Materials and fractal designs for 3D multifunctional integumentary membranes with capabilities in cardiac electrotherapy

3D Conformal Curvy Electronics: Design, Fabrication, and Application

Owing to their excellent conformability and functional advantages derived from spatially induced structures, 3D conformal curvy electronics have garnered attention for their emerging applications in biomedical healthcare, soft machines, curvy imagers, etc. In this perspective, the historical evolution of 3D conformal curvy electronics is summarized, with representative examples highlighted and developmental trends outlined. The design strategies of 3D conformal curvy electronics are discussed across materials, structures, interfaces, and conformability assessment. Subsequently, diverse fabrication technologies are reviewed, including direct fabrication, conformal transfer printing, and conformal shape reconfiguration. Afterward, the typical applications of 3D conformal curvy electronics are presented, classified by integration with biological tissues, machines, and function-engineered curvy surfaces. Finally, the existing challenges and potential research directions are provided for further exploration.

Catheter-Integrated Fractal Microelectronics for Low-Voltage Ablation and Minimally Invasive Sensing

Pulse field ablation (PFA) has become a popular technique for treating tens of millions of patients with atrial fibrillation, as it avoids many complications associated with traditional radiofrequency ablation. However, currently, limited studies have used millimeter-scale rigid electrodes modified from radiofrequency ablation to apply electrical pulses of thousands of volts without integrated sensing capabilities. Herein, we combine fractal microelectronics with biomedical catheters for low-voltage PFA, detection of electrode-tissue contact, and interventional electrocardiogram recording. The fractal configuration increases the ratio of the microelectrode insulating edge to area, which facilitates the transfer of current from the microelectrode to the tissue, increasing the ablation depth by 38.6% at 300 V (a 10-fold reduction compared to current technology). In vivo ablation experiments on living beagles successfully block electrical conduction, as demonstrated by voltage mapping and electrical pacing. More impressively, this study provides the first evidence that microelectrodes can selectively ablate cardiomyocytes without damaging nerves and blood vessels, greatly improving the safety of PFA. These results are essential for the clinical translation of PFA in the field of cardiac electrophysiology.

Flexible Electrode Arrays Based on a Wide Bandgap Semiconductors for Chronic Implantable Multiplexed Sensing and Heart Pacemakers

Implantable systems with chronic stability, high sensing performance, and extensive spatial-temporal resolution are a growing focus for monitoring and treating several diseases such as epilepsy, Parkinson's disease, chronic pain, and cardiac arrhythmias. These systems demand exceptional bendability, scalable size, durable electrode materials, and well-encapsulated metal interconnects. However, existing chronic implantable bioelectronic systems largely rely on materials prone to corrosion in biofluids, such as silicon nanomembranes or metals. This study introduces a multielectrode array featuring a wide bandgap (WBG) material as electrodes, demonstrating its suitability for chronic implantable applications. Our devices exhibit excellent flexibility and longevity, taking advantage of the low bending stiffness and chemical inertness in WBG nanomembranes and multimodalities for physical health monitoring, including temperature, strain, and impedance sensing. Our top-down manufacturing process enables the formation of distributed electrode arrays that can be seamlessly integrated onto the curvilinear surfaces of skins. As proof of concept for chronic cardiac pacing applications, we demonstrate the effective pacing functionality of our devices on rabbit hearts through a set of ex vivo experiments. The engineering approach proposed in this study overcomes the drawbacks of prior WBG material fabrication techniques, resulting in an implantable system with high bendability, effective pacing, and high-performance sensing.

Structural properties of conductive polymer blends interfaced with water: computational insights from PEDOT:PSS

In various bioelectronic applications, conductive polymers come into contact with biological tissues, where water is the major component. In this study, we investigated the interface between the conductive polymer poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS) and water, focusing on how the morphology of the PEDOT:PSS is altered by water permeation. We constructed well-equilibrated PEDOT:PSS-water systems in both PEDOT- and PSS-rich phases. Our findings show that water permeates into the polymer through a complex network of water channels, which exhibit a similar pore size distribution in both PEDOT- and PSS-rich phases, leading to similar water intake in these phases. Compared to the dry state of the polymer, water permeation leads to the formation of smaller, less ordered, and distantly located lamella crystallites, potentially resulting in reduced conductivity. Therefore, we argue that these structural changes from the dry state of the polymer to the wet state may be the origin of the significant conductivity reduction observed experimentally in PEDOT:PSS in water or PEDOT:PSS hydrogels.

Advances in Biointegrated Wearable and Implantable Optoelectronic Devices for Cardiac Healthcare

With the prevalence of cardiovascular disease, it is imperative that medical monitoring and treatment become more instantaneous and comfortable for patients. Recently, wearable and implantable optoelectronic devices can be seamlessly integrated into human body to enable physiological monitoring and treatment in an imperceptible and spatiotemporally unconstrained manner, opening countless possibilities for the intelligent healthcare paradigm. To achieve biointegrated cardiac healthcare, researchers have focused on novel strategies for the construction of flexible/stretchable optoelectronic devices and systems. Here, we overview the progress of biointegrated flexible and stretchable optoelectronics for wearable and implantable cardiac healthcare devices. Firstly, the device design is addressed, including the mechanical design, interface adhesion, and encapsulation strategies. Next, the practical applications of optoelectronic devices for cardiac physiological monitoring, cardiac optogenetics, and nongenetic stimulation are presented. Finally, an outlook on biointegrated flexible and stretchable optoelectronic devices and systems for intelligent cardiac healthcare is discussed.

