Catheter-integrated soft multilayer electronic arrays for multiplexed sensing and actuation during cardiac surgery

Smart Hydrogel Swelling State Detection Based on a Power-Transfer Transduction Principle

Stimulus-responsive (smart) hydrogels are a promising sensing material for biomedical contexts due to their reversible swelling change in response to target analytes. The design of application-specific sensors that utilize this behavior requires the development of suitable transduction concepts. The presented study investigates a power-transfer-based readout approach that is sensitive to small volumetric changes of the smart hydrogel. The concept employs two thin film polyimide substrates with embedded conductive strip lines, which are shielded from each other except at the tip region, where the smart hydrogel is sandwiched in between. The hydrogel's volume change in response to a target analyte alters the distance and orientation of the thin films, affecting the amount of transferred power between the two transducer parts and, consequently, the measured sensor output voltage. With proper calibration, the output signal can be used to determine the swelling change of the hydrogel and, consequently, to quantify the stimulus. In proof-of-principle experiments with glucose- and pH-sensitive smart hydrogels, high sensitivity to small analyte concentration changes was found along with very good reproducibility and stability. The concept was tested with two exemplary hydrogels, but the transduction principle in general is independent of the specific hydrogel material, as long as it exhibits a stimulus-dependent volume change. The application vision of the presented research is to integrate in situ blood analyte monitoring capabilities into standard (micro)catheters. The developed sensor is designed to fit into a catheter without obstructing its normal use and, therefore, offers great potential for providing a universally applicable transducer platform for smart catheter-based sensing.

Implantable Resistive Strain Sensor-Decorated Colloidal Crystal Hydrogel Catheter for Intestinal Tract Pressure Sensing

In the quest to develop advanced monitoring systems for intestinal peristaltic stress, this study introduces a groundbreaking approach inspired by nature's sensory networks. By the integration of novel materials and innovative manufacturing techniques, a multifunctional Janus hydrogel patch has been engineered. This unique patch not only demonstrates superior stress-sensing capabilities in the intricate intestinal environment but also enables adhesion to wet tissue surfaces. This achievement opens new avenues for real-time physiological monitoring and potential therapeutic interventions in the realm of gastrointestinal health.

Temperature Self-Compensating Intelligent Wireless Measuring Contact Lens for Quantitative Intraocular Pressure Monitoring

Flexible bioelectronic devices that can perform real-time and accurate intraocular pressure (IOP) monitoring in both clinical and home settings hold significant implications for the diagnosis and treatment of glaucoma, yet they face challenges due to the open physiological environment of the ocular. Herein, we develop an intelligent wireless measuring contact lens (WMCL) incorporating a dual inductor-capacitor-resistor (LCR) resonant system to achieve temperature self-compensation for quantitative IOP monitoring in different application environments. The WMCL utilizes a compact circuitry design, which enables the integration of low-frequency and high-frequency resonators within a single layer of a sensing circuit without causing visual impairment. Mechanically guided microscale 3D encapsulation strategy combined with flexible circuit printing techniques achieves the surface-adaptive fabrication of the WMCL. The specific design of frequency separation imparts distinct temperature response characteristics to the dual resonators, and the linear combination of the dual resonators can eliminate the impact of temperature variations on measurement accuracy. The WMCL demonstrates outstanding sensitivity and linearity in monitoring the IOP of porcine eyes in vitro while maintaining satisfactory measurement accuracy even with internal temperature variations exceeding 10 °C. Overcoming the impact of temperature variations on IOP monitoring from the system level, the WMCL showcases immense potential as the next generation of all-weather IOP monitoring devices.

A Review of Recent Advancements in Sensor-Integrated Medical Tools

A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.

