3D multifunctional integumentary membranes for spatiotemporal cardiac measurements and stimulation across the entire epicardium

3D printed PEDOT:PSS-based conducting and patternable eutectogel electrodes for machine learning on textiles

The proliferation of medical wearables necessitates the development of novel electrodes for cutaneous electrophysiology. In this work, poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) is combined with a deep eutectic solvent (DES) and polyethylene glycol diacrylate (PEGDA) to develop printable and biocompatible electrodes for long-term cutaneous electrophysiology recordings. The impact of printing parameters on the conducting properties, morphological characteristics, mechanical stability and biocompatibility of the material were investigated. The optimised eutectogel formulations were fabricated in four different patterns -flat, pyramidal, striped and wavy- to explore the influence of electrode geometry on skin conformability and mechanical contact. These electrodes were employed for impedance and forearm EMG measurements. Furthermore, arrays of twenty electrodes were embedded into a textile and used to generate body surface potential maps (BSPMs) of the forearm, where different finger movements were recorded and analysed. Finally, BSPMs for three different letters (B, I, O) in sign-language were recorded and used to train a logistic regressor classifier able to reliably identify each letter. This novel cutaneous electrode fabrication approach offers new opportunities for long-term electrophysiological recordings, online sign-language translation and brain-machine interfaces.

A His bundle pacing protocol for suppressing ventricular arrhythmia maintenance and improving defibrillation efficacy

BACKGROUND

The excitable gap (EG), defined as the excitable tissue between two subsequent wavefronts of depolarization, is critical for maintaining reentry that underlies deadly ventricular arrhythmias. EG in the His-Purkinje Network (HPN) plays an important role in the maintenance of electrical wave reentry that underlies these arrhythmias.

OBJECTIVE

To determine if rapid His bundle pacing (HBP) during reentry reduces the amount of EG in the HPN and ventricular myocardium to suppress reentry maintenance and/or improve defibrillation efficacy.

METHODS

In a virtual human biventricular model, reentry was initiated with rapid line pacing followed by HBP delivered for 3, 6, or 9 s at pacing cycle lengths (PCLs) ranging from 10 to 300 ms (n=30). EG was calculated independently for the HPN and myocardium over each PCL. Defibrillation efficacy was assessed for each PCL by stimulating myocardial surface EG with delays ranging from 0.25 to 9 s (increments of 0.25 s, n=36) after the start of HBP. Defibrillation was successful if reentry terminated within 1 s after EG stimulation. This defibrillation protocol was repeated without HBP. To test the approach under different pathological conditions, all protocols were repeated in the model with right (RBBB) or left (LBBB) bundle branch block.

RESULTS

Compared to without pacing, HBP for >3 seconds reduced average EG in the HPN and myocardium across a broad range of PCLs for the default, RBBB, and LBBB models. HBP >6 seconds terminated reentrant arrhythmia by converting HPN activation to a sinus rhythm behavior in the default (6/30 PCLs) and RBBB (7/30 PCLs) models. Myocardial EG stimulation during HBP increased the number of successful defibrillation attempts by 3%-19% for 30/30 PCLs in the default model, 3%-6% for 14/30 PCLs in the RBBB model, and 3%-11% for 27/30 PCLs in the LBBB model.

CONCLUSION

HBP can reduce the amount of excitable gap and suppress reentry maintenance in the HPN and myocardium. HBP can also improve the efficacy of low-energy defibrillation approaches targeting excitable myocardium. HBP during reentrant arrhythmias is a promising anti-arrhythmic and defibrillation strategy.

PhoCoil: An Injectable and Photodegradable Single-component Recombinant Protein Hydrogel for Localized Therapeutic Cell Delivery

Hydrogel biomaterials offer great promise for 3D cell culture and therapeutic delivery. Despite many successes, challenges persist in that gels formed from natural proteins are only marginally tunable while those derived from synthetic polymers lack intrinsic bioinstructivity. Towards the creation of biomaterials with both excellent biocompatibility and customizability, recombinant protein-based hydrogels have emerged as molecularly defined and user-programmable platforms that mimic the proteinaceous nature of the extracellular matrix. Here, we introduce PhoCoil, a dynamically tunable recombinant hydrogel formed from a single protein component with unique multi-stimuli responsiveness. Physical crosslinking through coiled-coil interactions promotes rapid shear-thinning and self-healing behavior, rendering the gel injectable, while an included photodegradable motif affords on-demand network dissolution via visible light. PhoCoil gel photodegradation can be spatiotemporally and lithographically controlled in a dose-dependent manner, through complex tissue, and without harm to encapsulated cells. We anticipate that PhoCoil will enable new applications in tissue engineering and regenerative medicine.

Highly stretchable and customizable microneedle electrode arrays for intramuscular electromyography

Stretchable three-dimensional (3D) penetrating microelectrode arrays have potential utility in various fields, including neuroscience, tissue engineering, and wearable bioelectronics. These 3D microelectrode arrays can penetrate and conform to dynamically deforming tissues, thereby facilitating targeted sensing and stimulation of interior regions in a minimally invasive manner. However, fabricating custom stretchable 3D microelectrode arrays presents material integration and patterning challenges. In this study, we present the design, fabrication, and applications of stretchable microneedle electrode arrays (SMNEAs) for sensing local intramuscular electromyography signals ex vivo. We use a unique hybrid fabrication scheme based on laser micromachining, microfabrication, and transfer printing to enable scalable fabrication of individually addressable SMNEA with high device stretchability (60 to 90%). The electrode geometries and recording regions, impedance, array layout, and length distribution are highly customizable. We demonstrate the use of SMNEAs as bioelectronic interfaces in recording intramuscular electromyography from various muscle groups in the buccal mass of Aplysia.

Robust Fiber-Shaped Flexible Temperature Sensors for Safety Monitoring with Ultrahigh Sensitivity

Flexible temperature sensors capable of detecting and transmitting temperature data from the human body, environment, and electronic devices hold significant potential for applications in electronic skins, human-machine interactions, and disaster prevention systems. Nonetheless, fabricating flexible temperature sensors with exceptional sensing performance remains a formidable task, primarily due to the intricate process of constructing an intrinsically flexible sensing element with high sensitivity. In this study, a facile in situ two-step synthetic method is introduced for fabricating flexible fiber-shaped NiO/carbon nanotube fiber (CNTF) composites. The resulting NiO/CNTF flexible temperature sensors demonstrate outstanding deformability and temperature sensing characteristics, encompassing a broad working range (-15 to 60 °C) and high sensitivity (maximum TCR of -20.2% °C-1 and B value of 3332 K). Importantly, the mechanical and thermal behaviors of the sensor in various application conditions are thoroughly examined using finite element analysis simulations. Moreover, the temperature sensors can effectively capture diverse thermal signals in wearable applications. Notably, a temperature monitoring and warning system is developed to prevent fire accidents resulting from abnormal thermal runaway in electronic devices.