Effect of Spatial Resolution on Accurate Detection and Localization of Arrhythmia Rotors in Human Right Ventricular Tachycardia

The goal of this study was to identify the spatial resolution requirements for accurate rotor detection and localization in human right ventricular tachyarrhythmias. Poor spatial resolution is often cited as a reason for the inaccuracy of cardiac mapping catheters in detecting and localizing arrhythmia rotors. High-resolution (0.7 mm) arrhythmia data from optical recordings obtained from human donor hearts (n = 12) were uniformly downsampled to lower resolutions (1.4-7 mm) to approximate the spatial resolution (4 mm) of clinical mapping catheters. Rotors were tracked at various subresolutions and compared to the rotors in the original data by computing F1-scores to create accuracy profiles for both rotor detection and localization. Further comparisons were made according to arrhythmia type, donor sex, anatomical region, and mapped surface: endocardium or epicardium. For a spatial resolution of 4.2 mm, the accuracies of rotor detection and localization were 57% ± 4% and 61% ± 7%, respectively. Arrhythmia type affected the accuracy of rotor detection (monomorphic ventricular tachycardia, 58% ± 4%; ventricular fibrillation, 56% ± 8%) and localization (monomorphic ventricular tachycardia, 70% ± 4%; ventricular fibrillation, 54% ± 13%). However, donor sex, anatomical region (right ventricular outflow tract, mid, and apical), and mapped surface (epicardium and endocardium) did not significantly affect rotor detection or localization accuracy. To achieve rotor detection accuracy of 80%, a spatial resolution of 1.4 mm or better is needed. The accuracy profiles provided here serve as a guideline for future mapping device development.

Soft Bioelectronics for Heart Monitoring

Cardiovascular diseases (CVDs) are a predominant global health concern, accounting for over 17.9 million deaths in 2019, representing approximately 32% of all global fatalities. In North America and Europe, over a million adults undergo cardiac surgeries annually. Despite the benefits, such surgeries pose risks and require precise postsurgery monitoring. However, during the postdischarge period, where monitoring infrastructures are limited, continuous monitoring of vital signals is hindered. In this area, the introduction of implantable electronics is altering medical practices by enabling real-time and out-of-hospital monitoring of physiological signals and biological information postsurgery. The multimodal implantable bioelectronic platforms have the capability of continuous heart sensing and stimulation, in both postsurgery and out-of-hospital settings. Furthermore, with the emergence of machine learning algorithms into healthcare devices, next-generation implantables will benefit artificial intelligence (AI) and connectivity with skin-interfaced electronics to provide more precise and user-specific results. This Review outlines recent advancements in implantable bioelectronics and their utilization in cardiovascular health monitoring, highlighting their transformative deployment in sensing and stimulation to the heart toward reaching truly personalized healthcare platforms compatible with the Sustainable Development Goal 3.4 of the WHO 2030 observatory roadmap. This Review also discusses the challenges and future prospects of these devices.

Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery

The advent of catheter-based minimally invasive surgical instruments has provided an effective means of diagnosing and treating human disease. However, conventional medical catheter devices are limited in functionalities, hindering their ability to gather tissue information or perform precise treatment during surgery. Recently, electronic catheters have integrated various sensing and therapeutic technologies through micro/nanoelectronics, expanding their capabilities. As micro/nanoelectronic devices become more miniaturized, flexible, and stable, electronic surgical catheters are evolving from simple tools to multiplexed sensing and theranostics for surgical applications. The review on multifunctional electronic surgical catheters is lacking and thus is not conducive to the reader's comprehensive understanding of the development trend in this field. This review covers the advances in multifunctional electronic catheters for precise and intelligent diagnosis and therapy in minimally invasive surgery. It starts with the summary of clinical minimally invasive surgical instruments, followed by the background of current clinical catheter devices for sensing and therapeutic applications. Next, intelligent electronic catheters with integrated electronic components are reviewed in terms of electronic catheters for diagnosis, therapy, and multifunctional applications. It highlights the present status and development potential of catheter-based minimally invasive surgical devices, while also illustrating several significant challenges that remain to be overcome.

E-Tattoos: Toward Functional but Imperceptible Interfacing with Human Skin

The human body continuously emits physiological and psychological information from head to toe. Wearable electronics capable of noninvasively and accurately digitizing this information without compromising user comfort or mobility have the potential to revolutionize telemedicine, mobile health, and both human-machine or human-metaverse interactions. However, state-of-the-art wearable electronics face limitations regarding wearability and functionality due to the mechanical incompatibility between conventional rigid, planar electronics and soft, curvy human skin surfaces. E-Tattoos, a unique type of wearable electronics, are defined by their ultrathin and skin-soft characteristics, which enable noninvasive and comfortable lamination on human skin surfaces without causing obstruction or even mechanical perception. This review article offers an exhaustive exploration of e-tattoos, accounting for their materials, structures, manufacturing processes, properties, functionalities, applications, and remaining challenges. We begin by summarizing the properties of human skin and their effects on signal transmission across the e-tattoo-skin interface. Following this is a discussion of the materials, structural designs, manufacturing, and skin attachment processes of e-tattoos. We classify e-tattoo functionalities into electrical, mechanical, optical, thermal, and chemical sensing, as well as wound healing and other treatments. After discussing energy harvesting and storage capabilities, we outline strategies for the system integration of wireless e-tattoos. In the end, we offer personal perspectives on the remaining challenges and future opportunities in the field.

Pioneering healthcare with soft robotic devices: A review

Recent advancements in soft robotics have been emerging as an exciting paradigm in engineering due to their inherent compliance, safe human interaction, and ease of adaptation with wearable electronics. Soft robotic devices have the potential to provide innovative solutions and expand the horizons of possibilities for biomedical applications by bringing robots closer to natural creatures. In this review, we survey several promising soft robot technologies, including flexible fluidic actuators, shape memory alloys, cable-driven mechanisms, magnetically driven mechanisms, and soft sensors. Selected applications of soft robotic devices as medical devices are discussed, such as surgical intervention, soft implants, rehabilitation and assistive devices, soft robotic exosuits, and prosthetics. We focus on how soft robotics can improve the effectiveness, safety and patient experience for each use case, and highlight current research and clinical challenges, such as biocompatibility, long-term stability, and durability. Finally, we discuss potential directions and approaches to address these challenges for soft robotic devices to move toward real clinical translations in the future.