Hard Magnetic Graphene Nanocomposite for Multimodal, Reconfigurable Soft Electronics

Soft electronics provide effective means for continuous monitoring of a diverse set of biophysical and biochemical signals from the human body. However, the sensitivities, functions, spatial distributions, and many other features of such sensors remain fixed after deployment and cannot be adjusted on demand. Here, laser-induced porous graphene is exploited as the sensing material, and dope it with permanent magnetic particles to create hard magnetic graphene nanocomposite (HMGN) that can self-assemble onto a flexible carrying substrate through magnetic force, in a reversible and reconfigurable manner. A set of soft electronics in HMGN exhibits enhanced performances in the measurements of electrophysiological signals, temperature, and concentrations of metabolites. All these flexible HMGN sensors can adhere to a carrying substrate at any position and in any spatial arrangement, to allow for wearable sensing with customizable sensitivity, modality, and spatial coverage. The HMGN represents a promising material for constructing soft electronics that can be reconfigured for various applications.

Millimeter-scale magnetic implants paired with a fully integrated wearable device for wireless biophysical and biochemical sensing

Implantable sensors can directly interface with various organs for precise evaluation of health status. However, extracting signals from such sensors mainly requires transcutaneous wires, integrated circuit chips, or cumbersome readout equipment, which increases the risks of infection, reduces biocompatibility, or limits portability. Here, we develop a set of millimeter-scale, chip-less, and battery-less magnetic implants paired with a fully integrated wearable device for measuring biophysical and biochemical signals. The wearable device can induce a large amplitude damped vibration of the magnetic implants and capture their subsequent motions wirelessly. These motions reflect the biophysical conditions surrounding the implants and the concentration of a specific biochemical depending on the surface modification. Experiments in rat models demonstrate the capabilities of measuring cerebrospinal fluid (CSF) viscosity, intracranial pressure, and CSF glucose levels. This miniaturized system opens the possibility for continuous, wireless monitoring of a wide range of biophysical and biochemical conditions within the living organism.

Fast-Response Variable-Stiffness Magnetic Catheters for Minimally Invasive Surgery

In minimally invasive surgery, such as cardiac ablation, magnetically steered catheters made of variable-stiffness materials can enable higher dexterity and higher force application to human tissue. However, the long transition time between soft and rigid states leads to a significant increase in procedure duration. Here, a fast-response, multisegmented catheter is described for minimally invasive surgery made of variable-stiffness thread (FRVST) that encapsulates a helical cooling channel. The rapid stiffness change in the FRVST, composed of a nontoxic shape memory polymer, is achieved by an active cooling system that pumps water through the helical channel. The FRVST displays a 66 times stiffness change and a 26 times transition enhancement compare with the noncooled version. The catheter allows for selective bending of each segment up to 127° in air and up to 76° in water under an 80 mT external magnetic field. The inner working channel can be used for cooling an ablation tip during a procedure and for information exchange via the deployment of wires or surgical tools.

Bioinspired Stimuli-Responsive Materials for Soft Actuators

Biological species can walk, swim, fly, jump, and climb with fast response speeds and motion complexity. These remarkable functions are accomplished by means of soft actuation organisms, which are commonly composed of muscle tissue systems. To achieve the creation of their biomimetic artificial counterparts, various biomimetic stimuli-responsive materials have been synthesized and developed in recent decades. They can respond to various external stimuli in the form of structural or morphological transformations by actively or passively converting input energy into mechanical energy. They are the core element of soft actuators for typical smart devices like soft robots, artificial muscles, intelligent sensors and nanogenerators. Significant progress has been made in the development of bioinspired stimuli-responsive materials. However, these materials have not been comprehensively summarized with specific actuation mechanisms in the literature. In this review, we will discuss recent advances in biomimetic stimuli-responsive materials that are instrumental for soft actuators. Firstly, different stimuli-responsive principles for soft actuators are discussed, including fluidic, electrical, thermal, magnetic, light, and chemical stimuli. We further summarize the state-of-the-art stimuli-responsive materials for soft actuators and explore the advantages and disadvantages of using electroactive polymers, magnetic soft composites, photo-thermal responsive polymers, shape memory alloys and other responsive soft materials. Finally, we provide a critical outlook on the field of stimuli-responsive soft actuators and emphasize the challenges in the process of their implementation to various industries.

