An ultra-compact and wireless tag for battery-free sweat glucose monitoring

Molecular and histological evidence for the biocompatibility of PEDOT-coated microneedles in human skin

The increasing demand for real-time, continuous health monitoring has driven improvements in wearable and skin-attachable devices, particularly in sensing vital body signs and biomarkers. Research on conducting polymers (CPs) in these devices is also growing due to their low cost, flexibility, and versatile fabrication. However, despite their widespread use and claims of biocompatibility, there are limited studies on the biocompatibility of CPs in human skin, and those that exist have only been conducted using cell cytotoxicity or animal testing, lacking proper and comprehensive assessments. To address this critical gap, this study investigates the biocompatibility of CPs, represented by poly(3,4-ethylenedioxythiophene) (PEDOT), in excised human skin. In addition to the pathological evaluation of skin biopsies, a novel assessment of CP's impact on the expression of stress-related gene markers is reported, providing a comprehensive analysis at both the tissue and molecular levels. PEDOT-coated microneedles were implanted in the skin for transdermal interrogation, and after 24 hours of incubation, the exposed skin was studied using histology and RT-PCR. This paper offers fundamental insights for future CP-engineered devices in skin applications, contributing valuable data to the materials community regarding the true biocompatibility of these widely used materials.

Thermal Transfer Printed Flexible and Wearable Bionic Skin with Bilayer Nanofiber for Comfortable Multimodal Health Management

The advent of bionic skin sensors represents a significant leap forward in the realm of wearable health monitoring technologies. Existing bionic skin technologies face several limitations, including complex and expensive manufacturing processes, low wearing comfort, and challenges in achieving comfortable real-time health monitoring. These shortcomings hinder the widespread adoption and practical utility of bionic skin in various applications. The bionic skin invention presented in this article addresses these issues by introducing a novel thermal transfer manufacturing process that is low-cost and easy to operate. This method is particularly suitable for the small-scale mass production required for bionic skin applications. Additionally, the innovative bilayer unidirectional moisture transport nanomembrane incorporated into the bionic skin offers high extensibility and breathability. This feature enhances the ability of the skin to absorb sweat, thereby facilitating comfortable real-time health monitoring. The specially designed bionic skin sensor embedded within this system can monitor various biomarkers in sweat, including glucose, lactic acid, uric acid, pH, temperature, and skin impedance. When combined with the CARE(Continuous Analyte Monitoring with Real-time Engagement) system, it enables real-time data transmission and processing, offering a comprehensive approach to health monitoring that is both comfortable and reliable.

Ga@MXene-based flexible wearable biosensor for glucose monitoring in sweat

Most wearable biosensors struggle to balance flexibility and conductivity in their sensing interfaces. In this study, we propose a wearable sensor featuring a highly stretchable, three-dimensional conductive network structure based on liquid metal. The sensor interface utilizes a patterned Ga@MXene hydrogel system, where gallium (Ga) grafted onto MXene provides enhanced electrical conductivity and malleability. MXene provides excellent conductivity and a three-dimensional layered structure. Additionally, the chitosan (CS) hydrogel, with its superior water absorption and stretchability, allows the electrode to retain sweat and closely stick to the skin. The sensor demonstrates a low limit of detection (0.77 μM), high sensitivity (1.122 μA⋅μM⁻1⋅cm⁻2), and a broad detection range (10-1,000 μM), meeting the requirements for a wide range of applications. Notably, the sensor can also induce perspiration in the wearer. The three-dimensional porous structure of the Ga@MXene/CS biosensor ensures excellent conductivity and flexibility, making it suitable for a variety of applications.

Tailoring Design of Microneedles for Drug Delivery and Biosensing

Microneedles (MNs) are emerging as versatile tools for both therapeutic drug delivery and diagnostic monitoring. Unlike hypodermic needles, MNs achieve these applications with minimal or no pain and customizable designs, making them suitable for personalized medicine. Understanding the key design parameters and the challenges during contact with biofluids is crucial to optimizing their use across applications. This review summarizes the current fabrication techniques and design considerations tailored to meet the distinct requirements for drug delivery and biosensing applications. We further underscore the current state of theranostic MNs that integrate drug delivery and biosensing and propose future directions for advancing MNs toward clinical use.