A Customizable Proteinic Bioadhesive Patch with Water-Switchable Underwater Adhesiveness, Adjustable Biodegradability, and Modifiable Stretchability for Healing Diverse Internal Wounds

Customizable bioadhesives for individual organ requirements, including tissue type and motion, are essential, especially given the rise in implantable medical device applications demanding adequate underwater adhesion. While synthetic bioadhesives are widely used, their toxicity upon degradation shifts focus to biocompatible natural biomaterials. However, enhancing the adhesive strengths of these biomaterials presents ongoing challenges while accommodating the unique properties of specific organs. To address these issues, three types of customized underwater bioadhesive patches (CUBAPs) with strong, water-responsive adhesion and controllable biodegradability and stretchability based on bioengineered mussel adhesive proteins conjugated with acrylic acid and/or methacrylic acid are proposed. The CUBAP system, although initially nonadhesive, shows strong underwater adhesion upon hydration, adjustable biodegradation, and adequate physical properties by adjusting the ratio of poly(acrylic acid) and poly(methacrylic acid). Through ex vivo and in vivo evaluations using defective organs and the implantation of electronic devices, the suitability of using CUBAPs for effective wound healing in diverse internal organs is demonstrated. Thus, this innovative CUBAP system offers strong underwater adhesiveness with tailored biodegradation timing and physical properties, giving it great potential in various biomedical applications.

A Review of Structure Engineering of Strain-Tolerant Architectures for Stretchable Electronics

Stretchable electronics possess significant advantages over their conventional rigid counterparts and boost game-changing applications such as bioelectronics, flexible displays, wearable health monitors, etc. It is, nevertheless, a formidable task to impart stretchability to brittle electronic materials such as silicon. This review provides a concise but critical discussion of the prevailing structural engineering strategies for achieving strain-tolerant electronic devices. Not only the more commonly discussed lateral designs of structures such as island-bridge, wavy structures, fractals, and kirigami, but also the less discussed vertical architectures such as strain isolation and elastoplastic principle are reviewed. Future opportunities are envisaged at the end of the paper.

Mechanically-Guided 3D Assembly for Architected Flexible Electronics

Architected flexible electronic devices with rationally designed 3D geometries have found essential applications in biology, medicine, therapeutics, sensing/imaging, energy, robotics, and daily healthcare. Mechanically-guided 3D assembly methods, exploiting mechanics principles of materials and structures to transform planar electronic devices fabricated using mature semiconductor techniques into 3D architected ones, are promising routes to such architected flexible electronic devices. Here, we comprehensively review mechanically-guided 3D assembly methods for architected flexible electronics. Mainstream methods of mechanically-guided 3D assembly are classified and discussed on the basis of their fundamental deformation modes (i.e., rolling, folding, curving, and buckling). Diverse 3D interconnects and device forms are then summarized, which correspond to the two key components of an architected flexible electronic device. Afterward, structure-induced functionalities are highlighted to provide guidelines for function-driven structural designs of flexible electronics, followed by a collective summary of their resulting applications. Finally, conclusions and outlooks are given, covering routes to achieve extreme deformations and dimensions, inverse design methods, and encapsulation strategies of architected 3D flexible electronics, as well as perspectives on future applications.

A Hierarchical Theory for the Tensile Stiffness of Non-Buckling Fractal-Inspired Interconnects

The design of non-buckling interconnects with thick sections has gained important applications in stretchable inorganic electronics due to their simultaneous achievement of high stretchability, low resistance, and low heat generation. However, at the same time, such a design sharply increased the tensile stiffness, which is detrimental to the conformal fit and skin comfort. Introducing the fractal design into the non-buckling interconnects is a promising approach to greatly reduce the tensile stiffness while maintaining other excellent performances. Here, a hierarchical theory is proposed for the tensile stiffness of the non-buckling fractal-inspired interconnects with an arbitrary shape at each order, which is verified by the finite element analysis. The results show that the tensile stiffness of the non-buckling fractal-inspired interconnects decreases with the increase in either the height/span ratio or the number of fractal orders but is not highly correlated with the ratio of the two adjacent dimensions. When the ratio of the two adjacent dimensions and height/span ratio are fixed, the tensile stiffness of the serpentine fractal-inspired interconnect is smaller than that of sinusoidal and zigzag fractal-inspired interconnects. These findings are of great significance for the design of non-buckling fractal-inspired interconnects of stretchable inorganic electronics.

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

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

An Analytic Model of Transient Heat Conduction for Bi-Layered Flexible Electronic Heaters by Symplectic Superposition

In a flexible electronic heater (FEH), periodic metal wires are often encapsulated into the soft elastic substrate as heat sources. It is of great significance to develop analytic models on transient heat conduction of such an FEH in order to provide a rapid analysis and preliminary designs based on a rapid parameter analysis. In this study, an analytic model of transient heat conduction for bi-layered FEHs is proposed, which is solved by a novel symplectic superposition method (SSM). In the Laplace transform domain, the Hamiltonian system-based governing equation for transient heat conduction is introduced, and the mathematical techniques incorporating the separation of variables and symplectic eigen expansion are manipulated to yield the temperature solutions of two subproblems, which is followed by superposition for the temperature solution of the general problem. The Laplace inversion gives the eventual temperature solution in the time domain. Comprehensive time-dependent temperatures by the SSM are presented in tables and figures for benchmark use, which agree well with their counterparts by the finite element method. A parameter analysis on the influence of the thermal conductivity ratio is also studied. The exceptional merit of the SSM is on a direct rigorous derivation without any assumption/predetermination of solution forms, and thus, the method may be extended to more heat conduction problems of FEHs with more complex structures.