Machine learning-coupled tactile recognition with high spatiotemporal resolution based on cross-striped nanocarbon piezoresistive sensor array

Flexible pressure sensor arrays have been playing important roles in various applications of human-machine interface, including robotic tactile sensing, electronic skin, prosthetics, and human-machine interaction. However, it remains challenging to simultaneously achieve high spatial and temporal resolution in developing pressure sensor arrays for tactile sensing with robust function to achieve precise signal recognition. This work presents the development of a flexible high spatiotemporal piezoresistive sensor array (PRSA) by coupling with machine learning algorithms to enhance tactile recognition. The sensor employs cross-striped nanocarbon-polymer composite as an active layer, though screen printing manufacture processes. A miniaturized signal readout circuit and transmission board is developed to achieve high-speed acquisition of distributed pressure signals from the PRSA. Test results indicate that the developed PRSA platform simultaneously possesses the characteristics of high spatial resolution up to 1.5 mm, fast temporal resolution of about 5 ms, and long-term durability with a variation of less than 2%. The PRSA platform also exhibits excellent performance in real-time visualization of multi-point touch, mapping embossed shapes, and tracking motion trajectory. To test the performance of PRSA in recognizing different shapes, we acquired pressure images by pressing the finger-type device coated with PRSA film on different embossed shapes and implementing the T-distributed Stochastic Neighbor Embedding model to visualize the distinction between images of different shapes. Then we adopted a one-layer neural network to quantify the discernibility between images of different shapes. The analysis results show that the PRSA could capture the embossed shapes clearly by one contact with high discernibility up to 98.9%. Collectively, the PRSA as a promising platform demonstrates its promising potential for robotic tactile sensing.

Low-dimensional nanostructures for monolithic 3D-integrated flexible and stretchable electronics

Flexible/stretchable electronics, which are characterized by their ultrathin design, lightweight structure, and excellent mechanical robustness and conformability, have garnered significant attention due to their unprecedented potential in healthcare, advanced robotics, and human-machine interface technologies. An increasing number of low-dimensional nanostructures with exceptional mechanical, electronic, and/or optical properties are being developed for flexible/stretchable electronics to fulfill the functional and application requirements of information sensing, processing, and interactive loops. Compared to the traditional single-layer format, which has a restricted design space, a monolithic three-dimensional (M3D) integrated device architecture offers greater flexibility and stretchability for electronic devices, achieving a high-level of integration to accommodate the state-of-the-art design targets, such as skin-comfort, miniaturization, and multi-functionality. Low-dimensional nanostructures possess small size, unique characteristics, flexible/elastic adaptability, and effective vertical stacking capability, boosting the advancement of M3D-integrated flexible/stretchable systems. In this review, we provide a summary of the typical low-dimensional nanostructures found in semiconductor, interconnect, and substrate materials, and discuss the design rules of flexible/stretchable devices for intelligent sensing and data processing. Furthermore, artificial sensory systems in 3D integration have been reviewed, highlighting the advancements in flexible/stretchable electronics that are deployed with high-density, energy-efficiency, and multi-functionalities. Finally, we discuss the technical challenges and advanced methodologies involved in the design and optimization of low-dimensional nanostructures, to achieve monolithic 3D-integrated flexible/stretchable multi-sensory systems.

Sensorized Endovascular Technologies: Additional Data to Enhance Decision-Making

BACKGROUND

Current endovascular procedures rely mostly on anatomic information, guided by fluoroscopy, to perform interventions (i.e. angioplasty, stent placement, coils). However, the structural parameters provided by these imaging technologies do not provide any physiological data on either the disease state or efficacy of intervention. Additional endovascular tools are needed to collect physiologic and other both anatomic and nonanatomic data to further individualize endovascular interventions with the ultimate goal of improving patient outcomes. This review details the current state of the art for these sensorized endovascular technologies and details systems under development with the aim of identifying gaps and new directions. The objective of this review was to survey the Vascular Surgery literature, engineering literature, and commercially available products to determine what exists in terms of sensor-enabled endovascular devices and where gaps and opportunities exist for further sensor integration.

METHODS

Search terms were entered into search engines such as Google and Google Scholar to identify endovascular devices containing sensors. A variety of terms were used including directly search for items such as "sensor-enabled endovascular devices" and then also completing more refined searches bases on areas of interest (i.e. fractional flow reserve, navigation, retrograde endovascular balloon occlusion of the aorta, etc.). For the most part, systems were included where the sensor was mounted directly onto the catheter and implantable sensors such as those that have been investigated for use with stents have been excluded.