Silicon-based transient electronics: principles, devices and applications

Recent advances in materials science, device designs and advanced fabrication technologies have enabled the rapid development of transient electronics, which represents a class of devices or systems that their functionalities and constitutions can be partially/completely degraded via chemical reaction or physical disintegration over a stable operation. Therefore, numerous potentials, including zero/reduced waste electronics, bioresorbable electronic implants, hardware security, and others, are expected. In particular, transient electronics with biocompatible and bioresorbable properties could completely eliminate the secondary retrieval surgical procedure after their in-body operation, thus offering significant potentials for biomedical applications. In terms of material strategies for the manufacturing of transient electronics, silicon nanomembranes (SiNMs) are of great interest because of their good physical/chemical properties, modest mechanical flexibility (depending on their dimensions), robust and outstanding device performances, and state-of-the-art manufacturing technologies. As a result, continuous efforts have been made to develop silicon-based transient electronics, mainly focusing on designing manufacturing strategies, fabricating various devices with different functionalities, investigating degradation or failure mechanisms, and exploring their applications. In this review, we will summarize the recent progresses of silicon-based transient electronics, with an emphasis on the manufacturing of SiNMs, devices, as well as their applications. After a brief introduction, strategies and basics for utilizing SiNMs for transient electronics will be discussed. Then, various silicon-based transient electronic devices with different functionalities are described. After that, several examples regarding on the applications, with an emphasis on the biomedical engineering, of silicon-based transient electronics are presented. Finally, summary and perspectives on transient electronics are exhibited.

Advancing Intelligent Organ-on-a-Chip Systems with Comprehensive In Situ Bioanalysis

In vitro models are essential to a broad range of biomedical research, such as pathological studies, drug development, and personalized medicine. As a potentially transformative paradigm for 3D in vitro models, organ-on-a-chip (OOC) technology has been extensively developed to recapitulate sophisticated architectures and dynamic microenvironments of human organs by applying the principles of life sciences and leveraging micro- and nanoscale engineering capabilities. A pivotal function of OOC devices is to support multifaceted and timely characterization of cultured cells and their microenvironments. However, in-depth analysis of OOC models typically requires biomedical assay procedures that are labor-intensive and interruptive. Herein, the latest advances toward intelligent OOC (iOOC) systems, where sensors integrated with OOC devices continuously report cellular and microenvironmental information for comprehensive in situ bioanalysis, are examined. It is proposed that the multimodal data in iOOC systems can support closed-loop control of the in vitro models and offer holistic biomedical insights for diverse applications. Essential techniques for establishing iOOC systems are surveyed, encompassing in situ sensing, data processing, and dynamic modulation. Eventually, the future development of iOOC systems featuring cross-disciplinary strategies is discussed.

Mechanically and Thermally Guided, Honeycomb-like Nanocomposites with Strain-Insensitive High Thermal Conductivity for Stretchable Electronics

Thermal management materials have become increasingly crucial for stretchable electronic devices and systems. Drastically different from conventional thermally conductive materials, which are applied at static conditions, thermal management materials for stretchable electronics additionally require strain-insensitive thermal conductivity, as they generally undergo cyclic deformation. However, realizing such a property remains challenging mainly because conventional thermally conductive polymer composites generally lack a mechanically guided design. Here, we report a honeycomb-like nanocomposite with a three-dimensional (3D) thermally conductive network fabricated by an arrayed ice-templating technique followed by elastomer infiltration. The hexagonal honeycomb-like structure with thin, compact walls (≈ 40 μm) endows our composite with a high through-plane thermal conductivity (≈ 1.54 W m-1 K-1) at an ultralow boron nitride nanosheet (BNNS) loading (≈ 0.85 vol %), with an enhancement factor of thermal conductivity up to 820% and thermal-insensitive strain up to 200%, which are 2.7 and 2 times higher than those reported in the literature. We report an intelligent strategy for the development of advanced thermal management materials for high-performance stretchable electronics.

Wireless Battery-free and Fully Implantable Organ Interfaces

Advances in soft materials, miniaturized electronics, sensors, stimulators, radios, and battery-free power supplies are resulting in a new generation of fully implantable organ interfaces that leverage volumetric reduction and soft mechanics by eliminating electrochemical power storage. This device class offers the ability to provide high-fidelity readouts of physiological processes, enables stimulation, and allows control over organs to realize new therapeutic and diagnostic paradigms. Driven by seamless integration with connected infrastructure, these devices enable personalized digital medicine. Key to advances are carefully designed material, electrophysical, electrochemical, and electromagnetic systems that form implantables with mechanical properties closely matched to the target organ to deliver functionality that supports high-fidelity sensors and stimulators. The elimination of electrochemical power supplies enables control over device operation, anywhere from acute, to lifetimes matching the target subject with physical dimensions that supports imperceptible operation. This review provides a comprehensive overview of the basic building blocks of battery-free organ interfaces and related topics such as implantation, delivery, sterilization, and user acceptance. State of the art examples categorized by organ system and an outlook of interconnection and advanced strategies for computation leveraging the consistent power influx to elevate functionality of this device class over current battery-powered strategies is highlighted.

Optical mapping and optogenetics in cardiac electrophysiology research and therapy: a state-of-the-art review

State-of-the-art innovations in optical cardiac electrophysiology are significantly enhancing cardiac research. A potential leap into patient care is now on the horizon. Optical mapping, using fluorescent probes and high-speed cameras, offers detailed insights into cardiac activity and arrhythmias by analysing electrical signals, calcium dynamics, and metabolism. Optogenetics utilizes light-sensitive ion channels and pumps to realize contactless, cell-selective cardiac actuation for modelling arrhythmia, restoring sinus rhythm, and probing complex cell-cell interactions. The merging of optogenetics and optical mapping techniques for 'all-optical' electrophysiology marks a significant step forward. This combination allows for the contactless actuation and sensing of cardiac electrophysiology, offering unprecedented spatial-temporal resolution and control. Recent studies have performed all-optical imaging ex vivo and achieved reliable optogenetic pacing in vivo, narrowing the gap for clinical use. Progress in optical electrophysiology continues at pace. Advances in motion tracking methods are removing the necessity of motion uncoupling, a key limitation of optical mapping. Innovations in optoelectronics, including miniaturized, biocompatible illumination and circuitry, are enabling the creation of implantable cardiac pacemakers and defibrillators with optoelectrical closed-loop systems. Computational modelling and machine learning are emerging as pivotal tools in enhancing optical techniques, offering new avenues for analysing complex data and optimizing therapeutic strategies. However, key challenges remain including opsin delivery, real-time data processing, longevity, and chronic effects of optoelectronic devices. This review provides a comprehensive overview of recent advances in optical mapping and optogenetics and outlines the promising future of optics in reshaping cardiac electrophysiology and therapeutic strategies.