Recent progress on nanomaterial-based electrochemical sensors for glucose detection in human body fluids

In the modern age, half of the population is facing various chronic illnesses due to glucose maintenance in the body, major causes of fatality and inefficiency. The early identification of glucose plays a crucial role in medical treatment and the food industry, particularly in diabetes diagnosis. In the past few years, non-enzymatic electrochemical glucose sensors have received a lot of interest for their ability to identify glucose levels accurately. Electrochemical biosensors are developing as a propitious solution for personalized health monitoring due to their accuracy, specificity, and affordability. This review article provides an observation of a variety of non-enzymatic glucose sensor resources, such as carbon nanomaterials, noble metals gold and silver, transition metal and their oxides, and porous material composites. Moreover, basic knowledge of the reaction mechanism of enzymatic and nonenzymatic glucose sensors are outlined and recent advancements in glucose sensors applications to various human body biofluids such as sweat, tears, urine, saliva, and blood are presented. Finally, this review summarizes electrochemical sensors for glucose detection in human body fluids, the challenges they faced, and their solutions.

Earable Multimodal Sensing and Stimulation: A Prospective Towards Unobtrusive Closed-Loop Biofeedback

The human ear has emerged as a bidirectional gateway to the brain's and body's signals. Recent advances in around-the-ear and in-ear sensors have enabled the assessment of biomarkers and physiomarkers derived from brain and cardiac activity using ear-electroencephalography (ear-EEG), photoplethysmography (ear-PPG), and chemical sensing of analytes from the ear, with ear-EEG having been taken beyond-the-lab to outer space. Parallel advances in non-invasive and minimally invasive brain stimulation techniques have leveraged the ear's access to two cranial nerves to modulate brain and body activity. The vestibulocochlear nerve stimulates the auditory cortex and limbic system with sound, while the auricular branch of the vagus nerve indirectly but significantly couples to the autonomic nervous system and cardiac output. Acoustic and current mode stimuli delivered using discreet and unobtrusive earables are an active area of research, aiming to make biofeedback and bioelectronic medicine deliverable outside of the clinic, with remote and continuous monitoring of therapeutic responsivity and long-term adaptation. Leveraging recent advances in ear-EEG, transcutaneous auricular vagus nerve stimulation (taVNS), and unobtrusive acoustic stimulation, we review accumulating evidence that combines their potential into an integrated earable platform for closed-loop multimodal sensing and neuromodulation, towards personalized and holistic therapies that are near, in- and around-the-ear.

A Passive Perspiration Inspired Wearable Platform for Continuous Glucose Monitoring

The demand for glucose monitoring devices has witnessed continuous growth from the rising diabetic population. The traditional approach of blood glucose (BG) sensor strip testing generates only intermittent glucose readings. Interstitial fluid-based devices measure glucose dynamically, but their sensing approaches remain either minimally invasive or prone to skin irritation. Here, a sweat glucose monitoring system is presented, which completely operates under rest with no sweat stimulation and can generate real-time BG dynamics. Osmotically driven hydrogels, capillary action with paper microfluidics, and self-powered enzymatic biochemical sensor are used for simultaneous sweat extraction, transport, and glucose monitoring, respectively. The osmotic forces facilitate greater flux inflow and minimize sweat rate fluctuations compared to natural perspiration-based sampling. The epidermal platform is tested on fingertip and forearm under varying physiological conditions. Personalized calibration models are developed and validated to obtain real-time BG information from sweat. The estimated BG concentration showed a good correlation with measured BG concentration, with all values lying in the A+B region of consensus error grid (MARD = 10.56% (fingertip) and 13.17% (forearm)). Overall, the successful execution of such osmotically driven continuous BG monitoring system from passive sweat can be a useful addition to the next-generation continuous sweat glucose monitors.