RESULTS

The authors were able to identify a body of literature in the area of endovascular devices that contain sensors to measure physiologic information. However, areas where additional sensing capabilities may be useful were identified.

CONCLUSIONS

Several different types of sensors and sensing systems were identified that have been integrated with endovascular catheters. Although a great deal of work has been done in this field, there are additional useful data that could be obtained from additional novel sensing technologies. Furthermore, significant effort needs to be allocated to carefully studying how these new technologies can be employed to actually improve patient outcomes.

Colloidal crystals array enabled bionic biliary stent for efficient domestic biofluid management

In vivo surgical interventions require effective management of biofluids, including controlling bleeding and removing excess biofluids such as bile, wound exudate, and blood. To address these issues, recent advances have emerged, such as self-sealing needles, drug-eluting stents, and shear-thinning hydrogels. However, complications associated with intestinal mucosal injury and secondary damage still persist. Therefore, a multifunctional stent is urgently required that can effectively remove excessive biofluid. Surface wettability of biliary stents is crucial in biofluid management, and conventional coatings can cause adhesion to wound tissue. To overcome this issue, we developed an interpenetrating Janus wettability stent coating, enabling unidirectional draining of excessive biofluid from its hydrophobic side to hydrophilic side, thereby preventing biofluid from wetting the wound. Furthermore, we demonstrate a directional biofluid movement using a self-pumping dressing in an infected tissue model, providing a new approach for in situ biofluid collection and disease diagnosis by detecting metal ion changes. Overall, our integrated system presents an opportunity to design wound dressings with effective biofluid management and metal ion detection capabilities.

A self-powered intracardiac pacemaker in swine model

Harvesting biomechanical energy from cardiac motion is an attractive power source for implantable bioelectronic devices. Here, we report a battery-free, transcatheter, self-powered intracardiac pacemaker based on the coupled effect of triboelectrification and electrostatic induction for the treatment of arrhythmia in large animal models. We show that the capsule-shaped device (1.75 g, 1.52 cc) can be integrated with a delivery catheter for implanting in the right ventricle of a swine through the intravenous route, which effectively converts cardiac motion energy to electricity and maintains endocardial pacing function during the three-week follow-up period. We measure in vivo open circuit voltage and short circuit current of the self-powered intracardiac pacemaker of about 6.0 V and 0.2 μA, respectively. This approach exhibits up-to-date progress in self-powered medical devices and it may overcome the inherent energy shortcomings of implantable pacemakers and other bioelectronic devices for therapy and sensing.

Integrated Sensors for Soft Medical Robotics

Minimally invasive procedures assisted by soft robots for surgery, diagnostics, and drug delivery have unprecedented benefits over traditional solutions from both patient and surgeon perspectives. However, the translation of such technology into commercialization remains challenging. The lack of perception abilities is one of the obstructive factors paramount for a safe, accurate and efficient robot-assisted intervention. Integrating different types of miniature sensors onto robotic end-effectors is a promising trend to compensate for the perceptual deficiencies in soft robots. For example, haptic feedback with force sensors helps surgeons to control the interaction force at the tool-tissue interface, impedance sensing of tissue electrical properties can be used for tumor detection. The last decade has witnessed significant progress in the development of multimodal sensors built on the advancement in engineering, material science and scalable micromachining technologies. This review article provides a snapshot on common types of integrated sensors for soft medical robots. It covers various sensing mechanisms, examples for practical and clinical applications, standard manufacturing processes, as well as insights on emerging engineering routes for the fabrication of novel and high-performing sensing devices.