Piezoelectric nanogenerators for personalized healthcare

The development of flexible piezoelectric nanogenerators has experienced rapid progress in the past decade and is serving as the technological foundation of future state-of-the-art personalized healthcare. Due to their highly efficient mechanical-to-electrical energy conversion, easy implementation, and self-powering nature, these devices permit a plethora of innovative healthcare applications in the space of active sensing, electrical stimulation therapy, as well as passive human biomechanical energy harvesting to third party power on-body devices. This article gives a comprehensive review of the piezoelectric nanogenerators for personalized healthcare. After a brief introduction to the fundamental physical science of the piezoelectric effect, material engineering strategies, device structural designs, and human-body centered energy harvesting, sensing, and therapeutics applications are also systematically discussed. In addition, the challenges and opportunities of utilizing piezoelectric nanogenerators for self-powered bioelectronics and personalized healthcare are outlined in detail.

Soft bioelectronics for cardiac interfaces

Bioelectronics for interrogation and intervention of cardiac systems is important for the study of cardiac health and disease. Interfacing cardiac systems by using conventional rigid bioelectronics is limited by the structural and mechanical disparities between rigid electronics and soft tissues as well as their limited performance. Recently, advances in soft electronics have led to the development of high-performance soft bioelectronics, which is flexible and stretchable, capable of interfacing with cardiac systems in ways not possible with conventional rigid bioelectronics. In this review, we first review the latest developments in building flexible and stretchable bioelectronics for the epicardial interface with the heart. Next, we introduce how stretchable bioelectronics can be integrated with cardiac catheters for a minimally invasive in vivo heart interface. Then, we highlight the recent progress in the design of soft bioelectronics as a new class of biomaterials for integration with different in vitro cardiac models. In particular, we highlight how these devices unlock opportunities to interrogate the cardiac activities in the cardiac patch and cardiac organoid models. Finally, we discuss future directions and opportunities using soft bioelectronics for the study of cardiac systems.

Recent Progress in Materials Chemistry to Advance Flexible Bioelectronics in Medicine

Designing bioelectronic devices that seamlessly integrate with the human body is a technological pursuit of great importance. Bioelectronic medical devices that reliably and chronically interface with the body can advance neuroscience, health monitoring, diagnostics, and therapeutics. Recent major efforts focus on investigating strategies to fabricate flexible, stretchable, and soft electronic devices, and advances in materials chemistry have emerged as fundamental to the creation of the next generation of bioelectronics. This review summarizes contemporary advances and forthcoming technical challenges related to three principal components of bioelectronic devices: i) substrates and structural materials, ii) barrier and encapsulation materials, and iii) conductive materials. Through notable illustrations from the literature, integration and device fabrication strategies and associated challenges for each material class are highlighted.

Organic Bioelectronics for In Vitro Systems

Bioelectronics have made strides in improving clinical diagnostics and precision medicine. The potential of bioelectronics for bidirectional interfacing with biology through continuous, label-free monitoring on one side and precise control of biological activity on the other has extended their application scope to in vitro systems. The advent of microfluidics and the considerable advances in reliability and complexity of in vitro models promise to eventually significantly reduce or replace animal studies, currently the gold standard in drug discovery and toxicology testing. Bioelectronics are anticipated to play a major role in this transition offering a much needed technology to push forward the drug discovery paradigm. Organic electronic materials, notably conjugated polymers, having demonstrated technological maturity in fields such as solar cells and light emitting diodes given their outstanding characteristics and versatility in processing, are the obvious route forward for bioelectronics due to their biomimetic nature, among other merits. This review highlights the advances in conjugated polymers for interfacing with biological tissue in vitro, aiming ultimately to develop next generation in vitro systems. We showcase in vitro interfacing across multiple length scales, involving biological models of varying complexity, from cell components to complex 3D cell cultures. The state of the art, the possibilities, and the challenges of conjugated polymers toward clinical translation of in vitro systems are also discussed throughout.

Seamless integration of bioelectronic interface in an animal model via in vivo polymerization of conjugated oligomers

Leveraging the biocatalytic machinery of living organisms for fabricating functional bioelectronic interfaces, in vivo, defines a new class of micro-biohybrids enabling the seamless integration of technology with living biological systems. Previously, we have demonstrated the in vivo polymerization of conjugated oligomers forming conductors within the structures of plants. Here, we expand this concept by reporting that Hydra, an invertebrate animal, polymerizes the conjugated oligomer ETE-S both within cells that expresses peroxidase activity and within the adhesive material that is secreted to promote underwater surface adhesion. The resulting conjugated polymer forms electronically conducting and electrochemically active μm-sized domains, which are inter-connected resulting in percolative conduction pathways extending beyond 100 μm, that are fully integrated within the Hydra tissue and the secreted mucus. Furthermore, the introduction and in vivo polymerization of ETE-S can be used as a biochemical marker to follow the dynamics of Hydra budding (reproduction) and regeneration. This work paves the way for well-defined self-organized electronics in animal tissue to modulate biological functions and in vivo biofabrication of hybrid functional materials and devices.

3D Electrodes for Bioelectronics

In recent studies related to bioelectronics, significant efforts have been made to form 3D electrodes to increase the effective surface area or to optimize the transfer of signals at tissue-electrode interfaces. Although bioelectronic devices with 2D and flat electrode structures have been used extensively for monitoring biological signals, these 2D planar electrodes have made it difficult to form biocompatible and uniform interfaces with nonplanar and soft biological systems (at the cellular or tissue levels). Especially, recent biomedical applications have been expanding rapidly toward 3D organoids and the deep tissues of living animals, and 3D bioelectrodes are getting significant attention because they can reach the deep regions of various 3D tissues. An overview of recent studies on 3D bioelectronic devices, such as the use of electrical stimulations and the recording of neural signals from biological subjects, is presented. Subsequently, the recent developments in materials and fabrication processing to 3D micro- and nanostructures are introduced, followed by broad applications of these 3D bioelectronic devices at various in vitro and in vivo conditions.