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.

Innovative Material-Based Wearable Non-Invasive Electrochemical Sweat Sensors towards Biomedical Applications

Sweat is an accessible biofluid that provides useful physiological information about the body's biomolecular state and systemic health. Wearable sensors possess various advantageous features, such as lightweight design, wireless connectivity, and compatibility with human skin, that make them suitable for continuous monitoring. Wearable electrochemical sweat sensors can diagnose diseases and monitor health conditions by detecting biomedical signal changes in sweat. This paper discusses the state-of-the-art research in the field of wearable sweat sensors and the materials used in their construction. It covers biomarkers present in sweat, sensing modalities, techniques for sweat collection, and ways to power these sensors. Innovative materials are categorized into three subcategories: sweat collection, sweat detection, and self-powering. These include substrates for sensor fabrication, analyte detection electrodes, absorbent patches, microfluidic devices, and self-powered devices. This paper concludes by forecasting future research trends and prospects in material-based wearable non-invasive sweat sensors.

Sweat Sensor Based on Wearable Janus Textiles for Sweat Collection and Microstructured Optical Fiber for Surface-Enhanced Raman Scattering Analysis

Wearable sweat sensors provide real-time monitoring of biomarkers, enabling individuals to gain real-time insight into their health status. Current sensors primarily rely on electrochemical mechanisms, limiting their capacity for the concurrent detection of multiple analytes. Surface-enhanced Raman scattering spectroscopy offers an alternative approach by providing molecular fingerprint information to facilitate the identification of intricate analytes. In this study, we combine a wearable Janus fabric for efficient sweat collection and a grapefruit optical fiber embedded with Ag nanoparticles as a sensitive SERS probe. The Janus fabric features a superhydrophobic side in contact with the skin and patterned superhydrophilic regions on the opposite surface, facilitating the unidirectional flow of sweat toward these hydrophilic zones. Grapefruit optical fibers feature sharp tips with the ability to penetrate transparent dressings. Its microchannels extract sweat through capillary force, and nanoliter-scale volumes of sweat are sufficient to completely fill them. The Raman signal of sweat components is greatly enhanced by the plasmonic hot spots and accumulates along the fiber length. We demonstrate sensitive detection of sodium lactate and urea in sweat with a detection limit much lower than the physiological concentration levels. Moreover, the platform shows its capability for multicomponent detection and extends to the analysis of real human sweat.

Access and Management of Sweat for Non-Invasive Biomarker Monitoring: A Comprehensive Review

Sweat is an important biofluid presents in the body since it regulates the internal body temperature, and it is relatively easy to access on the skin unlike other biofluids and contains several biomarkers that are also present in the blood. Although sweat sensing devices have recently displayed tremendous progress, most of the emerging devices primarily focus on the sensor development, integration with electronics, wearability, and data from in vitro studies and short-term on-body trials during exercise. To further the advances in sweat sensing technology, this review aims to present a comprehensive report on the approaches to access and manage sweat from the skin toward improved sweat collection and sensing. It is begun by delineating the sweat secretion mechanism through the skin, and the historical perspective of sweat, followed by a detailed discussion on the mechanisms governing sweat generation and management on the skin. It is concluded by presenting the advanced applications of sweat sensing, supported by a discussion of robust, extended-operation epidermal wearable devices aiming to strengthen personalized healthcare monitoring systems.

