Wearable Analytical Platform with Enzyme-Modulated Dynamic Range for the Simultaneous Colorimetric Detection of Sweat Volume and Sweat Biomarkers

Synergistic color-changing and conductive photonic cellulose nanocrystal patches for sweat sensing with biodegradability and biocompatibility

Given the ongoing requirements for versatility, sustainability, and biocompatibility in wearable applications, cellulose nanocrystal (CNC) photonic materials emerge as excellent candidates for multi-responsive wearable devices due to their tunable structural color, strong electron-donating capacity, and renewable nature. Nonetheless, most CNC-derived materials struggle to incorporate color-changing and electrical sensing into one system since the self-assembly of CNCs is incompatible with conventional conductive mediums. Here we report the design of a conductive photonic patch through constructing a CNC/polyvinyl alcohol hydrogel modulated by phytic acid (PA). The introduction of PA significantly enhances the hydrogen bonding interaction, resulting in the composite film with impressive flexibility (1.4 MJ m-3) and progressive color changes from blue, green, yellow, to ultimately red upon sweat wetting. Interestingly, this system simultaneously demonstrates selective and sensitive electrical sensing functions, as well as satisfactory biocompatibility, biodegradability, and breathability. Importantly, a proof-of-concept demonstration of a skin-adhesive patch is presented, where the optical and electrical dual-signal sweat sensing allows for intuitive visual and multimode electric localization of sweat accumulation during physical exercises. This innovative interactive strategy for monitoring human metabolites could offer a fresh perspective into the design of wearable health-sensing devices, while greatly expanding the applications of CNC-based photonic materials in medicine-related fields.

Reagent-Free Lactate Detection Using Prussian Blue and Electropolymerized-Molecularly Imprinted Polymers-Based Electrochemical Biosensors

Sweat lactate, a promising biomarker for assessing physical performance and health conditions, calls for noninvasive, convenient, and affordable detection methods. This study leverages molecularly imprinted polymers (MIPs) as a synthetic biorecognition element for lactate detection due to their affordability and high stability. Traditional MIPs-based electrochemical sensors often require external redox probes such as ferricyanide/ferrocyanide in the solution to signal the binding between analytes and MIPs, which restricts their applicability. To address this, our study introduces an innovative approach utilizing a layer of Prussian blue (PB) nanoparticles as the internal redox probe on screen-printed carbon electrodes (SPCE), followed by a layer of electropolymerized MIP (eMIP) for molecular recognition, enabling reagent-free lactate detection. The real-time growth of eMIP and the processes of template elution and lactate rebinding were examined and validated using electrochemical surface plasmon resonance (EC-SPR) spectroscopy. The sensor's performance was thoroughly investigated using Differential Pulsed Voltammetry (DPV) and Electrochemical Impedance Spectroscopy (EIS) with samples spiked in 0.1 M KCl solution and artificial sweat. The developed sensors demonstrated a fast and selective response to lactate, detecting concentrations from 1 to 35 mM with a Limit of Detection (LOD) of 0.20 mM, defined by a signal-to-noise ratio of 3 in the DPV measurements. They also exhibited excellent reproducibility, reusability, and a shelf life of up to 10 months under ambient conditions. These eMIP/PB/SPCE-based lactate sensors show considerable potential as point-of-care (POC) devices for sweat lactate detection, and the technology could be adapted for reagent-free detection of a broad spectrum of molecules.

Detecting Hypoxia Through the Non-Invasive and Simultaneous Monitoring of Sweat Lactate and Tissue Oxygenation

Hypoxia, characterized by inadequate tissue oxygenation, may result in tissue damage and organ failure if not addressed. Current detection approaches frequently prove insufficient, depending on symptoms and rudimentary metrics such as tissue oxygenation, which fail to comprehensively identify the onset of hypoxia. The European Pressure Ulcer Advisory Panel (EPUAP) has recognized sweat lactate as a possible marker for the early identification of decubitus ulcers, nevertheless, neither sweat lactate nor oxygenation independently provides an appropriate diagnosis of hypoxia. We have fabricated a wearable device that non-invasively and concurrently monitors sweat lactate and tissue oxygenation to fill this gap. The apparatus comprises three essential components: (i) a hydrogel-based colorimetric lactate biosensor, (ii) a near-infrared (NIR) sensor for assessing tissue oxygenation, and (iii) an integrated form factor for enhanced wearability. The lactate sensor alters its hue upon interaction with lactate in sweat, whereas the NIR sensor monitors tissue oxygenation levels in real-time. The device underwent testing on phantom exhibiting tissue-mimicking characteristics and on human sweat post aerobic and anaerobic activities. Moreover, the device was demonstrated to be capable of real-time "on-body" simultaneous monitoring of sweat lactate spikes and tissue oxygenation (StO2) drops, which showed strong correlation during a hypoxia protocol. This innovative technology has a wide range of potential applications, such as post-operative care, sepsis detection, and athletic performance monitoring, and may provide economical healthcare solutions in resource-limited regions.