Optical ventricular cardioversion by local optogenetic targeting and LED implantation in a cardiomyopathic rat model

AIMS

Ventricular tachyarrhythmias (VTs) are common in the pathologically remodelled heart. These arrhythmias can be lethal, necessitating acute treatment like electrical cardioversion to restore normal rhythm. Recently, it has been proposed that cardioversion may also be realized via optically controlled generation of bioelectricity by the arrhythmic heart itself through optogenetics and therefore without the need of traumatizing high-voltage shocks. However, crucial mechanistic and translational aspects of this strategy have remained largely unaddressed. Therefore, we investigated optogenetic termination of VTs 1) in the pathologically remodelled heart using a 2) implantable multi-LED device for 3) in vivo closed-chest, local illumination.

METHODS AND RESULTS

In order to mimic a clinically relevant sequence of events, transverse aortic constriction (TAC) was applied to adult male Wistar rats before optogenetic modification. This modification took place three weeks later by intravenous delivery of adeno-associated virus vectors encoding red-activatable channelrhodopsin (ReaChR) or Citrine for control experiments. At 8 to 10 weeks after TAC, VTs were induced ex vivo and in vivo, followed by programmed local illumination of the ventricular apex by a custom-made implanted multi-LED device. This resulted in effective and repetitive VT termination in the remodelled adult rat heart after optogenetic modification, leading to sustained restoration of sinus rhythm in the intact animal. Mechanistically, studies on the single cell and tissue level revealed collectively that, despite the cardiac remodelling, there were no significant differences in bioelectricity generation and subsequent transmembrane voltage responses between diseased and control animals, thereby providing insight into the observed robustness of optogenetic VT termination.

CONCLUSION

Our results show that implant-based optical cardioversion of VTs is feasible in the pathologically remodelled heart in vivo after local optogenetic targeting because of preserved optical control over bioelectricity generation. These findings add novel mechanistic and translational insight into optical ventricular cardioversion.

Flexible Electrodes for In Vivo and In Vitro Electrophysiological Signal Recording

A variety of electrophysiological signals (electrocardiography, electromyography, electroencephalography, etc.) are generated during the physiological activities of human bodies, which can be collected by electrodes and thus provide critical insights into health status or facilitate fundamental scientific research. The long-term stable and high-quality recording of electrophysiological signals is the premise for their further applications, leading to demands for flexible electrodes with similar mechanical modulus and minimized irritation to human bodies. This review summarizes the latest advances in flexible electrodes for the acquisition of various electrophysiological signals. First, the concept of electrophysiological signals and the characteristics of different subcategory signals are introduced. Second, the invasive and noninvasive methods are reviewed for electrophysiological signal recording with a highlight on the design of flexible electrodes, followed by a discussion on their material selection. Subsequently, the applications of the electrophysiological signal acquisition in pathological diagnosis and restoration of body functions are discussed, showing the advantages of flexible electrodes. Finally, the main challenges and opportunities in this field are discussed. It is believed that the further exploration of materials for flexible electrodes and the combination of multidisciplinary technologies will boost the applications of flexible electrodes for medical diagnosis and human-machine interface.

Well-rounded devices: the fabrication of electronics on curved surfaces - a review

With the arrival of the internet of things and the rise of wearable computing, electronics are playing an increasingly important role in our everyday lives. Until recently, however, the rigid angular nature of traditional electronics has prevented them from being integrated into many of the organic, curved shapes that interface with our bodies (such as ergonomic equipment or medical devices) or the natural world (such as aerodynamic or optical components). In the past few years, many groups working in advanced manufacturing and soft robotics have endeavored to develop strategies for fabricating electronics on these curved surfaces. This is their story. In this work, we describe the motivations, challenges, methodologies, and applications of curved electronics, and provide a outlook for this promising field.

Rapid custom prototyping of soft poroelastic biosensor for simultaneous epicardial recording and imaging

The growing need for the implementation of stretchable biosensors in the body has driven rapid prototyping schemes through the direct ink writing of multidimensional functional architectures. Recent approaches employ biocompatible inks that are dispensable through an automated nozzle injection system. However, their application in medical practices remains challenged in reliable recording due to their viscoelastic nature that yields mechanical and electrical hysteresis under periodic large strains. Herein, we report sponge-like poroelastic silicone composites adaptable for high-precision direct writing of custom-designed stretchable biosensors, which are soft and insensitive to strains. Their unique structural properties yield a robust coupling to living tissues, enabling high-fidelity recording of spatiotemporal electrophysiological activity and real-time ultrasound imaging for visual feedback. In vivo evaluations of custom-fit biosensors in a murine acute myocardial infarction model demonstrate a potential clinical utility in the simultaneous intraoperative recording and imaging on the epicardium, which may guide definitive surgical treatments.