Biodegradable, Biocompatible, and Implantable Multifunctional Sensing Platform for Cardiac Monitoring

Cardiac monitoring after heart surgeries is crucial for health maintenance and detecting postoperative complications early. However, current methods like rigid implants have limitations, as they require performing second complex surgeries for removal, increasing infection and inflammation risks, thus prompting research for improved sensing monitoring technologies. Herein, we introduce a nanosensor platform that is biodegradable, biocompatible, and integrated with multifunctions, suitable for use as implants for cardiac monitoring. The device has two electrochemical biosensors for sensing lactic acid and pH as well as a pressure sensor and a chemiresistor array for detecting volatile organic compounds. Its biocompatibility with myocytes has been tested in vitro, and its biodegradability and sensing function have been proven with ex vivo experiments using a three-dimensional (3D)-printed heart model and 3D-printed cardiac tissue patches. Moreover, an artificial intelligence-based predictive model was designed to fuse sensor data for more precise health assessment, making it a suitable candidate for clinical use. This sensing platform promises impactful applications in the realm of cardiac patient care, laying the foundation for advanced life-saving developments.

An Integrated Optogenetic and Bioelectronic Platform for Regulating Cardiomyocyte Function

We report an integrated optogenetic and bioelectronic platform for stable and long-term modulation and monitoring of cardiomyocyte function in vitro. Optogenetic inputs were achieved through expression of a photoactivatable adenylyl cyclase (bPAC), that when activated by blue light caused a dose-dependent and time-limited increase in autonomous cardiomyocyte beat rate. Bioelectronic readouts were achieved through an integrated planar multi-electrode array (MEA) that provided real-time readouts of electrophysiological activity from 32 spatially-distinct locations. Irradiation at 27 μW/mm2 resulted in a ca. 14% increase in beat rate within 20-25 minutes, which remained stable for at least 2 hours. The beating rate could be cycled through repeated "on" and "off' states, and its magnitude was a monotonic function of irradiation intensity. Our integrated platform opens new avenues in bioelectronic medicine, including closed-loop feedback systems, with potential applications for cardiac regulation including arrhythmia diagnosis and intervention.

Electrophysiological mapping of the epicardium via 3D-printed flexible arrays

Cardiac electrophysiology mapping and ablation are widely used to treat heart rhythm disorders such as atrial fibrillation (AF) and ventricular tachycardia (VT). Here, we describe an approach for rapid production of three dimensional (3D)-printed mapping devices derived from magnetic resonance imaging. The mapping devices are equipped with flexible electronic arrays that are shaped to match the epicardial contours of the atria and ventricle and allow for epicardial electrical mapping procedures. We validate that these flexible arrays provide high-resolution mapping of epicardial signals in vivo using porcine models of AF and myocardial infarction. Specifically, global coverage of the epicardial surface allows for mapping and ablation of myocardial substrate and the capture of premature ventricular complexes with precise spatial-temporal resolution. We further show, as proof-of-concept, the localization of sites of VT by means of beat-to-beat whole-chamber ventricular mapping of ex vivo Langendorff-perfused human hearts.

Flexible Electrodes for Brain-Computer Interface System

Brain-computer interface (BCI) has been the subject of extensive research recently. Governments and companies have substantially invested in relevant research and applications. The restoration of communication and motor function, the treatment of psychological disorders, gaming, and other daily and therapeutic applications all benefit from BCI. The electrodes hold the key to the essential, fundamental BCI precondition of electrical brain activity detection and delivery. However, the traditional rigid electrodes are limited due to their mismatch in Young's modulus, potential damages to the human body, and a decline in signal quality with time. These factors make the development of flexible electrodes vital and urgent. Flexible electrodes made of soft materials have grown in popularity in recent years as an alternative to conventional rigid electrodes because they offer greater conformance, the potential for higher signal-to-noise ratio (SNR) signals, and a wider range of applications. Therefore, the latest classifications and future developmental directions of fabricating these flexible electrodes are explored in this paper to further encourage the speedy advent of flexible electrodes for BCI. In summary, the perspectives and future outlook for this developing discipline are provided.

Electroanatomical mapping of the stomach with simultaneous biomagnetic measurements

Gastric motility is coordinated by bioelectric slow waves (SWs) and dysrhythmic SW activity has been linked with motility disorders. Magnetogastrography (MGG) is the non-invasive measurement of the biomagnetic fields generated by SWs. Dysrhythmia identification using MGG is currently challenging because source models are not well developed and the impact of anatomical variation is not well understood. A novel method for the quantitative spatial co-registration of serosal SW potentials, MGG, and geometric models of anatomical structures was developed and performed on two anesthetized pigs to verify feasibility. Electrode arrays were localized using electromagnetic transmitting coils. Coil localization error for the volume where the stomach is normally located under the sensor array was assessed in a benchtop experiment, and mean error was 4.2±2.3mm and 3.6±3.3° for a coil orientation parallel to the sensor array and 6.2±5.7mm and 4.5±7.0° for a perpendicular coil orientation. Stomach geometries were reconstructed by fitting a generic stomach to up to 19 localization coils, and SW activation maps were mapped onto the reconstructed geometries using the registered positions of 128 electrodes. Normal proximal-to-distal and ectopic SW propagation patterns were recorded from the serosa and compared against the simultaneous MGG measurements. Correlations between the center-of-gravity of normalized MGG and the mean position of SW activity on the serosa were 0.36 and 0.85 for the ectopic and normal propagation patterns along the proximal-distal stomach axis, respectively. This study presents the first feasible method for the spatial co-registration of MGG, serosal SW measurements, and subject-specific anatomy. This is a significant advancement because these data enable the development and validation of novel non-invasive gastric source characterization methods.

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.

Soft Bioelectronics for Therapeutics

Soft bioelectronics play an increasingly crucial role in high-precision therapeutics due to their softness, biocompatibility, clinical accuracy, long-term stability, and patient-friendliness. In this review, we provide a comprehensive overview of the latest representative therapeutic applications of advanced soft bioelectronics, ranging from wearable therapeutics for skin wounds, diabetes, ophthalmic diseases, muscle disorders, and other diseases to implantable therapeutics against complex diseases, such as cardiac arrhythmias, cancer, neurological diseases, and others. We also highlight key challenges and opportunities for future clinical translation and commercialization of soft therapeutic bioelectronics toward personalized medicine.

Flexible electronics for cardiovascular healthcare monitoring

Cardiovascular diseases (CVDs) are one of the most urgent threats to humans worldwide, which are responsible for almost one-third of global mortality. Over the last decade, research on flexible electronics for monitoring and treatment of CVDs has attracted tremendous attention. In contrast to conventional medical instruments in hospitals that are usually bulky, hard to move, monofunctional, and time-consuming, flexible electronics are capable of continuous, noninvasive, real-time, and portable monitoring. Notable progress has been made in this emerging field, and thus a number of significant achievements and concomitant research prospects deserve attention for practical implementation. Here, we comprehensively review the latest progress of flexible electronics for CVDs, focusing on new functions provided by flexible electronics. First, the characteristics of CVDs and flexible electronics and the foundation of their combination are briefly reviewed. Then, four representative applications of flexible electronics for CVDs are elaborated: blood pressure (BP) monitoring, electrocardiogram (ECG) monitoring, echocardiogram monitoring, and direct epicardium monitoring. Their operational principles, progress, merits and demerits, and future efforts are discussed. Finally, the remaining challenges and opportunities for flexible electronics for cardiovascular healthcare are outlined.