Rational Design of Flexible Mechanical Force Sensors for Healthcare and Diagnosis

Over the past decade, there has been a significant surge in interest in flexible mechanical force sensing devices and systems. Tremendous efforts have been devoted to the development of flexible mechanical force sensors for daily healthcare and medical diagnosis, driven by the increasing demand for wearable/portable devices in long-term healthcare and precision medicine. In this review, we summarize recent advances in diverse categories of flexible mechanical force sensors, covering piezoresistive, capacitive, piezoelectric, triboelectric, magnetoelastic, and other force sensors. This review focuses on their working principles, design strategies and applications in healthcare and diagnosis, with an emphasis on the interplay among the sensor architecture, performance, and application scenario. Finally, we provide perspectives on the remaining challenges and opportunities in this field, with particular discussions on problem-driven force sensor designs, as well as developments of novel sensor architectures and intelligent mechanical force sensing systems.

Recent Advances in Sensor-Actuator Hybrid Soft Systems: Core Advantages, Intelligent Applications, and Future Perspectives

The growing demand for soft intelligent systems, which have the potential to be used in a variety of fields such as wearable technology and human-robot interaction systems, has spurred the development of advanced soft transducers. Among soft systems, sensor-actuator hybrid systems are considered the most promising due to their effective and efficient performance, resulting from the synergistic and complementary interaction between their sensor and actuator components. Recent research on integrated sensor and actuator systems has resulted in a range of conceptual and practical soft systems. This review article provides a comprehensive analysis of recent advances in sensor and actuator integrated systems, which are grouped into three categories based on their primary functions: i) actuator-assisted sensors for intelligent detection, ii) sensor-assisted actuators for intelligent movement, and iii) sensor-actuator interactive devices for a hybrid of intelligent detection and movement. In addition, several bottlenecks in current studies are discussed, and prospective outlooks, including potential applications, are presented. This categorization and analysis will pave the way for the advancement and commercialization of sensor and actuator-integrated systems.

Finite element analysis of the interaction between high-compliant balloon catheters and non-cylindrical vessel structures: towards tactile sensing balloon catheters

Aiming for sensing balloon catheters which are able to provide intraoperative information of the vessel stiffness and shape, the present study uses finite element analysis (FEA) to evaluate the interaction between high-compliant elastomer balloon catheters with the inner wall of a non-cylindrical-shaped lumen structure. The contact simulations are based on 3D models with varying balloon thicknesses and varying tissue geometries to analyse the resulting balloon and tissue deformation as well as the inflation pressure dependent contact area. The wrinkled tissue structure is modelled by utilizing a two-layer fibre-based Holzapfel-Gasser-Ogden constitutive model and the model parameters are adapted based on available biomechanical data for human urethral vessel samples. The balloon catheter structure is implemented as a high-compliant hyper-elastic silicone material (based on polydimethylsiloxane (PDMS)) with a varying catheter wall thickness between 0.5 and 2.5 µm. Two control parameters are introduced to describe the balloon shape adaption in reaction to a wrinkled vessel wall during the inflation process. Basic semi-quantitative relations are revealed depending on the evolving balloon deformation and contact surface. Based on these relations some general design guidelines for balloon-based sensor catheters are presented. The results of the conducted in-silico study reveal some general interdependencies with respect to the compliance ratio between balloon and tissue and also in respect of the tissue aspect ratio. Further they support the proposed concept of high-compliant balloon catheters equipped for tactile sensing as diagnosis approach in urology and angioplasty.

Direct-Ink-Writing 3D-Printed Bioelectronics

The development of wearable and implantable bioelectronics has garnered significant momentum in recent years, driven by the ever-increasing demand for personalized health monitoring, remote patient management, and real-time physiological data collection. The elevated sophistication and advancement of these devices have thus led to the use of many new and unconventional materials which cannot be fulfilled through traditional manufacturing techniques. Three-dimension (3D) printing, also known as additive manufacturing, is an emerging technology that opens new opportunities to fabricate next-generation bioelectronic devices. Some significant advantages include its capacity for material versatility and design freedom, rapid prototyping, and manufacturing efficiency with enhanced capabilities. This review provides an overview of the recent advances in 3D printing of bioelectronics, particularly direct ink writing (DIW), encompassing the methodologies, materials, and applications that have emerged in this rapidly evolving field. This review showcases the broad range of bioelectronic devices fabricated through 3D printing including wearable biophysical sensors, biochemical sensors, electrophysiological sensors, energy devices, multimodal systems, implantable devices, and soft robots. This review will also discuss the advantages, existing challenges, and outlook of applying DIW 3D printing for the development of bioelectronic devices toward healthcare applications.