Screen-Printed Nickel-Zinc Batteries: A Review of Additive Manufacturing and Evaluation Methods

The advent of personalized wearable devices has boosted the demand for portable, compact power sources. Compared with lithographic techniques, printed devices have lower fabrication costs, while still maintaining high throughput and precision. These factors make thick film printing or additive manufacturing ideal for the fabrication of low-cost batteries suitable for personalized devices. This article provides comprehensive guidelines for thick-film battery fabrication and characterization, with the focus on printed nickel-zinc (Ni-Zn) batteries. Ni-Zn batteries are a more environmental-friendly option compared with lithium-ion batteries (LIBs) as they are fully recyclable. In this work, important battery fundamentals have been described, especially terms of electrochemistry, basic design approaches, and the printing technology. Different design approaches, such as lateral, concentric, and stacked, are also discussed. Printed batteries can be configured as series or parallel constructions, depending on the power requirements of the application. The fabrication flow of printed battery electrodes for the laboratory-scale prototyping process starts from chemical preparation, mixing, printing, drying, pressing, stacking to finally sealing and testing. Of particular importance is the process of electrolyte injection and pouch sealing for the printed batteries to reduce leakage. This entire process flow is also compared with industrial fabrication flow for LIBs. Criteria for material and equipment selection are also addressed in this article to ensure appropriate electrode consistency and good performance. Two main testing methods cyclic voltammetry for the electrodes and charge-discharge for the battery are also explained in detail to serve as systematic guide for users to validate the functionality of their electrodes. This review article concludes with commercial applications of printed electrodes in the field of health and personalized wearable devices. This work indicates that printed Ni-Zn and other zinc alkaline batteries have a promising future. The success of these devices also opens up different areas of research, such as ink rheology, composition, and formulation of ink using sustainable sources.

Flexible Hybrid Electronics for Monitoring Hypoxia

Hypoxia refers to insufficient oxygen amounts at the tissue level unable to maintain adequate homeostasis. Severe hypoxia may occur in the absence of subjective breathlessness due to respiratory failure. Precise monitoring of low blood oxygen saturation is crucially desired, catering to the clinical requirements. However, current pulse oximeters cannot function well in monitoring peripheral oxygen saturation limited by the weak peripheral blood circulation at a low oxygen level. In this work, we propose a flexible hybrid electronic (FHE) with a compact structure and high sensitivity for conveniently monitoring hypoxia. This FHE is composed of 10-µm thickness semiconductors with different materials, functionalities, and sizes. Its performance is demonstrated by monitoring arterial blood oxygen saturation (SaO₂) at the body's different arteries. The absolute error is less than 2% within a SaO₂ ranging from 99% to 63%. The efficient techniques presented in this work may bring light to the next-generation flexible hybrid electronics and provide potential widespread use in research and clinical applications, especially for emergency treatment.

Wearable and Implantable Electroceuticals for Therapeutic Electrostimulations

Wearable and implantable electroceuticals (WIEs) for therapeutic electrostimulation (ES) have become indispensable medical devices in modern healthcare. In addition to functionality, device miniaturization, conformability, biocompatibility, and/or biodegradability are the main engineering targets for the development and clinical translation of WIEs. Recent innovations are mainly focused on wearable/implantable power sources, advanced conformable electrodes, and efficient ES on targeted organs and tissues. Herein, nanogenerators as a hotspot wearable/implantable energy-harvesting technique suitable for powering WIEs are reviewed. Then, electrodes for comfortable attachment and efficient delivery of electrical signals to targeted tissue/organ are introduced and compared. A few promising application directions of ES are discussed, including heart stimulation, nerve modulation, skin regeneration, muscle activation, and assistance to other therapeutic modalities.

Continuous measurement of surface electrical potentials from transplanted cardiomyocyte tissue derived from human-induced pluripotent stem cells under physiological conditions in vivo

Recording the electrical potentials of bioengineered cardiac tissue after transplantation would help to monitor the maturation of the tissue and detect adverse events such as arrhythmia. However, a few studies have reported the measurement of myocardial tissue potentials in vivo under physiological conditions. In this study, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSCM) sheets were stacked and ectopically transplanted into the subcutaneous tissue of rats for culture in vivo. Three months after transplantation, a flexible nanomesh sensor was implanted onto the hiPSCM tissue to record its surface electrical potentials under physiological conditions, i.e., without the need for anesthetic agents that might adversely affect cardiomyocyte function. The nanomesh sensor was able to record electrical potentials in non-sedated, ambulating animals for up to 48 h. When compared with recordings made with conventional needle electrodes in anesthetized animals, the waveforms obtained with the nanomesh sensor showed less dispersion of waveform interval and waveform duration. However, waveform amplitude tended to show greater dispersion for the nanomesh sensor than for the needle electrodes, possibly due to motion artifacts produced by movements of the animal or local tissue changes in response to surgical implantation of the sensor. The implantable nanomesh sensor utilized in this study potentially could be used for long-term monitoring of bioengineered myocardial tissue in vivo under physiological conditions.

3D Interfacing between Soft Electronic Tools and Complex Biological Tissues

Recent developments in soft functional materials have created opportunities for building bioelectronic devices with tissue-like mechanical properties. Their integration with the human body could enable advanced sensing and stimulation for medical diagnosis and therapies. However, most of the available soft electronics are constructed as planar sheets, which are difficult to interface with the target organs and tissues that have complex 3D structures. Here, the recent approaches are highlighted to building 3D interfaces between soft electronic tools and complex biological organs and tissues. Examples involve mesh devices for conformal contact, imaging-guided fabrication of organ-specific electronics, miniaturized probes for neurointerfaces, instrumented scaffold for tissue engineering, and many other soft 3D systems. They represent diverse routes for reconciling the interfacial mismatches between electronic tools and biological tissues. The remaining challenges include device scaling to approach the complexity of target organs, biological data acquisition and processing, 3D manufacturing techniques, etc., providing a range of opportunities for scientific research and technological innovation.

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.

Soft sensors for a sensing-actuation system with high bladder voiding efficiency

Sensing-actuation systems can assist a bladder with lost sensation and weak muscle control. Here, we advance the relevant technology by integrating a soft and thin capacitive sensor with a shape memory alloy-based actuator to achieve a high-performance closed-loop configuration. In our design, sensors capable of continuous bladder volume detection and actuators with strong emptying force have been used. This integration has previously hindered performance due to large bladder volume changes. Our solution integrates sensing-actuation elements that are bladder compatible but do not interfere with one another, achieving real-time bladder management. The system attains a highly desirable voiding target of 71 to 100% of a rat's bladder with a volume sensitivity of 0.7 μF/liter. Our system represents an efficient voiding solution that avoids overfilling and represents a technological solution to bladder impairment treatment, serving as a model for similar soft sensor-actuator integration with other organs.