A new colorimetric lactate biosensor based on CUPRAC reagent using binary enzyme (lactate-pyruvate oxidases)-immobilized silanized magnetite nanoparticles

A novel optical lactate biosensor is presented that utilizes a colorimetric interaction between H2O2 liberated by a binary enzymatic reaction and bis(neocuproine)copper(II) complex ([Cu(Nc)2]2+) known as CUPRAC (cupric reducing antioxidant capacity) reagent. In the first step, lactate oxidase (LOx) and pyruvate oxidase (POx) were separately immobilized on silanized magnetite nanoparticles (SiO2@Fe3O4 NPs), and thus, 2 mol of H2O2 was released per 1 mol of the substrate due to a sequential enzymatic reaction of the mixture of LOx-SiO2@Fe3O4 and POx-SiO2@Fe3O4 NPs with lactate and pyruvate, respectively. In the second step, the absorbance at 450 nm of the yellow-orange [Cu(Nc)2]+ complex formed through the color reaction of enzymatically produced H2O2 with [Cu(Nc)2]2+ was recorded. The results indicate that the developed colorimetric binary enzymatic biosensor exhibits a broad linear range of response between 0.5 and 50.0 µM for lactate under optimal conditions with a detection limit of 0.17 µM. The fabricated biosensor did not respond to other saccharides, while the positive interferences of certain reducing compounds such as dopamine, ascorbic acid, and uric acid were minimized through their oxidative removal with a pre-oxidant (NaBiO3) before enzymatic and colorimetric reactions. The fabricated optical biosensor was applied to various samples such as artificial blood, artificial/real sweat, and cow milk. The high recovery values (close to 100%) achieved for lactate-spiked samples indicate an acceptable accuracy of this colorimetric biosensor in the determination of lactate in real samples. Due to the increase in H2O2 production with the bienzymatic lactate sensor, the proposed method displays double-fold sensitivity relative to monoenzymatic biosensors and involves a neat color reaction with cupric-neocuproine having a clear stoichiometry as opposed to the rather indefinite stoichiometry of analogous redox dye methods.

3D-Printed Flexible Microfluidic Health Monitor for In Situ Sweat Analysis and Biomarker Detection

Wearable sweat biosensors have shown great progress in noninvasive, in situ, and continuous health monitoring to demonstrate individuals' physiological states. Advances in novel nanomaterials and fabrication methods promise to usher in a new era of wearable biosensors. Here, we introduce a three-dimensional (3D)-printed flexible wearable health monitor fabricated through a unique one-step continuous manufacturing process with self-supporting microfluidic channels and novel single-atom catalyst-based bioassays for measuring the sweat rate and concentration of three biomarkers. Direct ink writing is adapted to print the microfluidic device with self-supporting structures to harvest human sweat, which eliminates the need for removing sacrificial supporting materials and addresses the contamination and sweat evaporation issues associated with traditional sampling methods. Additionally, the pick-and-place strategy is employed during the printing process to accurately integrate the bioassays, improving manufacturing efficiency. A single-atom catalyst is developed and utilized in colorimetric bioassays to improve sensitivity and accuracy. A feasibility study on human skin successfully demonstrates the functionality and reliability of our health monitor, generating reliable and quantitative in situ results of sweat rate, glucose, lactate, and uric acid concentrations during physical exercise.

Continuous and Non-Invasive Lactate Monitoring Techniques in Critical Care Patients

Lactate, once merely regarded as an indicator of tissue hypoxia and muscular fatigue, has now gained prominence as a pivotal biomarker across various medical disciplines. Recent research has unveiled its critical role as a high-value prognostic marker in critical care medicine. The current practice of lactate detection involves periodic blood sampling. This approach is invasive and confined to measurements at six-hour intervals, leading to resource expenditure, time consumption, and patient discomfort. This review addresses non-invasive sensors that enable continuous monitoring of lactate in critical care patients. After the introduction, it discusses the iontophoresis system, followed by a description of the structural materials that are universally employed to create an interface between the integumentary system and the sensor. Subsequently, each method is detailed according to its physical principle, outlining its advantages, limitations, and pertinent aspects. The study concludes with a discussion and conclusions, aiming at the design of an intelligent sensor (Internet of Medical Things or IoMT) to facilitate continuous lactate monitoring and enhance the clinical decision-making support system in critical care medicine.