Emerging trends in the development of flexible optrode arrays for electrophysiology

Optical-electrode (optrode) arrays use light to modulate excitable biological tissues and/or transduce bioelectrical signals into the optical domain. Light offers several advantages over electrical wiring, including the ability to encode multiple data channels within a single beam. This approach is at the forefront of innovation aimed at increasing spatial resolution and channel count in multichannel electrophysiology systems. This review presents an overview of devices and material systems that utilize light for electrophysiology recording and stimulation. The work focuses on the current and emerging methods and their applications, and provides a detailed discussion of the design and fabrication of flexible arrayed devices. Optrode arrays feature components non-existent in conventional multi-electrode arrays, such as waveguides, optical circuitry, light-emitting diodes, and optoelectronic and light-sensitive functional materials, packaged in planar, penetrating, or endoscopic forms. Often these are combined with dielectric and conductive structures and, less frequently, with multi-functional sensors. While creating flexible optrode arrays is feasible and necessary to minimize tissue-device mechanical mismatch, key factors must be considered for regulatory approval and clinical use. These include the biocompatibility of optical and photonic components. Additionally, material selection should match the operating wavelength of the specific electrophysiology application, minimizing light scattering and optical losses under physiologically induced stresses and strains. Flexible and soft variants of traditionally rigid photonic circuitry for passive optical multiplexing should be developed to advance the field. We evaluate fabrication techniques against these requirements. We foresee a future whereby established telecommunications techniques are engineered into flexible optrode arrays to enable unprecedented large-scale high-resolution electrophysiology systems.

Flexible and Stretchable Electrochemical Sensors for Biological Monitoring

The rise of flexible and stretchable electronics has revolutionized biosensor techniques for probing biological systems. Particularly, flexible and stretchable electrochemical sensors (FSECSs) enable the in situ quantification of numerous biochemical molecules in different biological entities owing to their exceptional sensitivity, fast response, and easy miniaturization. Over the past decade, the fabrication and application of FSECSs have significantly progressed. This review highlights key developments in electrode fabrication and FSECSs functionalization. It delves into the electrochemical sensing of various biomarkers, including metabolites, electrolytes, signaling molecules, and neurotransmitters from biological systems, encompassing the outer epidermis, tissues/organs in vitro and in vivo, and living cells. Finally, considering electrode preparation and biological applications, current challenges and future opportunities for FSECSs are discussed.

Trends and Challenges in the Development of 3D-Printed Heart Valves and Other Cardiac Implants: A Review of Current Advances

This article provides a comprehensive review of the current trends and challenges in the development of 3D-printed heart valves and other cardiac implants. By providing personalized solutions and pushing the limits of regenerative medicine, 3D printing technology has revolutionized the field of cardiac healthcare. The use of several organic and synthetic polymers in 3D printing heart valves is explored in this article, with emphasis on both their benefits and drawbacks. In cardiac tissue engineering, stem cells are essential, and their potential to lessen immunological rejection and thrombogenic consequences is highlighted. In the clinical applications section, the article emphasizes the importance of 3D printing in preoperative planning. Surgery results are enhanced when surgeons can visualize and assess the size and placement of implants using patient-specific anatomical models. Customized implants that are designed to match the anatomy of a particular patient reduce the likelihood of complications and enhance postoperative results. The development of physiologically active cardiac implants, made possible by 3D bioprinting, shows promise by eliminating the need for artificial valves. In conclusion, this paper highlights cutting-edge research and the promise of 3D-printed cardiac implants to improve patient outcomes and revolutionize cardiac treatment.

Subcutaneous mechano-electrocardiogram (MECG) sensor for complementary cardiac diagnosis

Since the heart pumps out the blood through the excitation-contraction coupling, simultaneous monitoring of the electrical and mechanical characteristics is beneficial for comprehensive diagnosis of cardiac disorders. Currently, these characteristics are monitored separately with electrocardiogram (ECG) and medical imaging techniques. This work presents a fully implantable device named mechano-electrocardiogram (MECG) sensor that can measure mechanocardiogram (MCG) and ECG together. The key to the success is fabrication of permeable electrodes on a single low-modulus porous nanofiber mat, which helps immediate adhesion of the sensor on the tissue. A strain-insensitive electrode is used as the ECG electrode and a strain-sensitive electrode is used for MCG. The MECG device is implanted subcutaneously in the skin above the heart of the rat. Through a vasopressor (phenylephrine) injection test, the MECG signals indicate that the MCG amplitude is related with blood pressure and the ECG peak interval is more related with heart rate. These results confirm that the MECG device is clinically meaningful for continuous and comprehensive monitoring of the electrical and mechanical characteristics of the heart.

Graphene Biointerface for Cardiac Arrhythmia Diagnosis and Treatment

Heart rhythm disorders, known as arrhythmias, cause significant morbidity and are one of the leading causes of mortality. Cardiac arrhythmias are frequently treated by implantable devices, such as pacemakers and defibrillators, or by ablation therapy guided by electroanatomical mapping. Both implantable and ablation therapies require sophisticated biointerfaces for electrophysiological measurements of electrograms and delivery of therapeutic stimulation or ablation energy. In this work, a graphene biointerface for in vivo cardiac electrophysiology is reported for the first time. Leveraging sub-micrometer-thick tissue-conformable graphene arrays, sensing and stimulation of the open mammalian heart are demonstrated both in vitro and in vivo. Furthermore, the graphene biointerface treatment of atrioventricular block (the kind of arrhythmia where the electrical conduction from the atria to the ventricles is interrupted) is demonstrated. The graphene arrays show effective electrochemical properties, namely interface impedance down to 40 Ω cm² at 1 kHz, charge storage capacity up to 63.7 mC cm^-2 , and charge injection capacity up to 704 µC cm^-2 . Transparency of the graphene structures allows for simultaneous optical mapping of cardiac action potentials, calcium transients, and optogenetic stimulation while performing electrical measurements and stimulation. The report presents evidence of the significant potential of graphene biointerfaces for advanced cardiac electrophysiology and arrhythmia therapy.

A biodegradable, flexible photonic patch for in vivo phototherapy

Diagnostic and therapeutic illumination on internal organs and tissues with high controllability and adaptability in terms of spectrum, area, depth, and intensity remains a major challenge. Here, we present a flexible, biodegradable photonic device called iCarP with a micrometer scale air gap between a refractive polyester patch and the embedded removable tapered optical fiber. ICarP combines the advantages of light diffraction by the tapered optical fiber, dual refractions in the air gap, and reflection inside the patch to obtain a bulb-like illumination, guiding light towards target tissue. We show that iCarP achieves large area, high intensity, wide spectrum, continuous or pulsatile, deeply penetrating illumination without puncturing the target tissues and demonstrate that it supports phototherapies with different photosensitizers. We find that the photonic device is compatible with thoracoscopy-based minimally invasive implantation onto beating hearts. These initial results show that iCarP could be a safe, precise and widely applicable device suitable for internal organs and tissue illumination and associated diagnosis and therapy.