Colorimetric sweat analysis using wearable hydrogel patch sensors for detection of chloride and glucose

Sweat is a promising non-invasive biofluid that can provide valuable insights into the physiological state of the human body. However, a major obstacle to analyzing sweat in real-time is the fabrication of simple, fast-acting, accurate, and low-cost sensing constructs. To address this challenge, we introduced easily-prepared wearable hydrogel sensors that can be placed on the skin and used colorimetric techniques to assess sweat analytes without invasive procedures. Two typical sweat sensors, chloride ion (Cl-) responsive patches for cystic fibrosis (CF) analysis and glucose response patches for diabetic monitoring, were demonstrated for real sample analysis. The Cl- colorimetric sensor, with a detection limit down to 100 μM, shows a good linear response from 1.56 mM to 200 mM Cl-, and the glucose colorimetric sensor, with a detection limit down to 1 μM, exhibits an adequate linear response from 10 μM to 1 mM glucose. These colorimetric hydrogel sensors are also incorporated into a medical dressing to create wearable sensor devices for real-time sweat analysis. The acquired readings closely match the results obtained from the benchmark analyzing instrument, with a small deviation of less than 10%. Therefore, our simple colorimetric hydrogel sensing patches hold great potential to advance real-time sweat testing and contribute to the transitional development of wearable medical devices.

Recent Advances in Batteryless NFC Sensors for Chemical Sensing and Biosensing

This article reviews the recent advances in the field of batteryless near-field communication (NFC) sensors for chemical sensing and biosensing. The commercial availability of low-cost commercial NFC integrated circuits (ICs) and their massive integration in smartphones, used as readers and cloud interfaces, have aroused great interest in new batteryless NFC sensors. The fact that coil antennas are not importantly affected by the body compared with other wireless sensors based on far-field communications makes this technology suitable for future wearable point-of-care testing (PoCT) devices. This review first compares energy harvesting based on NFC to other energy-harvesting technologies. Next, some practical recommendations for designing and tuning NFC-based tags are described. Power transfer is key because in most cases, the energy harvested has to be stable for several seconds and not contaminated by undesired signals. For this reason, the effect of the dimensions of the coils and the conductivity on the wireless power transfer is thoroughly discussed. In the last part of the review, the state of the art in NFC-based chemical and biosensors is presented. NFC-based tags (or sensor tags) are mainly based on commercial or custom NFC ICs, which are used to harvest the energy from the RF field generated by the smartphone to power the electronics. Low-consumption colorimeters and potentiostats can be integrated into these NFC tags, opening the door to the integration of chemical sensors and biosensors, which can be harvested and read from a smartphone. The smartphone is also used to upload the acquired information to the cloud to facilitate the internet of medical things (IoMT) paradigm. Finally, several chipless sensors recently proposed in the literature as a low-cost alternative for chemical applications are discussed.

Focus Review on Nanomaterial-Based Electrochemical Sensing of Glucose for Health Applications

Diabetes management can be considered the first paradigm of modern personalized medicine. An overview of the most relevant advancements in glucose sensing achieved in the last 5 years is presented. In particular, devices exploiting both consolidated and innovative electrochemical sensing strategies, based on nanomaterials, have been described, taking into account their performances, advantages and limitations, when applied for the glucose analysis in blood and serum samples, urine, as well as in less conventional biological fluids. The routine measurement is still largely based on the finger-pricking method, which is usually considered unpleasant. In alternative, glucose continuous monitoring relies on electrochemical sensing in the interstitial fluid, using implanted electrodes. Due to the invasive nature of such devices, further investigations have been carried out in order to develop less invasive sensors that can operate in sweat, tears or wound exudates. Thanks to their unique features, nanomaterials have been successfully applied for the development of both enzymatic and non-enzymatic glucose sensors, which are compliant with the specific needs of the most advanced applications, such as flexible and deformable systems capable of conforming to skin or eyes, in order to produce reliable medical devices operating at the point of care.