Skin-Interfaced Bifluidic Paper-Based Device for Quantitative Sweat Analysis

The erratic, intermittent, and unpredictable nature of sweat production, resulting from physiological or psychological fluctuations, poses intricacies to consistently and accurately sample and evaluate sweat biomarkers. Skin-interfaced microfluidic devices that rely on colorimetric mechanisms for semi-quantitative detection are particularly susceptible to these inaccuracies due to variations in sweat secretion rate or instantaneous volume. This work introduces a skin-interfaced colorimetric bifluidic sweat device with two synchronous channels to quantify sweat rate and biomarkers in real-time, even during uncertain sweat activities. In the proposed bifluidic-distance metric approach, with one channel to measure sweat rate and quantify collected sweat volume, the other channel can provide an accurate analysis of the biomarkers based on the collected sweat volume. The closed channel design also reduces evaporation and resists contamination from the external environment. The feasibility of the device is highlighted in a proof-of-the-concept demonstration to analyze sweat chloride for evaluating hydration status and sweat glucose for assessing glucose levels. The low-cost yet highly accurate device provides opportunities for clinical sweat analysis and disease screening in remote and low-resource settings. The developed device platform can be facilely adapted for the other biomarkers when corresponding colorimetric reagents are exploited.

The use of biological fluids in microfluidic paper-based analytical devices (μPADs): Recent advances, challenges and future perspectives

The use of microfluidic paper-based analytical devices (μPADs) for aiding medical diagnosis is a growing trend in the literature mainly due to their low cost, easy use, simple manufacturing, and great potential for application in low-resource settings. Many important biomarkers (proteins, ions, lipids, hormones, DNA, RNA, drugs, whole cells, and more) and biofluids are available for precise detection and diagnosis. We have reviewed the advances μPADs in medical diagnostics have achieved in the last few years, focusing on the most common human biofluids (whole blood/plasma, sweat, urine, tears, and saliva). The challenges of detecting specific biomarkers in each sample are discussed, along with innovative techniques that overcome such limitations. Finally, the difficulties of commercializing μPADs are considered, and future trends are presented, including wearable devices and integrating multiple steps in a single platform.

A Bifunctional Wearable Sensor Based on a Nanoporous Membrane for Simultaneous Detection of Sweat Lactate and Temperature

Wearable sensors for non-invasive, real-time detection of sweat lactate have far-reaching implications in the fields of health care and exercise physiological responses. Here, we propose a wearable electrochemical sensor with gold nanoelectrode arrays fabricated on the nanoporous polycarbonate (PC) membrane by encapsulating lactate oxidase (LOx) in chitosan (CS) hydrogel for detecting body temperature and sweat lactate concurrently. Flexible gold nanoporous electrodes not only enhance electrode area but also offer a nanoconfined space to accelerate the catalytic reaction of LOx and control substrate concentration on the surface of LOx to decrease substrate inhibition. The proposed sensor has a long durability of 13 days and better selectivity for the detection of sweat lactate over a wide linear range (0.01-35 mM) with a low detection limit (0.144 μM). Furthermore, temperature-dependent transmembrane currents passing through the sensor are used to estimate body temperature. We then use multiple linear regression to adjust the effect of temperature on lactate detection and succeed in monitoring lactate molecules in sweat and body temperature during exercise.

Explainable Deep Learning-Assisted Self-Calibrating Colorimetric Patches for In Situ Sweat Analysis

Sweat has emerged as a compelling analyte for noninvasive biosensing technology because it contains a wealth of important biomarkers in hormones, organic biomacromolecules, and various ionic mixtures. These components offer valuable insights and can reflect an individual's physiological conditions. Here, we introduced an explainable deep learning (DL)-assisted wearable self-calibrating colorimetric biosensing analysis platform to efficiently and precisely detect the biomarker's concentration in sweat. Specifically, we have integrated the advantages of the colorimetric sensing method, adsorbing-swelling hydrogel, and explainable DL algorithms to develop an enzyme/indicator-immobilized colorimetric patch, which has reliable colorimetric sensing ability and excellent adsorbing-swelling function. A total of 5625 colorimetric images were collected as the analysis data set and assessed two DL algorithms and seven machine learning (ML) algorithms. Zn2+, glucose, and Ca2+ in human sweats could be facilely classified and quantified with 100% accuracy via the convolutional neural network (CNN) model, and the testing results of actual sweats via the DL-assisted colorimetric approach are 91.7-97.2% matching with the classical UV-vis spectrum. Class activation mapping (CAM) was utilized to visualize the inner working mechanism of CNN operation, which contributes to verify and explicate the design rationality of the noninvasive biosensing technology. An "end-to-end" model was established to ascertain the black box of the DL algorithm, promoted software design or principium optimization, and contributed facile indicators for health monitoring, disease prevention, and clinical diagnosis.

Microfluidic-Based Non-Invasive Wearable Biosensors for Real-Time Monitoring of Sweat Biomarkers

Wearable biosensors are attracting great interest thanks to their high potential for providing clinical-diagnostic information in real time, exploiting non-invasive sampling of biofluids. In this context, sweat has been demonstrated to contain physiologically relevant biomarkers, even if it has not been exhaustively exploited till now. This biofluid has started to gain attention thanks to the applications offered by wearable biosensors, as it is easily collectable and can be used for continuous monitoring of some parameters. Several studies have reported electrochemical and optical biosensing strategies integrated with flexible, biocompatible, and innovative materials as platforms for biospecific recognition reactions. Furthermore, sampling systems as well as the transport of fluids by microfluidics have been implemented into portable and compact biosensors to improve the wearability of the overall analytical device. In this review, we report and discuss recent pioneering works about the development of sweat sensing technologies, focusing on opportunities and open issues that can be decisive for their applications in routine-personalized healthcare practices.