Deployment of an electrocorticography system with a soft robotic actuator

Electrocorticography (ECoG) is a minimally invasive approach frequently used clinically to map epileptogenic regions of the brain and facilitate lesion resection surgery and increasingly explored in brain-machine interface applications. Current devices display limitations that require trade-offs among cortical surface coverage, spatial electrode resolution, aesthetic, and risk consequences and often limit the use of the mapping technology to the operating room. In this work, we report on a scalable technique for the fabrication of large-area soft robotic electrode arrays and their deployment on the cortex through a square-centimeter burr hole using a pressure-driven actuation mechanism called eversion. The deployable system consists of up to six prefolded soft legs, and it is placed subdurally on the cortex using an aqueous pressurized solution and secured to the pedestal on the rim of the small craniotomy. Each leg contains soft, microfabricated electrodes and strain sensors for real-time deployment monitoring. In a proof-of-concept acute surgery, a soft robotic electrode array was successfully deployed on the cortex of a minipig to record sensory cortical activity. This soft robotic neurotechnology opens promising avenues for minimally invasive cortical surgery and applications related to neurological disorders such as motor and sensory deficits.

Liquid Metal-Based Electrode Array for Neural Signal Recording

Neural electrodes are core devices for research in neuroscience, neurological diseases, and neural-machine interfacing. They build a bridge between the cerebral nervous system and electronic devices. Most of the neural electrodes in use are based on rigid materials that differ significantly from biological neural tissue in flexibility and tensile properties. In this study, a liquid-metal (LM) -based 20-channel neural electrode array with a platinum metal (Pt) encapsulation material was developed by microfabrication technology. The in vitro experiments demonstrated that the electrode has stable electrical properties and excellent mechanical properties such as flexibility and bending, which allows the electrode to form conformal contact with the skull. The in vivo experiments also recorded electroencephalographic signals using the LM-based electrode from a rat under low-flow or deep anesthesia, including the auditory-evoked potentials triggered by sound stimulation. The auditory-activated cortical area was analyzed using source localization technique. These results indicate that this 20-channel LM-based neural electrode array satisfies the demands of brain signal acquisition and provides high-quality-electroencephalogram (EEG) signals that support source localization analysis.

Wireless, Fully Implantable and Expandable Electronic System for Bidirectional Electrical Neuromodulation of the Urinary Bladder

Current standard clinical options for patients with detrusor underactivity (DUA) or underactive bladder─the inability to release urine naturally─include the use of medications, voiding techniques, and intermittent catheterization, for which the patient inserts a tube directly into the urethra to eliminate urine. Although those are life-saving techniques, there are still unfavorable side effects, including urinary tract infection (UTI), urethritis, irritation, and discomfort. Here, we report a wireless, fully implantable, and expandable electronic complex that enables elaborate management of abnormal bladder function via seamless integrations with the urinary bladder. Such electronics can not only record multiple physiological parameters simultaneously but also provide direct electrical stimulation based on a feedback control system. Uniform distribution of multiple stimulation electrodes via mesh-type geometry realizes low-impedance characteristics, which improves voiding/urination efficiency at the desired times. In vivo evaluations using live, free-moving animal models demonstrate system-level functionality.

Highly Elastic and Strain Sensing Corn Protein Electrospun Fibers for Monitoring of Wound Healing

Due to the lack of sufficient elasticity and strain sensing capability, protein-based ultrafine fibrous tissue engineering scaffolds, though favorable for skin repair, can hardly fulfill on-spot wound monitoring during healing. Herein, we designed highly elastic corn protein ultrafine fibrous smart scaffolds with a three-layer structure for motion tracking at an unpackaged state. The densely cross-linked protein networks were efficiently established by introducing a highly reactive epoxy and provided the fiber substrates with wide-range stretchability (360% stretching range) and ultrahigh elasticity (99.91% recovery rate) at a wet state. With the assistance of the polydopamine bonding layer, a silver conductive sensing layer was built on the protein fibers and endowed the scaffolds with wide strain sensing range (264%), high sensitivity (gauge factor up to 210.55), short response time (<70 ms), reliable cycling stability, and long-lasting duration (up to 30 days). The unpackaged smart scaffolds could not only support cell growth and accelerate wound closure but also track motions on skin and in vivo and trigger alarms once excessive wound deformations occurred. These features not only confirmed the great potential of these smart scaffolds for applications in tissue reconstruction and wound monitoring but also proved the possibility of employing various plant protein ultrafine fibers as flexible bioelectronics.

Development of an Implantable Capacitive Pressure Sensor for Biomedical Applications

In this study, a subminiature implantable capacitive pressure sensor is proposed for biomedical applications. The proposed pressure sensor comprises an array of elastic silicon nitride (SiN) diaphragms formed by the application of a polysilicon (p-Si) sacrificial layer. In addition, using the p-Si layer, a resistive temperature sensor is also integrated into one device without additional fabrication steps or extra cost, thus enabling the device to measure pressure and temperature simultaneously. The sensor with a size of 0.5 × 1.2 mm was fabricated using microelectromechanical systems (MEMS) technology and was packaged in needle-shaped metal housing that is both insertable and biocompatible. The packaged pressure sensor immersed in a physiological saline solution exhibited excellent performance without leakage. The sensor achieved a sensitivity of approximately 1.73 pF/bar and a hysteresis of about 1.7%, respectively. Furthermore, it was confirmed that the pressure sensor operated normally for 48 h without experiencing insulation breakdown or degradation of the capacitance. The integrated resistive temperature sensor also worked properly. The response of the temperature sensor varied linearly with temperature variation. It had an acceptable temperature coefficient of resistance (TCR) of approximately 0.25%/°C.

Water-soluble conjugated polymers for bioelectronic systems

Bioelectronics is an interdisciplinary field of research that aims to establish a synergy between electronics and biology. Contributing to a deeper understanding of bioelectronic processes and the built bioelectronic systems, a variety of new phenomena, mechanisms and concepts have been derived in the field of biology, medicine, energy, artificial intelligence science, etc. Organic semiconductors can promote the applications of bioelectronics in improving original performance and creating new features for organisms due to their excellent photoelectric and electrical properties. Recently, water-soluble conjugated polymers (WSCPs) have been employed as a class of ideal interface materials to regulate bioelectronic processes between biological systems and electronic systems, relying on their satisfying ionic conductivity, water-solubility, good biocompatibility and the additional mechanical and electrical properties. In this review, we summarize the prominent contributions of WSCPs in the aspect of the regulation of bioelectronic processes and highlight the latest advances in WSCPs for bioelectronic applications, involving biosynthetic systems, photosynthetic systems, biophotovoltaic systems, and bioelectronic devices. The challenges and outlooks of WSCPs in designing high-performance bioelectronic systems are also discussed.

