carnitines, sphingolipids and N-acyl-amino acids, among others, were exclusively identified in dry sweat. Comparison of both samples allowed concluding that dry sweat is better for analysis of low polar metabolites and fresh sweat is more suited for polar compounds. As most of the identified metabolites are involved in key biochemical pathways, this study opens interesting possibilities to the use of dry sweat as a source of metabolite markers for specific disorders. Sampling of dry sweat could provide a standardized approach for collection of this biofluid, thus overcoming the variability limitations of fresh sweat.

Microfluidic Chip-Based Wearable Colorimetric Sensor for Simple and Facile Detection of Sweat Glucose

This study reports a microfluidic chip-based wearable colorimetric sensor for detecting sweat glucose. The device consisted of five microfluidic channels branching out from the center and connected to the detection microchambers. The microchannels could route the sweat excreted from the epidermis to the microchambers, and each of them was integrated with a check valve to avoid the risk of the backflow of the chemical reagents from the microchamber. The microchambers contained the pre-embedded glucose oxidase (GOD)-peroxidase-o-dianisidine reagents for sensing the glucose in sweat. It was found that the color change caused by the enzymatic oxidation of o-dianisidine could show a more sensitive response to the glucose than that of the conventional GOD-peroxidase-KI system. This sensor could perform five parallel detections at one time. The obtained linear range for sweat glucose was 0.1-0.5 mM with a limit of detection of 0.03 mM. The sensor was also used to detect the glucose in sweat samples from a group of subjects engaged in both fasting and postprandial trials. The results showed that our wearable colorimetric sensor can reveal the subtle differences existing in the sweat glucose concentration after the fasting and the oral glucose uptake.

Flexible graphene photodetectors for wearable fitness monitoring

Wearable health and wellness trackers based on optical detection are promising candidates for public health uses due to their noninvasive tracking of vital health signs. However, so far, the use of rigid technologies hindered the ultimate performance and form factor of the wearable. Here, we demonstrate a new class of flexible and transparent wearables based on graphene sensitized with semiconducting quantum dots (GQD). We show several prototype wearable devices that are able to monitor vital health signs noninvasively, including heart rate, arterial oxygen saturation (SpO2), and respiratory rate. Operation with ambient light is demonstrated, offering low-power consumption. Moreover, using heterogeneous integration of a flexible ultraviolet (UV)-sensitive photodetector with a near-field communication circuit board allows wireless communication and power transfer between the photodetectors and a smartphone, offering battery-free operation. This technology paves the way toward seamlessly integrated wearables, and empowers the user through wireless probing of the UV index.

Bioinspired Adhesive Architectures: From Skin Patch to Integrated Bioelectronics

The attachment phenomena of various hierarchical architectures found in nature have extensively drawn attention for developing highly biocompatible adhesive on skin or wet inner organs without any chemical glue. Structural adhesive systems have become important to address the issues of human-machine interactions by smart outer/inner organ-attachable devices for diagnosis and therapy. Here, advances in designs of biologically inspired adhesive architectures are reviewed in terms of distinct structural properties, attachment mechanisms to biosurfaces by physical interactions, and noteworthy fabrication methods. Recent demonstrations of bioinspired adhesive architectures as adhesive layers for medical applications from skin patches to multifunctional bioelectronics are presented. To conclude, current challenges and prospects on potential applications are also briefly discussed.

Soft, Skin-Interfaced Microfluidic Systems with Passive Galvanic Stopwatches for Precise Chronometric Sampling of Sweat

Comprehensive analysis of sweat chemistry provides noninvasive health monitoring capabilities that complement established biophysical measurements such as heart rate, blood oxygenation, and body temperature. Recent developments in skin-integrated soft microfluidic systems address many challenges associated with standard technologies in sweat collection and analysis. However, recording of time-dependent variations in sweat composition requires bulky electronic systems and power sources, thereby constraining form factor, cost, and modes of use. Here, presented are unconventional design concepts, materials, and device operation principles that address this challenge. Flexible galvanic cells embedded within skin-interfaced microfluidics with passive valves serve as sweat-activated "stopwatches" that record temporal information associated with collection of discrete microliter volumes of sweat. The result allows for precise measurements of dynamic sweat composition fluctuations using in situ or ex situ analytical techniques. Integrated electronics based on near-field communication (NFC) protocols or docking stations equipped with standard electronic measurement tools provide means for extracting digital timing results from the stopwatches. Human subject studies of time-stamped sweat samples by in situ colorimetric methods and ex situ techniques based on inductively coupled plasma mass spectroscopy (ICP-MS) and chlorodimetry illustrate the ability to quantitatively capture time-dynamic sweat chemistry in scenarios compatible with field use.