Progress in the design of portable colorimetric chemical sensing devices

The need for precise determination of heavy metals, anions, biomolecules, pesticides, drugs, and other substances is vital across clinical, environmental, and food safety domains. Recent years have seen significant progress in portable colorimetric chemical sensing devices, revolutionizing on-the-spot analysis. This review offers a comprehensive overview of these advancements, covering handheld colorimetry, RGB-based colorimetry, paper-based colorimetry, and wearable colorimetry devices. It explores the underlying principles, functional materials (chromophoric reagents/dyes and nanoparticles), detection mechanisms, and their applications in environmental monitoring, clinical care, and food safety. Noble metal nanoparticles (NPs) have arisen as promising substitutes in the realm of sensing materials. They display notable advantages, including heightened sensitivity, the ability to fine-tune their plasmonic characteristics for improved selectivity, and the capacity to induce visible color changes, and simplifying detection. Integration of NPs fabricated paper device with smartphones and wearables facilitates reagent-free, cost-effective, and portable colorimetric sensing, enabling real-time analysis and remote monitoring.

WASP: Wearable Analytical Skin Probe for Dynamic Monitoring of Transepidermal Water Loss

Early diagnosis of skin barrier dysfunction helps provide timely preventive care against diseases such as atopic dermatitis, psoriasis, food allergies, and other atopic skin disorders. Skin barrier function is commonly evaluated by measuring the transepidermal water loss (TEWL) through stratum corneum due to its noninvasive characteristics. However, existing commercial TEWL devices are significantly affected by many factors, such as ambient temperature, humidity, air flow, water accumulation, initial water contents on the skin surface, bulky sizes, high costs, and requirements for well-controlled environments. Here, we developed a wearable closed-chamber hygrometer-based TEWL device (Wearable Analytical Skin Probe, WASP) and the related algorithm for accurate and continuous monitoring of skin water vapor flux. The WASP uses short dry air purges to dry the skin surface and chamber before each water vapor flux measurement. Its design ensures a highly controlled local environment, such as consistent initial dry conditions for the skin surface and the chamber. We further applied WASP to measure the water vapor flux from six different locations of a small group of human participants. It is found that the WASP can not only measure and distinguish between insensible sweating (i.e., TEWL) and sensible sweating (i.e., thermal sweating) but also track skin dehydration-rehydration cycles. Comparisons with a commercial TEWL device, AquaFlux, show that the results obtained by both devices agree well. The WASP will be broadly applicable to clinical, cosmetic, and biomedical research.

Smart Janus fabrics for one-way sweat sampling and skin-friendly colorimetric detection

Functionalized textiles with biofluid management capability have attracted tremendous attention in recent years due to their significant roles in health monitoring and dehydration prevention. Here we propose a one-way colorimetric sweat sampling and sensing system based on a Janus fabric using interfacial modification techniques. The opposite wettability of Janus fabric enables sweat to be quickly moved from the skin surface to the hydrophilic side and colorimetric patches. The unidirectional sweat-wicking performance of Janus fabric not only facilitates adequate sweat sampling but also inhibits the backflow of hydrated colorimetric regent from the assay patch toward the skin, eliminating potential epidermal contaminations. On this basis, visual and portable detection of sweat biomarkers including chloride, pH, and urea is also achieved. The results show that the true concentrations of chloride, pH, and urea in sweat are ∼10 mM, ∼7.2, and ∼10 mM, respectively. The detection limits of chloride and urea are 1.06 mM and 3.05 mM. This work bridges the gap between sweat sampling and a friendly epidermal microenvironment, providing a promising way for multifunctional textiles.

Dual-signal readout paper-based wearable biosensor with a 3D origami structure for multiplexed analyte detection in sweat

In this research, we design and implement a small, convenient, and noninvasive paper-based microfluidic sweat sensor that can simultaneously detect multiple key biomarkers in human sweat. The origami structure of the chip includes colorimetric and electrochemical sensing regions. Different colorimetric sensing regions are modified with specific chromogenic reagents to selectively identify glucose, lactate, uric acid, and magnesium ions in sweat, as well as the pH value. The regions of electrochemical sensing detect cortisol in sweat by molecular imprinting. The entire chip is composed of hydrophilically and hydrophobically treated filter paper, and 3D microfluidic channels are constructed by using folding paper. The thread-based channels formed after the hydrophilic and hydrophobic modifications are used to control the rate of sweat flow, which in turn can be used to control the sequence of reactions in the differently developing colored regions to ensure that signals of the best color can be captured simultaneously by the colorimetric sensing regions. Finally, the results of on-body experiments verify the reliability of the proposed sweat sensor and its potential for the noninvasive identification of a variety of sweat biomarkers.