Full-colour Jabuticaba-like nanostructures via the multiplex and orthogonal self-assembly of protein-conjugated quantum dots with engineered biofilms

The integration of inorganic components with bacterial biofilms is of great significance for expanding the functionality of artificial biological materials. However, so far, the complexities and functionalities of biofilm-based scaffolds assembled via metal-peptide coordination chemistries remain limited. Here, we present a platform for the multiplexed and specific coupling of recombinant protein-functionalized fluorescent red-green-blue (RGB) quantum dots (QDs) with engineered biofilms to form Jabuticaba-like nanostructures. Full-color living Jabuticaba-like nanostructures have been achieved through the interaction of extracellular peptides that are fabricated by biofilms with the proteins that modify the surface of the RGB QDs through orthogonal SpyTag/SpyCatcher, IsopeptagN/PilinN, and IsopeptagC/PilinC pairs. We envision that living cell populations will enable the multiplexable, scalable and bottom-up assembly of versatile materials that integrate both abiotic and biotic components into multifunctional systems.

Optogenetic termination of atrial tachyarrhythmias by brief pulsed light stimulation

AIMS

The most efficient way to acutely restore sinus rhythm from atrial fibrillation (AF) is electrical cardioversion, which is painful without adequate sedation. Recent studies in various experimental models have indicated that optogenetic termination of AF using light-gated ion channels may provide a myocardium-specific and potentially painless alternative future therapy. However, its underlying mechanism(s) remain(s) incompletely understood. As brief pulsed light stimulation, even without global illumination, can achieve optogenetic AF termination, besides direct conduction block also modulation of action potential (AP) properties may be involved in the termination mechanism. We studied the relationship between optogenetic AP duration (APD) and effective refractory period (ERP) prolongation by brief pulsed light stimulation and termination of atrial tachyarrhythmia (AT).

METHODS AND RESULTS

Hearts from transgenic mice expressing the H134R variant of channelrhodopsin-2 in atrial myocytes were explanted and perfused retrogradely. AT induced by electrical stimulation was terminated by brief pulsed blue light stimulation (470 nm, 10 ms, 16 mW/mm²) with 68% efficacy. The termination rate was dependent on pulse duration and light intensity. Optogenetically imposed APD and ERP changes were systematically examined and optically monitored. Brief pulsed light stimulation (10 ms, 6 mW/mm²) consistently prolonged APD and ERP when light was applied at different phases of the cardiac action potential. Optical tracing showed light-induced APD prolongation during the termination of AT.

CONCLUSION

Our results directly demonstrate that cationic channelrhodopsin activation by brief pulsed light stimulation prolongs the atrial refractory period suggesting that this is one of the key mechanisms of optogenetic termination of AT.

Conductive and Adhesive Granular Alginate Hydrogels for On-Tissue Writable Bioelectronics

Conductive hydrogels are promising materials in bioelectronics that ensure a tissue-like soft modulus and re-enact the electrophysiological function of damaged tissues. However, recent approaches to fabricating conductive hydrogels have proved difficult: fixing of the conductive hydrogels on the target tissues hydrogels requires the aids from other medical glues because of their weak tissue-adhesiveness. In this study, an intrinsically conductive and tissue-adhesive granular hydrogel consisting of a PEDOT:PSS conducting polymer and an adhesive catechol-conjugated alginate polymer was fabricated via an electrohydrodynamic spraying method. Because alginate-based polymers can be crosslinked by calcium ions, alginate-catechol polymers mixed with PEDOT:PSS granular hydrogels (ACP) were easily fabricated. The fabricated ACP exhibited not only adhesive and shear-thinning properties but also conductivity similar to that of muscle tissue. Additionally, the granular structure makes the hydrogel injectable through a syringe, enabling on-tissue printing. This multifunctional granular hydrogel can be applied to soft and flexible electronics to connect humans and machines.

Multifunctional tendon-mimetic hydrogels

We report multifunctional tendon-mimetic hydrogels constructed from anisotropic assembly of aramid nanofiber composites. The stiff nanofibers and soft polyvinyl alcohol in these anisotropic composite hydrogels (ACHs) mimic the structural interplay between aligned collagen fibers and proteoglycans in tendons. The ACHs exhibit a high modulus of ~1.1 GPa, strength of ~72 MPa, fracture toughness of 7333 J/m2, and many additional characteristics matching those of natural tendons, which was not achieved with previous synthetic hydrogels. The surfaces of ACHs were functionalized with bioactive molecules to present biophysical cues for the modulation of morphology, phenotypes, and other behaviors of attached cells. Moreover, soft bioelectronic components can be integrated on ACHs, enabling in situ sensing of various physiological parameters. The outstanding mechanics and functionality of these tendon mimetics suggest their further applications in advanced tissue engineering, implantable prosthetics, human-machine interactions, and other technologies.

Decoupling Transmission and Transduction for Improved Durability of Highly Stretchable, Soft Strain Sensing: Applications in Human Health Monitoring

This work presents a modular approach to the development of strain sensors for large deformations. The proposed method separates the extension and signal transduction mechanisms using a soft, elastomeric transmission and a high-sensitivity microelectromechanical system (MEMS) transducer. By separating the transmission and transduction, they can be optimized independently for application-specific mechanical and electrical performance. This work investigates the potential of this approach for human health monitoring as an implantable cardiac strain sensor for measuring global longitudinal strain (GLS). The durability of the sensor was evaluated by conducting cyclic loading tests over one million cycles, and the results showed negligible drift. To account for hysteresis and frequency-dependent effects, a lumped-parameter model was developed to represent the viscoelastic behavior of the sensor. Multiple model orders were considered and compared using validation and test data sets that mimic physiologically relevant dynamics. Results support the choice of a second-order model, which reduces error by 73% compared to a linear calibration. In addition, we evaluated the suitability of this sensor for the proposed application by demonstrating its ability to operate on compliant, curved surfaces. The effects of friction and boundary conditions are also empirically assessed and discussed.

Soft Fiber Electronics Based on Semiconducting Polymer

Fibers, originating from nature and mastered by human, have woven their way throughout the entire history of human civilization. Recent developments in semiconducting polymer materials have further endowed fibers and textiles with various electronic functions, which are attractive in applications such as information interfacing, personalized medicine, and clean energy. Owing to their ability to be easily integrated into daily life, soft fiber electronics based on semiconducting polymers have gained popularity recently for wearable and implantable applications. Herein, we present a review of the previous and current progress in semiconducting polymer-based fiber electronics, particularly focusing on smart-wearable and implantable areas. First, we provide a brief overview of semiconducting polymers from the viewpoint of materials based on the basic concepts and functionality requirements of different devices. Then we analyze the existing applications and associated devices such as information interfaces, healthcare and medicine, and energy conversion and storage. The working principle and performance of semiconducting polymer-based fiber devices are summarized. Furthermore, we focus on the fabrication techniques of fiber devices. Based on the continuous fabrication of one-dimensional fiber and yarn, we introduce two- and three-dimensional fabric fabricating methods. Finally, we review challenges and relevant perspectives and potential solutions to address the related problems.

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.