Breathable Nanowood Biofilms as Guiding Layer for Green On-Skin Electronics

Thin-film electronics are urged to be directly laminated onto human skin for reliable, sensitive biosensing together with feedback transdermal therapy, their self-power supply using the thermoelectric and moisture-induced-electric effects also has gained great attention (skin and on-skin electronics (On-skinE) themselves are energy storehouses). However, "thin-film" On-skinE 1) cannot install "bulky" heatsinks or sweat transport channels, but the output power of thermoelectric generator and moisture-induced-electric generator relies on the temperature difference (∆T ) across generator and the ambient humidity (AH), respectively; 2) lack a routing and accumulation of sweat for biosensing, lack targeted delivery of drugs for precise transdermal therapy; and 3) need insulation between the heat-generating unit and heat-sensitive unit. Here, two breathable nanowood biofilms are demonstrated, which can help insulate between units and guide the heat and sweat to another in-plane direction. The transparent biofilms achieve record-high transport_// /transport_⊥ (//: along cellulose nanofiber alignment direction, ⊥: perpendicular direction) of heat (925%) and sweat (338%), winning applications emphasizing on ∆T/AH-dependent output power and "reliable" biosensing. The porous biofilms are competent in applications where "sensitive" biosensing (transporting_// sweat up to 11.25 mm s^-1 at the 1st second), "insulating" between units, and "targeted" delivery of saline-soluble drugs are of uppermost priority.

Regional and correlative sweat analysis using high-throughput microfluidic sensing patches toward decoding sweat

Recent technological advancements in wearable sensors have made it easier to detect sweat components, but our limited understanding of sweat restricts its application. A critical bottleneck for temporal and regional sweat analysis is achieving uniform, high-throughput fabrication of sweat sensor components, including microfluidic chip and sensing electrodes. To overcome this challenge, we introduce microfluidic sensing patches mass fabricated via roll-to-roll (R2R) processes. The patch allows sweat capture within a spiral microfluidic for real-time measurement of sweat parameters including [Na⁺], [K⁺], [glucose], and sweat rate in exercise and chemically induced sweat. The patch is demonstrated for investigating regional sweat composition, predicting whole-body fluid/electrolyte loss during exercise, uncovering relationships between sweat metrics, and tracking glucose dynamics to explore sweat-to-blood correlations in healthy and diabetic individuals. By enabling a comprehensive sweat analysis, the presented device is a crucial tool for advancing sweat testing beyond the research stage for point-of-care medical and athletic applications.

Wearable sensors for monitoring the internal and external workload of the athlete

The convergence of semiconductor technology, physiology, and predictive health analytics from wearable devices has advanced its clinical and translational utility for sports. The detection and subsequent application of metrics pertinent to and indicative of the physical performance, physiological status, biochemical composition, and mental alertness of the athlete has been shown to reduce the risk of injuries and improve performance and has enabled the development of athlete-centered protocols and treatment plans by team physicians and trainers. Our discussions in this review include commercially available devices, as well as those described in scientific literature to provide an understanding of wearable sensors for sports medicine. The primary objective of this paper is to provide a comprehensive review of the applications of wearable technology for assessing the biomechanical and physiological parameters of the athlete. A secondary objective of this paper is to identify collaborative research opportunities among academic research groups, sports medicine health clinics, and sports team performance programs to further the utility of this technology to assist in the return-to-play for athletes across various sporting domains. A companion paper discusses the use of wearables to monitor the biochemical profile and mental acuity of the athlete.

Wearable sensors for monitoring the physiological and biochemical profile of the athlete

Athletes are continually seeking new technologies and therapies to gain a competitive edge to maximize their health and performance. Athletes have gravitated toward the use of wearable sensors to monitor their training and recovery. Wearable technologies currently utilized by sports teams monitor both the internal and external workload of athletes. However, there remains an unmet medical need by the sports community to gain further insight into the internal workload of the athlete to tailor recovery protocols to each athlete. The ability to monitor biomarkers from saliva or sweat in a noninvasive and continuous manner remain the next technological gap for sports medical personnel to tailor hydration and recovery protocols per the athlete. The emergence of flexible and stretchable electronics coupled with the ability to quantify biochemical analytes and physiological parameters have enabled the detection of key markers indicative of performance and stress, as reviewed in this paper.

Noninvasive Sweat-Lactate Biosensor Emplsoying a Hydrogel-Based Touch Pad

This study is the first report demonstrating proof-of-concept for a hydrogel-based touch sensor pad used for the non-invasive extraction and detection of sweat components. The sensor device was composed of an electrochemical L-lactate biosensor covered with an agarose gel in a phosphate buffer saline. When human skin contacts the agarose gel, L-lactate in sweat was continuously extracted into the gel, followed by in-situ potentiometric detection without controlled conditions. This novel type of sweat sensor is expected to enable the simple, non-invasive daily periodic monitoring of sweat biomarkers for advanced personal healthcare methods in the future.