Paper-based microfluidics in sweat detection: from design to application

Sweat, as a sample that includes a lot of biochemical information, is good for non-invasive monitoring. In recent years, there have been an increasing number of studies on in situ monitoring of sweat. However, there are still some challenges for the continuous analysis of samples. As a hydrophilic, easy-to-process, environmentally friendly, inexpensive and easily accessible material, paper is an ideal substrate material for making in situ sweat analysis microfluidics. This review introduces the development of paper as a sweat analysis microfluidic substrate material, focusing on the advantages of the structural characteristics of paper, trench design and equipment integration applications to expand the design and research ideas for the development of in situ sweat detection technology.

Flexible Sweat Sensors: From Films to Textiles

Flexible sweat sensors have found widespread potential applications for long-term wear and tracking and real-time monitoring of human health. However, the main substrate currently used in common flexible sweat sensors is thin film, which has disadvantages such as poor air permeability and the need for additional wearables. In this Review, the recent progress of sweat sensors has been systematically summarized by the types of monitoring methods of sweat sensors. In addition, this Review introduces and compares the performance of sweat sensors based on thin film and textile substrates such as fiber/yarn. Finally, opportunities and suggestions for the development of flexible sweat sensors are presented by summarizing the integration methods of sensors and human body monitoring sites.

Epidermal Wearable Biosensors for Monitoring Biomarkers of Chronic Disease in Sweat

Biological information detection technology is mainly used for the detection of physiological and biochemical parameters closely related to human tissues and organ lesions, such as biomarkers. This technology has important value in the clinical diagnosis and treatment of chronic diseases in their early stages. Wearable biosensors can be integrated with the Internet of Things and Big Data to realize the detection, transmission, storage, and comprehensive analysis of human physiological and biochemical information. This technology has extremely wide applications and considerable market prospects in frontier fields including personal health monitoring, chronic disease diagnosis and management, and home medical care. In this review, we systematically summarized the sweat biomarkers, introduced the sweat extraction and collection methods, and discussed the application and development of epidermal wearable biosensors for monitoring biomarkers in sweat in preclinical research in recent years. In addition, the current challenges and development prospects in this field were discussed.

Novel Wearable Optical Sensors for Vital Health Monitoring Systems-A Review

Wearable sensors are pioneering devices to monitor health issues that allow the constant monitoring of physical and biological parameters. The immunity towards electromagnetic interference, miniaturization, detection of nano-volumes, integration with fiber, high sensitivity, low cost, usable in harsh environments and corrosion-resistant have made optical wearable sensor an emerging sensing technology in the recent year. This review presents the progress made in the development of novel wearable optical sensors for vital health monitoring systems. The details of different substrates, sensing platforms, and biofluids used for the detection of target molecules are discussed in detail. Wearable technologies could increase the quality of health monitoring systems at a nominal cost and enable continuous and early disease diagnosis. Various optical sensing principles, including surface-enhanced Raman scattering, colorimetric, fluorescence, plasmonic, photoplethysmography, and interferometric-based sensors, are discussed in detail for health monitoring applications. The performance of optical wearable sensors utilizing two-dimensional materials is also discussed. Future challenges associated with the development of optical wearable sensors for point-of-care applications and clinical diagnosis have been thoroughly discussed.

Wearable artificial intelligence biosensor networks

The demand for high-quality healthcare and well-being services is remarkably increasing due to the ageing global population and modern lifestyles. Recently, the integration of wearables and artificial intelligence (AI) has attracted extensive academic and technological attention for its powerful high-dimensional data processing of wearable biosensing networks. This work reviews the recent developments in AI-assisted wearable biosensing devices in disease diagnostics and fatigue monitoring demonstrating the trend towards personalised medicine with highly efficient, cost-effective, and accurate point-of-care diagnosis by finding hidden patterns in biosensing data and detecting abnormalities. The reliability of adaptive learning and synthetic data and data privacy still need further investigation to realise personalised medicine in the next decade. Due to the worldwide popularity of smartphones, they have been utilised for sensor readout, wireless data transfer, data processing and storage, result display, and cloud server communication leading to the development of smartphone-based biosensing systems. The recent advances have demonstrated a promising future for the healthcare system because of the increasing data processing power, transfer efficiency and storage capacity and diversifying functionalities.