Multimaterial Three-Dimensional Printing of Ultraviolet-Curable Ionic Conductive Elastomers with Diverse Polymers for Multifunctional Flexible Electronics

Ionic conductive elastomers (ICEs) are emerging stretchable and ionic conductive materials that are solvent-free and thus demonstrate excellent thermal stability. Three-dimensional (3D) printing that creates complex 3D structures in free forms is considered as an ideal approach to manufacture sophisticated ICE-based devices. However, the current technologies constrain 3D printed ICE structures in a single material, which greatly limits functionality and performance of ICE-based devices and machines. Here, we report a digital light processing (DLP)-based multimaterial 3D printing capability to seemly integrate ultraviolet-curable ICE (UV-ICE) with nonconductive materials to create ionic flexible electronic devices in 3D forms with enhanced performance. This unique capability allows us to readily manufacture various 3D flexible electronic devices. To demonstrate this, we printed UV-ICE circuits into polymer substrates with different mechanical properties to create resistive strain and force sensors; we printed flexible capacitive sensors with high sensitivity (2 kPa^-1) and a wide range of measured pressures (from 5 Pa to 550 kPa) by creating a complex microstructure in the dielectric layer; we even realized ionic conductor-activated four-dimensional (4D) printing by printing a UV-ICE circuit into a shape memory polymer substrate. The proposed approach paves a new efficient way to realize multifunctional flexible devices and machines by bonding ICEs with other polymers in 3D forms.

Fully Atomistic Molecular Dynamics Simulation of a TIPS-Pentacene:Polystyrene Mixed Film Obtained via the Solution Process

Organic thin-film transistors using small-molecule semiconductor materials such as 6,13-bis(triisopropylsilylethynyl)pentacene (TIPS-P) have been recently studied for the production of flexible and printed electronic devices. Blending a semiconductor with an insulating polymer, such as polystyrene, is known to improve the device performance; however, its molecular-level structure remains unknown. In this study, we performed molecular dynamics (MD) simulations on a mixed system of TIPS-P and atactic polystyrene (aPS) with fully atomistic models to understand the structure of the mixed thin film at the molecular level and the influence on the device properties. To reproduce the deposition from the solution, we gradually reduced the number of toluene molecules in the simulation. The dynamic characteristics of the system, mean squared displacement, diffusion coefficient, density profile, and P₂ order parameter were analyzed. Some of the simulated systems reached the equilibrium state. In these systems, the simulated structures suggested the presence of more TIPS-P molecules on the surface than inside the bulk, even at the low molecular weight of aPS, where phase separation was not observed experimentally. The results of the fully atomistic MD simulations are also a basis for the coarse-grained model to increase the speed of the MD simulation.

Novel Nanotechnology-Driven Prototypes for AI-Enriched Implanted Prosthetics Following Organ Failure

Meeting medical challenges posed by global burdens is proven to be of primary interest. One example is the COVID-19 epidemic that humankind is currently experiencing, since around December 2019. Innovation is key to respond rapidly and effectively to sanitary and health emergencies, when human lives are severely threatened. In this scenery, medical devices that can be rapidly launched in the market and manufactured at scale are crucial for saving lives. One example is a lifesaving respiratory device launched in about 10 days (Mercedes F1 team's new device based on continuous positive airway pressure devices) and rapidly approved by international agencies responsible for assuring drug and medical devices safety, in response to the COVID-19 burden. Remarkably, it is the first time in history that mankind observes disease spread reaching such high proportions, globally, in such short time scale. However, while this epidemic had, in March 2020, reached the critical figures of about 38,000 deaths and c. 738,000 infected, organ donation and transplantation patients are suffering for years, accounting for an increasing number of affected, annually. These patients are invisible for the general public. Therefore, this chapter approaches the organ donation and transplantation burden, proposing effective solutions to leverage the suffering, improving life quality of patients enduring several underlying issues, from hemodialysis complications and critical organ failure to lacking compatible donors. This, on the basis of technology repurposing, to speed up approval processes followed by international agencies responsible for assuring drug and medical devices safety, while adding innovative methods to existing technology and reducing invasiveness.

Mapping of Spatiotemporal Auricular Electrophysiological Signals Reveals Human Biometric Clusters

Underneath the ear skin there are rich vascular network and sensory nerve branches. Hence, the 3D mapping of auricular electrophysiological signals can provide new biomedical perspectives. However, it is still extremely challenging for current sensing techniques to cover the entire ultra-curved auricle. Here, a 3D graphene-based ear-conformable sensing device with embedded and distributed 3D electrodes for full-auricle physiological monitoring is reported. As a proof-of-concept, spatiotemporal auricular electrical skin resistance (AESR) mapping is demonstrated for the first time, and human subject-specific AESR distributions are observed. From the data of more than 30 ears (both right and left ears), the auricular region-specific AESR changes after cycling exercise are observed in 98% of the tests and are clustered into four groups via machine learning-based data analyses. Correlations of AESR with heart rate and blood pressure are also studied. This 3D electronic platform and AESR-based biometrical findings show promising biomedical applications.

Robust and Multifunctional Kirigami Electronics with a Tough and Permeable Aramid Nanofiber Framework

Kirigami designs are advantageous for the construction of wearable electronics due to their high stretchability and conformability on the 3D dynamic surfaces of the skin. However, suitable materials technologies that enable robust kirigami devices with desired functionality for skin-interfaces remain limited. Here, a versatile materials platform based on a composite nanofiber framework (CNFF) is exploited for the engineering of wearable kirigami electronics. The self-assembled fibrillar network involving aramid nanofibers and poly(vinyl alcohol) combines high toughness, permeability, and manufacturability, which are desirable for the fabrication of hybrid devices. Multiscale simulations are conducted to explain the high fracture resistance of the CNFF-based kirigami structures and provide essential guidance for the design, which can be further generalized to other kirigami devices. Various microelectronic sensors and electroactive polymers are integrated onto a CNFF-based materials platform to achieve electrocardiogram (ECG), electromyogram (EMG), skin-temperature measurements, and measurement of other physiological parameters. These mechanically robust, multifunctional, lightweight, and biocompatible kirigami devices can shed new insights for the development of advanced wearable systems and human-machine interfaces.

Guidelines for assessment of cardiac electrophysiology and arrhythmias in small animals

Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. Although recent advances in cell-based models, including human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM), are contributing to our understanding of electrophysiology and arrhythmia mechanisms, preclinical animal studies of cardiovascular disease remain a mainstay. Over the past several decades, animal models of cardiovascular disease have advanced our understanding of pathological remodeling, arrhythmia mechanisms, and drug effects and have led to major improvements in pacing and defibrillation therapies. There exist a variety of methodological approaches for the assessment of cardiac electrophysiology and a plethora of parameters may be assessed with each approach. This guidelines article will provide an overview of the strengths and limitations of several common techniques used to assess electrophysiology and arrhythmia mechanisms at the whole animal, whole heart, and tissue level with a focus on small animal models. We also define key electrophysiological parameters that should be assessed, along with their physiological underpinnings, and the best methods with which to assess these parameters.

Totally Organic Hydrogel-Based Self-Closing Cuff Electrode for Vagus Nerve Stimulation

An intrinsically soft organic electrode consisting of poly(3,4-ethylenedioxythiophene)-modified polyurethane (PEDOT-PU) is embedded into a bilayer film of polyvinyl alcohol (PVA) hydrogels for developing a self-closing cuff electrode for neuromodulation. The curled form of the PVA hydrogel is prepared by releasing internal stress in the bilayer structure. The inner diameter of the cuff electrode is set to less than 2 mm for immobilization to the vagus nerve (VN) of humans and pigs. The stability of the immobilization is examined, while the pressure applied to a nerve bundle is at a harmless level (≈200 Pa). Since the electrode is totally organic, MRI measurements can be conducted without image artifacts. The large electric capacitance of the PEDOT-PU (≈27 mF cm^-2 ) ensures a safe stimulation of living tissues without Faradaic reactions. The practical performance of the cuff electrode for VN stimulation is demonstrated by observation of bradycardia induction in a pig.