Computational wrapping: A universal method to wrap 3D-curved surfaces with nonstretchable materials for conformal devices

This study starts from the counterintuitive question of how we can render conventional stiff, nonstretchable, and even brittle materials sufficiently conformable to fully wrap curved surfaces, such as spheres, without failure. Here, we extend the geometrical design method of computational origami to wrapping. Our computational wrapping approach provides a robust and reliable method for fabricating conformal devices for arbitrary curved surfaces with a computationally designed nonpolyhedral developable net. This computer-aided design transforms two-dimensional (2D)-based materials, such as Si wafers and steel sheets, into various targeted conformal structures that can fully wrap desired 3D structures without fracture or severe plastic deformation. We further demonstrate that our computational wrapping approach enables a design platform that can transform conventional nonstretchable 2D-based devices, such as electroluminescent lighting and flexible batteries, into conformal 3D curved devices.

Mechanically-Guided Structural Designs in Stretchable Inorganic Electronics

Over the past decade, the area of stretchable inorganic electronics has evolved very rapidly, in part because the results have opened up a series of unprecedented applications with broad interest and potential for impact, especially in bio-integrated systems. Low modulus mechanics and the ability to accommodate extreme mechanical deformations, especially high levels of stretching, represent key defining characteristics. Most existing studies exploit structural material designs to achieve these properties, through the integration of hard inorganic electronic components configured into strategic 2D/3D geometries onto patterned soft substrates. The diverse structural geometries developed for stretchable inorganic electronics are summarized, covering the designs of functional devices and soft substrates, with a focus on fundamental principles, design approaches, and system demonstrations. Strategies that allow spatial integration of 3D stretchable device layouts are also highlighted. Finally, perspectives on the remaining challenges and open opportunities are provided.

Flexible Hybrid Electronics for Digital Healthcare

Recent advances in material innovation and structural design provide routes to flexible hybrid electronics that can combine the high-performance electrical properties of conventional wafer-based electronics with the ability to be stretched, bent, and twisted to arbitrary shapes, revolutionizing the transformation of traditional healthcare to digital healthcare. Here, material innovation and structural design for the preparation of flexible hybrid electronics are reviewed, a brief chronology of these advances is given, and biomedical applications in bioelectrical monitoring and stimulation, optical monitoring and treatment, acoustic imitation and monitoring, bionic touch, and body-fluid testing are described. In conclusion, some remarks on the challenges for future research of flexible hybrid electronics are presented.

Flexible Ultrasonic Transducer Array with Bulk PZT for Adjuvant Treatment of Bone Injury

Flexible electronic devices are developing rapidly, especially in medical applications. This paper reports an arrayed flexible piezoelectric micromachined ultrasonic transducer (FPMUT) with a sandwich structure for adjuvant treatment of bone injury. To make the device conformable and stretchable for attaching to the skin surface, the flexible substrate of polydimethylsiloxane (PDMS) was combined with the flexible metal line interconnection between the bulk lead zirconate titanate (PZT) arrays. Simulations and experiments were carried out to verify the resonant frequency and tensile property of the reported FPMUT device. The device had a resonant frequency of 321.15 KHz and a maximum sound pressure level (SPL) of 180.19 dB at the distance of 5 cm in water. In addition, detailed experiments were carried out to test its acoustic performance with different pork tissues, and the results indicated good ultrasound penetration. These findings confirm that the FPMUT shows unique advantages for adjuvant treatment of bone injury.

Assembling Metal-Organic Frameworks into the Fractal Scale for Sweat Sensing

Many natural organizations with some special functional properties possess fractal tissues which display nearly the same at every scale. The benefit of mimicking fractal structure in synthetic functional materials warrants further exploration. To tackle this challenge, we assemble metal-organic frameworks (MOFs) into fractal structures by using a bottom-up approach inspired from evaporation-driven crystallization. Such hierarchically branched MOFs exhibit some unexpected performances in electrochemistry, and can be a versatile biosensor for sweat analysis. Our work provides an interesting and efficient example for fabricating fractal MOFs as well as uncovering their new properties. This fractal-guided strategy can be extended to synthesize and explore new characteristics of other materials, holding potential in various applications including sensors, catalysis, and energy storage.

Integration of biological systems with electronic-mechanical assemblies

Biological systems continuously interact with the surrounding environment because they are dynamically evolving. The interaction is achieved through mechanical, electrical, chemical, biological, thermal, optical, or a synergistic combination of these cues. To provide a fundamental understanding of the interaction, recent efforts that integrate biological systems with the electronic-mechanical assemblies create unique opportunities for simultaneous monitoring and eliciting the responses to the biological system. Recent innovations in materials, fabrication processes, and device integration approaches have created the enablers to yield bio-integrated devices to interface with the biological system, ranging from cells and tissues to organs and living individual. In this short review, we will provide a brief overview of the recent development on the integration of the biological systems with electronic-mechanical assemblies across multiple scales, with applications ranging from healthcare monitoring to therapeutic options such as drug delivery and rehabilitation therapies. STATEMENT OF SIGNIFICANCE: An overview of the recent progress on the integration of the biological system with both electronic and mechanical assemblies is discussed. The integration creates the unique opportunity to simultaneously monitor and elicit the responses to the biological system, which provides a fundamental understanding of the interaction between the biological system and the electronic-mechanical assemblies. Recent innovations in materials, fabrication processes, and device integration approaches have created the enablers to yield bio-integrated devices to interface with the biological system, ranging from cells and tissues to organs and living individual.