Recent Advances in Wearable Biosensors for Non-Invasive Detection of Human Lactate

Lactate, a crucial product of the anaerobic metabolism of carbohydrates in the human body, is of enormous significance in the diagnosis and treatment of diseases and scientific exercise management. The level of lactate in the bio-fluid is a crucial health indicator because it is related to diseases, such as hypoxia, metabolic disorders, renal failure, heart failure, and respiratory failure. For critically ill patients and those who need to regularly control lactate levels, it is vital to develop a non-invasive wearable sensor to detect lactate levels in matrices other than blood. Due to its high sensitivity, high selectivity, low detection limit, simplicity of use, and ability to identify target molecules in the presence of interfering chemicals, biosensing is a potential analytical approach for lactate detection that has received increasing attention. Various types of wearable lactate biosensors are reviewed in this paper, along with their preparation, key properties, and commonly used flexible substrate materials including polydimethylsiloxane (PDMS), polyethylene terephthalate (PET), paper, and textiles. Key performance indicators, including sensitivity, linear detection range, and detection limit, are also compared. The challenges for future development are also summarized, along with some recommendations for the future development of lactate biosensors.

Emerging Approaches to Monitor and Modify Care in the Era of Cystic Fibrosis Transmembrane Conductance Regulators

As we characterize the clinical benefits of highly effective modulator therapy (HEMT) in the cystic fibrosis (CF) population, our paradigm for treating and monitoring disease continues to evolve. More sensitive approaches are necessary to detect early disease and clinical progression. This article reviews evolving strategies to assess disease control and progression in the HEMT era. This article also explores developments in pulmonary function monitoring, advanced respiratory imaging, tools for the collection of patient-reported outcomes, and their application to profile individual responses, guide therapeutic decisions, and improve the quality of life of people with CF.

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

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

End-to-end design of wearable sensors

Wearable devices provide an alternative pathway to clinical diagnostics by exploiting various physical, chemical and biological sensors to mine physiological (biophysical and/or biochemical) information in real time (preferably, continuously) and in a non-invasive or minimally invasive manner. These sensors can be worn in the form of glasses, jewellery, face masks, wristwatches, fitness bands, tattoo-like devices, bandages or other patches, and textiles. Wearables such as smartwatches have already proved their capability for the early detection and monitoring of the progression and treatment of various diseases, such as COVID-19 and Parkinson disease, through biophysical signals. Next-generation wearable sensors that enable the multimodal and/or multiplexed measurement of physical parameters and biochemical markers in real time and continuously could be a transformative technology for diagnostics, allowing for high-resolution and time-resolved historical recording of the health status of an individual. In this Review, we examine the building blocks of such wearable sensors, including the substrate materials, sensing mechanisms, power modules and decision-making units, by reflecting on the recent developments in the materials, engineering and data science of these components. Finally, we synthesize current trends in the field to provide predictions for the future trajectory of wearable sensors.

Chemical-Based Surface Plasmon Resonance Imaging of Fingerprints

Fingerprints are extremely useful in personal identification; however, they are usually based on physical rather than chemical images because it remains a challenge to reveal a clear chemical fingerprint easily and sensitively. Herein, a surface plasmon resonance imaging (SPRi) method, combined with a chemically selective stepwise signal amplification (CS³A) strategy, is proposed to chemically image fingerprints with adjustable sensitivity and clarity. High-fidelity glucose-associated fingerprint images were obtained at five to seven cycles of CS³A based on the recognition reaction of concanavalin A (ConA) with dextran. The method is also extendable to image substances that possess and/or can be tagged with ConA- or dextran-recognizable groups. For demonstration, SPRi of carboxylic substances was conducted by amidating the carboxyl group with glucosamine to enable the ConA-based CS³A. Glucose- and carboxyl-based fingerprints were simultaneously and clearly imaged, allowing us to perform quantitative analysis of the representative of either glucose or amino acid (e.g., serine) or both. The curves measured from the standard spots were linear in the ranges of 1-4000 μM for glucose and 3.2-4000 μM for serine, with linear correlated coefficients of 0.9979 and 0.9962, respectively. It was then applied to the study of metabolic secretions in fingerprints during running exercise, yielding variation tendencies similar to those measured from sweat samples in the literature. As a noninvasive tool, the CS³A-coupled SPRi reveals both clear images of fingerprints and quantitative chemical information, and it is anticipated to become a competitive new method for chemically imaging fingerprints.

Dissolvable Polymer Valves for Sweat Chrono-Sampling in Wearable Paper-Based Analytical Devices

Paper sensors with colorimetric signal transduction mechanisms are promising for developing single-use wearable patches that only require a smartphone to quantify signals. However, measuring biomarker fluctuations with colorimetric wearable sensors requires implementing a chrono-sampling method for performing sequential measurements. In this article, we report on a chrono-sampling method that enables the fabrication of wearable devices made entirely of filter paper. It consists of using dried polymers as closed valves that deflect the flow of liquids to different transducers of a multisensor. As time passes by, the polymer dissolves and the valve opens. The sequential opening of the valves results in a succession of measurements that reveals fluctuations in the concentration of the target analyte. This concept was demonstrated with a paper multisensor capable of performing nine consecutive pH measurements. The device was also adapted for developing a urea biosensor that detects pH measurements generated by the hydrolysis of the analyte catalyzed by urease. The proposed analytical platform could monitor the pH of sweat with an accuracy and precision comparable to a laboratory-based method when worn during an exercise routine. The results shown here pave the way for developing colorimetric wearable biosensors that measure variations in the concentration of biomarkers such as glucose, lactate, creatinine, or uric acid over time.