Wireless, fully implantable cardiac stimulation and recording with on-device computation for closed-loop pacing and defibrillation

Monitoring and control of cardiac function are critical for investigation of cardiovascular pathophysiology and developing life-saving therapies. However, chronic stimulation of the heart in freely moving small animal subjects, which offer a variety of genotypes and phenotypes, is currently difficult. Specifically, real-time control of cardiac function with high spatial and temporal resolution is currently not possible. Here, we introduce a wireless battery-free device with on-board computation for real-time cardiac control with multisite stimulation enabling optogenetic modulation of the entire rodent heart. Seamless integration of the biointerface with the heart is enabled by machine learning-guided design of ultrathin arrays. Long-term pacing, recording, and on-board computation are demonstrated in freely moving animals. This device class enables new heart failure models and offers a platform to test real-time therapeutic paradigms over chronic time scales by providing means to control cardiac function continuously over the lifetime of the subject.

High-Sensitivity Flexible Sensor Based on Biomimetic Strain-Stiffening Hydrogel

Recently, flexible wearable and implantable electronic devices have attracted enormous interest in biomedical applications. However, current bioelectronic systems have not solved the problem of mechanical mismatch of tissue-electrode interfaces. Therefore, the biomimetic hydrogel with tissue-like mechanical properties is highly desirable for flexible electronic devices. Herein, we propose a strategy to fabricate a biomimetic hydrogel with strain-stiffening property via regional chain entanglements. The strain-stiffening property of the biomimetic hydrogel is realized by embedding highly swollen poly(acrylate sodium) microgels to act as the microregions of dense entanglement in the soft polyacrylamide matrix. In addition, poly(acrylate sodium) microgels can release Na⁺ ions, endowing hydrogel with electrical signals to serve as strain sensors for detecting different human movements. The resultant sensors own a low Young's modulus (22.61-112.45 kPa), high nominal tensile strength (0.99 MPa), and high sensitivity with a gauge factor up to 6.77 at strain of 300%. Based on its simple manufacture process, well mechanical matching suitability, and high sensitivity, the as-prepared sensor might have great potential for a wide range of large-scale applications such as wearable and implantable electronic devices.

In situ diagnosis and simultaneous treatment of cardiac diseases using a single-device platform

The in situ diagnosis of cardiac activities with simultaneous therapeutic electrical stimulation of the heart is key to preventing cardiac arrhythmia. Here, we present an unconventional single-device platform that enables in situ monitoring even in a wet condition and control of beating heart motions without interferences to the recording signal. This platform consists of the active-matrix array of pressure-sensitive transistors for detecting cardiac beatings, biocompatible, low-impedance electrodes for cardiac stimulations, and an alginate-based hydrogel adhesive for attaching this platform conformally to the epicardium. In contrast to conventional electrophysiological sensing using electrodes, the pressure-sensitive transistors measured mechanophysiological characteristics by monitoring the spatiotemporal distributions of cardiac pressures during heart beating motions. In vivo tests show mechanophysiological readings having good correlation with electrocardiography and negligible interference with the electrical artifacts caused during cardiac stimulations. This platform can therapeutically synchronize the rhythm of abnormal heartbeats through efficient pacing of cardiac arrhythmia.

Assembly of complex 3D structures and electronics on curved surfaces

Electronic devices with engineered three-dimensional (3D) architectures are indispensable for frictional-force sensing, wide-field optical imaging, and flow velocity measurement. Recent advances in mechanically guided assembly established deterministic routes to 3D structures in high-performance materials, through controlled rolling/folding/buckling deformations. The resulting 3D structures are, however, mostly formed on planar substrates and cannot be transferred directly onto another curved substrate. Here, we introduce an ordered assembly strategy to allow transformation of 2D thin films into sophisticated 3D structures on diverse curved surfaces. The strategy leverages predefined mechanical loadings that deform curved elastomer substrates into flat/cylindrical configurations, followed by an additional uniaxial/biaxial prestretch to drive buckling-guided assembly. Release of predefined loadings results in an ordered assembly that can be accurately captured by mechanics modeling, as illustrated by dozens of complex 3D structures assembled on curved substrates. Demonstrated applications include tunable dipole antennas, flow sensors inside a tube, and integrated electronic systems capable of conformal integration with the heart.

Hardware-Mappable Cellular Neural Networks for Distributed Wavefront Detection in Next-Generation Cardiac Implants

Artificial intelligence algorithms are being adopted to analyze medical data, promising faster interpretation to support doctors' diagnostics. The next frontier is to bring these powerful algorithms to implantable medical devices. Herein, a closed-loop solution is proposed, where a cellular neural network is used to detect abnormal wavefronts and wavebrakes in cardiac signals recorded in human tissue is trained to achieve >96% accuracy, >92% precision, >99% specificity, and >93% sensitivity, when floating point precision weights are assumed. Unfortunately, the current hardware technologies for floating point precision are too bulky or energy intensive for compact standalone applications in medical implants. Emerging device technologies, such as memristors, can provide the compact and energy-efficient hardware fabric to support these efforts and can be reliably embedded with existing sensor and actuator platforms in implantable devices. A distributed design that considers the hardware limitations in terms of overhead and limited bit precision is also discussed. The proposed distributed solution can be easily adapted to other medical technologies that require compact and efficient computing, like wearable devices and lab-on-chip platforms.

A Snakeskin-Inspired, Soft-Hinge Kirigami Metamaterial for Self-Adaptive Conformal Electronic Armor

A majority of soft-body creatures evolve armor or shells to protect themselves. Similar protection demand is for flexible electronics working in complex environments. Existing works mainly focus on improving the sensing capabilities such as electronic skin (E-skin). Inspired by snakeskin, a novel electronic armor (E-armor) is proposed, which not only possesses mechanical flexibility and electronic functions similar to E-skin, but is also able to protect itself and the underlying soft body from external physical damage. The geometry of the kirigami mechanical metamaterial (Kiri-MM) ensures auxetic stretchability and meanwhile large areal coverage for sufficient protection. Moreover, to suppress the inherent but undesired out-of-plane buckling of conventional Kiri-MMs for conformal applications, soft hinges are used to form a distinct soft (hinges)-rigid (tiles) configuration. Analytical, computational, and experimental studies of the mechanical behaviors of the soft-hinge Kiri-MM E-armor demonstrate the merits of this design, i.e., stretchability, conformability, and protectability, as applied to flexible electronics. Deploying a conductive soft material at the hinges enables facile wiring strategies for large-scale circuit arrays. Functional E-armor systems for controllable display and sensing purposes provide simple examples of a wide spectrum of applications of this concept.