Craft-and-Stick Xurographic Manufacturing of Integrated Microfluidic Electrochemical Sensing Platform

An innovative modular approach for facile design and construction of flexible microfluidic biosensor platforms based on a dry manufacturing "craft-and-stick" approach is developed. The design and fabrication of the flexible graphene paper electrode (GPE) unit and polyethylene tetraphthalate sheet (PET)6/adhesive fluidic unit are completed by an economic and generic xurographic craft approach. The GPE widths and the microfluidic channels can be constructed down to 300 μm and 200 μm, respectively. Both units were assembled by simple double-sided adhesive tapes into a microfluidic integrated GPE (MF-iGPE) that are flexible, thin (<0.5 mm), and lightweight (0.4 g). We further functionalized the iGPE with Prussian blue and glucose oxidase for the fabrication of MF-iGPE glucose biosensors. With a closed-channel PET fluidic pattern, the MF-iGPE glucose biosensors were packaged and sealed to protect the integrated device from moisture for storage and could easily open with scissors for sample loading. Our glucose biosensors showed 2 linear dynamic regions of 0.05-1.0 and 1.0-5.5 mmol L^-1 glucose. The MF-iGPE showed good reproducibility for glucose detection (RSD < 6.1%, n = 6) and required only 10 μL of the analyte. This modular craft-and-stick manufacturing approach could potentially further develop along the concept of paper-crafted model assembly kits suitable for low-resource laboratories or classroom settings.

Photolithography-Based Microfabrication of Biodegradable Flexible and Stretchable Sensors

Biodegradable sensors based on integrating conductive layers with polymeric materials in flexible and stretchable forms have been established. However, the lack of a generalized microfabrication method results in large-sized, low spatial density, and low device yield compared to the silicon-based devices manufactured via batch-compatible microfabrication processes. Here, a batch fabrication-compatible photolithography-based microfabrication approach for biodegradable and highly miniaturized essential sensor components is presented on flexible and stretchable substrates. Up to 1600 devices are fabricated within a 1 cm² footprint and then the functionality of various biodegradable passive electrical components, mechanical sensors, and chemical sensors is demonstrated on flexible and stretchable substrates. The results are highly repeatable and consistent, proving the proposed method's high device yield and high-density potential. This simple, innovative, and robust fabrication recipe allows complete freedom over the applicability of various biodegradable materials with different properties toward the unique application of interests. The process offers a route to utilize standard micro-fabrication procedures toward scalable fabrication of highly miniaturized flexible and stretchable transient sensors and electronics.

Electrochemical Nanosensors for Sensitization of Sweat Metabolites: From Concept Mapping to Personalized Health Monitoring

Sweat contains a broad range of important biomarkers, which may be beneficial for acquiring non-invasive biochemical information on human health status. Therefore, highly selective and sensitive electrochemical nanosensors for the non-invasive detection of sweat metabolites have turned into a flourishing contender in the frontier of disease diagnosis. A large surface area, excellent electrocatalytic behavior and conductive properties make nanomaterials promising sensor materials for target-specific detection. Carbon-based nanomaterials (e.g., CNT, carbon quantum dots, and graphene), noble metals (e.g., Au and Pt), and metal oxide nanomaterials (e.g., ZnO, MnO2, and NiO) are widely used for modifying the working electrodes of electrochemical sensors, which may then be further functionalized with requisite enzymes for targeted detection. In the present review, recent developments (2018-2022) of electrochemical nanosensors by both enzymatic as well as non-enzymatic sensors for the effectual detection of sweat metabolites (e.g., glucose, ascorbic acid, lactate, urea/uric acid, ethanol and drug metabolites) have been comprehensively reviewed. Along with this, electrochemical sensing principles, including potentiometry, amperometry, CV, DPV, SWV and EIS have been briefly presented in the present review for a conceptual understanding of the sensing mechanisms. The detection thresholds (in the range of mM-nM), sensitivities, linear dynamic ranges and sensing modalities have also been properly addressed for a systematic understanding of the judicious design of more effective sensors. One step ahead, in the present review, current trends of flexible wearable electrochemical sensors in the form of eyeglasses, tattoos, gloves, patches, headbands, wrist bands, etc., have also been briefly summarized, which are beneficial for on-body in situ measurement of the targeted sweat metabolites. On-body monitoring of sweat metabolites via wireless data transmission has also been addressed. Finally, the gaps in the ongoing research endeavors, unmet challenges, outlooks and future prospects have also been discussed for the development of advanced non-invasive self-health-care-monitoring devices in the near future.