Wearable Potentiometric Sensor Based on Na0.44MnO2 for Non-invasive Monitoring of Sodium Ions in Sweat

Here, we present a wearable potentiometric ion sensor for real-time monitoring of sodium ions (Na⁺) in human sweat samples using Na_0.44MnO₂ as the sensing material. Na_0.44MnO₂ is an attractive material for developing wearable electrochemical sensors due to its good Na⁺ incorporation ability, electrical conductivity, stability, and low fabrication cost. In the first step, the analytical performance of the electrode prepared using Na_0.44MnO₂ is presented. Then, a miniaturized potentiometric cell integrated into a wearable substrate is developed, which reveals a Nernstian response (58 mV dec^-1). We achieved the detection of Na⁺ in the linear ranges of 0.21-24.54 mmol L^-1, which is well within the physiological range of Na⁺. Finally, for on-body sweat analysis, the potentiometric sensor is fully integrated into a headband textile. This platform can be employed for non-invasive analysis of Na⁺ in human sweat for healthcare and disease diagnosis.

Plasmonic Gold Nanoparticles Stain Hydrogels for the Portable and High-Throughput Monitoring of Mercury Ions

The hybrid of l-cysteine and agarose can reduce HAuCl₄ and support the rapid growth of plasmonic gold nanoparticles (Au NPs) in the hydrogel phase. The l-cysteine-doped agarose hydrogel (C-AGH) not only offers the substrate the capacity to reduce Au(III) ions but also stabilizes and precisely modulates the in situ grown Au NPs with high repeatability, easy operation, and anti-interference performance. Herein, before the incubation of HAuCl₄, the improved hydrogel is preincubated in the aqueous solution containing mercury ions, and the cysteine can specifically conjugate with mercury via the thiol groups. Subsequently, the responsive allochroic bands from dark blue to red can be identified in the solid hydrogel after the incubation of HAuCl₄, which is attributed to the formation of regulated Au-Hg nanoamalgams. As a proof-of-concept, toxic Hg²⁺ ions are exploited as targets for constructing novel sensing assays based on the improved C-AGH protocol. Based on naked-eye recognition, Hg²⁺ could be rapidly and simply measured. Additionally, the high-throughput and trace analysis with a low limit of detection (3.7 nM) is performed using a microplate reader. On the basis of the filtering technique and remodeling of hydrogels, C-AGH working as the filtering membrane can even achieve the integration of enrichment and measurement with enhanced sensitivity. Significantly, the strategy of using an allochroic hydrogel with the staining of Au NPs can promote the rapid and primary assessment of water quality in environmental analysis.

Wearable Sweat Loss Measuring Devices: From the Role of Sweat Loss to Advanced Mechanisms and Designs

Wearable sweat sensors have received significant research interest and have become popular as sweat contains considerable health information about physiological and psychological states. However, measured biomarker concentrations vary with sweat rates, which has a significant effect on the accuracy and reliability of sweat biosensors. Wearable sweat loss measuring devices (SLMDs) have recently been proposed to overcome the limitations of biomarker tracking and reduce inter- and intraindividual variability. In addition, they offer substantial potential for monitoring human body homeostasis, because sweat loss plays an indispensable role in thermoregulation and skin hydration. Previous studies have not carried out a comprehensive and systematic review of the principles, importance, and development of wearable SLMDs. This paper reviews wearable SLMDs with a new health perspective from the role of sweat loss to advanced mechanisms and designs. Two types of sweat and their measurement significance for practical applications are highlighted. Then, a comprehensive review of advances in different wearable SLMDs based on hygrometers, absorbent materials, and microfluidics is presented by describing their respective device architectures, present situations, and future directions. Finally, concluding remarks on opportunities for future application fields and challenges for future sweat sensing are presented.

Advances in Medical Wearable Biosensors: Design, Fabrication and Materials Strategies in Healthcare Monitoring

In the past decade, wearable biosensors have radically changed our outlook on contemporary medical healthcare monitoring systems. These smart, multiplexed devices allow us to quantify dynamic biological signals in real time through highly sensitive, miniaturized sensing platforms, thereby decentralizing the concept of regular clinical check-ups and diagnosis towards more versatile, remote, and personalized healthcare monitoring. This paradigm shift in healthcare delivery can be attributed to the development of nanomaterials and improvements made to non-invasive biosignal detection systems alongside integrated approaches for multifaceted data acquisition and interpretation. The discovery of new biomarkers and the use of bioaffinity recognition elements like aptamers and peptide arrays combined with the use of newly developed, flexible, and conductive materials that interact with skin surfaces has led to the widespread application of biosensors in the biomedical field. This review focuses on the recent advances made in wearable technology for remote healthcare monitoring. It classifies their development and application in terms of electrochemical, mechanical, and optical modes of transduction and type of material used and discusses the shortcomings accompanying their large-scale fabrication and commercialization. A brief note on the most widely used materials and their improvements in wearable sensor development is outlined along with instructions for the future of medical wearables.