Ultrastretchable and Wireless Bioelectronics Based on All-Hydrogel Microfluidics

Hydrogel bioelectronics that can interface biological tissues and flexible electronics is at the core of the growing field of healthcare monitoring, smart drug systems, and wearable and implantable devices. Here, a simple strategy is demonstrated to prototype all-hydrogel bioelectronics with embedded arbitrary conductive networks using tough hydrogels and liquid metal. Due to their excellent stretchability, the resultant all-hydrogel bioelectronics exhibits stable electrochemical properties at large tensile stretch and various modes of deformation. The potential of fabricated all-hydrogel bioelectronics is demonstrated as wearable strain sensors, cardiac patches, and near-field communication (NFC) devices for monitoring various physiological conditions wirelessly. The presented simple platform paves the way of implantable hydrogel electronics for Internet-of-Things and tissue-machine interfacing applications.

A widely adaptable analytical method for thermal analysis of flexible electronics with complex heat source structures

Flexible electronics, as a relatively new category of device, exhibit prodigious potential in many applications, especially in bio-integrated fields. It is critical to understand that thermal management of certain kinds of exothermic flexible electronics is a crucial issue, whether to avoid or to take advantage of the excessive temperature. A widely adaptable analytical method, validated by finite-element analysis and experiments, is conducted to investigate the thermal properties of exothermic flexible electronics with a heat source in complex shape or complex array layout. The main theoretical strategy to obtain the thermal field is through an integral along the complex curve source region. The results predicted by the analytical model enable accurate control of temperature and heat flow in the flexible electronics, which may help in the design and fabrication of flexible electronic devices in the future.

Sensor-Instrumented Scaffold Integrated with Microporous Spongelike Ultrabuoy for Long-Term 3D Mapping of Cellular Behaviors and Functions

Real-time monitoring of cellular behaviors and functions with sensor-instrumented scaffolds can provide a profound impact on fundamental studies of the underlying biophysics and disease modeling. Although quantitative measurement of predictive data for in vivo tests and physiologically relevant information in these contexts is important, the long-term reliable monitoring of cellular functions in three-dimensional (3D) environments is limited by the required set under wet cell culture conditions that are unfavorable to electronic instrument settings. Here, we introduce an ultrabuoyant 3D instrumented scaffold that can remain afloat on the surface of culture medium and thereby provides favorable environments for the entire electronic components in the air while the cells reside and grow underneath. This setting enables high-fidelity recording of electrical cell-substrate impedance and electrophysiological signals for a long period of time (weeks). Comprehensive in vitro studies reveal the utility of this platform as an effective tool for drug screening and tissue development.

Bimetallic Pt,Ir-containing coatings formed by MOCVD for medical applications

Biocompatible Pt_xIr_(1-x) layers combining high mechanical strength of the iridium component and outstanding corrosion resistance of the platinum component providing reversible charge transfer reactions in the living tissue are one of the important materials required for implantable medical electrodes. The modern trend to complicate the shape and reduce the electrode dimensions includes the challenge to develop precise methods to obtain such bimetallic coatings with enhanced surface area and advanced electrochemical characteristics. Herein, Pt_xIr_(1-x) coatings were firstly obtained on cathode and anode pole tips of endocardial electrodes for pacemakers using chemical vapor deposition technique. To deposit Pt_xIr_(1-x) coatings with a wide range of metal ratios (x = 0.5-0.9) the combination of acetylacetonate-based volatile precursors with compatible thermal characteristics was used for the first time. The expected metal ratio in the coatings was regulated by a partial pressure of the precursor vapors in the reaction zone and was in the good agreement with its real value measured by various methods, including energy-dispersive and wavelength dispersive spectroscopy, X-ray photoelectron spectroscopy. According to the X-ray powder diffraction analysis, Pt_xIr_(1-x) coatings consisted of fcc-Pt_xIr_(1-x) solid solution phases. The microscopy data confirmed the formation of Pt_xIr_1-x coatings with the enhanced surface areas. The effect of electrochemical activation on the surface composition and morphology of the samples was studied. The electrochemical characteristics of samples were estimated from cyclic voltammetry and electrochemical impedance spectroscopy data. The charge storage capacity (CSC) values of activated samples were in the range of 19-108 mCcm^-2 (phosphate buffer saline solution, 100 mV/s).

Recent advances in micro-supercapacitors

Micro-supercapacitors (MSCs) possessing the remarkable features of high electrochemical performance and relatively small volume are promising candidates for energy storage in micro-devices. Tremendous effort has been devoted in recent years to design and to fabricate MSCs with different active electrode materials, including carbon-based materials, conducting polymers, and graphene/metal oxide composites. Moreover, various methods have been developed to prepare MSCs, such as photolithography, laser direct writing, printing methods. This review presents a summary of the recent developments in MSC technology, including electrode materials, fabrication methods, and patterning. Finally, future developments, perspectives, and challenges in the MSC industry are also discussed.

High-performance stretchable conductive nanocomposites: materials, processes, and device applications

Highly conductive and intrinsically stretchable electrodes are vital components of soft electronics such as stretchable transistors and circuits, sensors and actuators, light-emitting diode arrays, and energy harvesting devices. Many kinds of conducting nanomaterials with outstanding electrical and mechanical properties have been integrated with elastomers to produce stretchable conductive nanocomposites. Understanding the characteristics of these nanocomposites and assessing the feasibility of their fabrication are therefore critical for the development of high-performance stretchable conductors and electronic devices. We herein summarise the recent advances in stretchable conductors based on the percolation networks of nanoscale conductive fillers in elastomeric media. After discussing the material-, dimension-, and size-dependent properties of conductive fillers and their implications, we highlight various techniques that are used to reduce the contact resistance between the conductive filler materials. Furthermore, we categorize elastomer matrices with different stretchabilities and mechanical properties based on their polymeric chain structures. Then, we discuss the fabrication techniques of stretchable conductive nanocomposites toward their use in soft electronics. Finally, we provide representative examples of stretchable device applications and conclude the review with a brief outlook for future research.