Smart Materials Enabled with Artificial Intelligence for Healthcare Wearables

Contemporary medicine suffers from many shortcomings in terms of successful disease diagnosis and treatment, both of which rely on detection capacity and timing. The lack of effective, reliable, and affordable detection and real‐time monitoring limits the affordability of timely diagnosis and treatment. A new frontier that overcomes these challenges relies on smart health monitoring systems that combine wearable sensors and an analytical modulus. This review presents the latest advances in smart materials for the development of multifunctional wearable sensors while providing a bird's eye‐view of their characteristics, functions, and applications. The review also presents the state‐of‐the‐art on wearables fitted with artificial intelligence (AI) and support systems for clinical decision in early detection and accurate diagnosis of disorders. The ongoing challenges and future prospects for providing personal healthcare with AI‐assisted support systems relating to clinical decisions are presented and discussed.

Colorimetric detection of human alpha-2-macroglobulin by janus imprinted nanoparticles constructed dual molecular imprinting immunosandwich strategy

Simple and rapid detection of disease-related bio-markers are significant for early clinical diagnosis and can potentially improve the survival rate. However, establishing a high-specificity colorimetric detection method for bio-markers are still challenges due to their inevitable natural antibody used or enzymatic labeling. Herein, a cost-efficient and easy-to-use approach, which called dual molecular imprinting immunosandwich colorimetric strategy (DMI-ICS) was constructed for detection alpha-2-macroglobulin (α2MG) by janus imprinted nanoparticles. The unique detection principle was contained with two mimic antibody parts, the first part was α2MG glass slides molecularly imprinted material (GS-MIP) as a "Separation antibody", which can specifically rapid separate the protein in the complex sample; Another part was asymmetrically modified janus molecularly imprinted gold nanoparticles nanozyme (J-GNPs-MIP) as a "Detection antibody", which has the properties of specific recognition and catalytic substrate color performance at the same time. The concentration of α2MG can be determined by the substrate color changes and observed with naked eyes. Under the optimized conditions, the DMI-ICS had a great performance and offering lower relative standard deviation (RSD, 7.69%), good linear range (0.297-130 μg/mL, R² = 0.994), high imprinting factor (IF: 3.74) with lower detection limit (0.089 μg/mL). This strategy provides an easy operation and low cost signal readout method for direct detection and separation of α2MG in human serum samples, which is a versatile tool for point-of-care diagnosis, while also offering a new perspective on antibody simulation technology, multifunctional antibody preparation and contribute to detection of disease-related bio-marker in nonspecialized laboratory infrastructure.

State of Sweat: Emerging Wearable Systems for Real-Time, Noninvasive Sweat Sensing and Analytics

Skin-interfaced wearable systems with integrated colorimetric assays, microfluidic channels, and electrochemical sensors offer powerful capabilities for noninvasive, real-time sweat analysis. This Perspective details recent progress in the development and translation of novel wearable sensors for personalized assessment of sweat dynamics and biomarkers, with precise sampling and real-time analysis. Sensor accuracy, system ruggedness, and large-scale deployment in remote environments represent key opportunity areas, enabling broad deployment in the context of field studies, clinical trials, and recent commercialization. On-body measurements in these contexts show good agreement compared to conventional laboratory-based sweat analysis approaches. These device demonstrations highlight the utility of biochemical sensing platforms for personalized assessment of performance, wellness, and health across a broad range of applications.

Detection of low glucose levels in sweat with colorimetric wearable biosensors

Low glucose levels during exercise may lead to hypoglycemia, which can have grave consequences in diabetic athletes. Mobile colorimetric wearable biosensors that measure glucose levels in sweat are ideal for self-monitoring as they can utilize the camera in smartphones for signal reading. However, colorimetric biosensors proposed thus far have higher limit of detection (LOD) than electrochemical devices, which makes them unsuitable for detecting hypoglycemia. In this manuscript we describe colorimetric wearable biosensors that detect glucose in sweat with an LOD of 0.01 mM and a dynamic range up to 0.15 mM. The devices are made of filter paper and incorporate a sweat volume sensor and a color chart for signal correction. The biosensors do not suffer from interferences originated by delayed sample readings, or differences in bending angle and sample pH. When applied to volunteers performing an exercise routine, sweat glucose levels corrected with sweat volume measurements correlated well with blood glucose measurements performed with a commercial device. The devices are lightweight and easily disposable. These features, along with the smartphone-based colorimetric readout, makes them promising as "over-the-counter" tests for measuring glucose levels non-invasively during exercise.