Insight into the surface behavior and dynamic absorptivity of laser removal of multilayer materials

Laser-materials interaction is the fascinating nexus where laser optics, physical/ chemistry, and materials science intersect. Exploring the dynamic interaction process and mechanism of laser pulses with materials is of great significance for analyzing laser processing. Laser micro/nano processing of multilayer materials is not an invariable state, but rather a dynamic reaction with unbalanced and multi-scale, which involves multiple physical states including laser ablation, heat accumulation and conduction, plasma excitation and shielding evolution. Among them, several physical characteristics interact and couple with each other, including the surface micromorphology of the ablated material, laser absorption characteristics, substrate temperature, and plasma shielding effects. In this paper, we propose an in-situ monitoring system for laser scanning processing with coaxial spectral detection, online monitoring and identification of the characteristic spectral signals of multilayer heterogeneous materials during repeated scanning removal by laser-induced breakdown spectroscopy. Additionally, we have developed an equivalent roughness model to quantitatively analyze the influence of surface morphology changes on laser absorptivity. The influence of substrate temperature on material electrical conductivity and laser absorptivity was calculated theoretically. This reveals the physical mechanism of dynamic variations in laser absorptivity caused by changes in plasma characteristics, surface roughness, and substrate temperature, and it provides valuable guidance for understanding the dynamic process and interaction mechanism of laser with multilayer materials.

A self-assembled implantable microtubular pacemaker for wireless cardiac electrotherapy

The current cardiac pacemakers are battery dependent, and the pacing leads are prone to introduce valve damage and infection, plus a complete pacemaker retrieval is needed for battery replacement. Despite the reported wireless bioelectronics to pace the epicardium, open-chest surgery (thoracotomy) is required to implant the device, and the procedure is invasive, requiring prolonged wound healing and health care burden. We hereby demonstrate a fully biocompatible wireless microelectronics with a self-assembled design that can be rolled into a lightweight microtubular pacemaker for intravascular implantation and pacing. The radio frequency was used to transfer energy to the microtubular pacemaker for electrical stimulation. We show that this pacemaker provides effective pacing to restore cardiac contraction from a nonbeating heart and have the capacity to perform overdrive pacing to augment blood circulation in an anesthetized pig model. Thus, this microtubular pacemaker paves the way for the minimally invasive implantation of leadless and battery-free microelectronics.

Mechanically-Compliant Bioelectronic Interfaces through Fatigue-Resistant Conducting Polymer Hydrogel Coating

Because of their distinct electrochemical and mechanical properties, conducting polymer hydrogels have been widely exploited as soft, wet, and conducting coatings for conventional metallic electrodes, providing mechanically compliant interfaces and mitigating foreign body responses. However, the long-term viability of these hydrogel coatings is hindered by concerns regarding fatigue crack propagation and/or delamination caused by repetitive volumetric expansion/shrinkage during long-term electrical interfacing. This study reports a general yet reliable approach to achieving a fatigue-resistant conducting polymer hydrogel coating on conventional metallic bioelectrodes by engineering nanocrystalline domains at the interface between the hydrogel and metallic substrates. It demonstrates the efficacy of this robust, biocompatible, and fatigue-resistant conducting hydrogel coating in cardiac pacing, showcasing its ability to effectively reduce the pacing threshold voltage and enhance the long-term reliability of electric stimulation. This study findings highlight the potential of its approach as a promising design and fabrication strategy for the next generation of seamless bioelectronic interfaces.

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.

Highly sensitive and broadband meta-mechanoreceptor via mechanical frequency-division multiplexing

Bio-mechanoreceptors capable of micro-motion sensing have inspired mechanics-guided designs of micro-motion sensors in various fields. However, it remains a major challenge for mechanics-guided designs to simultaneously achieve high sensitivity and broadband sensing due to the nature of resonance effect. By mimicking rat vibrissae, here we report a metamaterial mechanoreceptor (MMR) comprised of piezoelectric resonators with distributed zero effective masses featuring a broad range of local resonances, leading to near-infinite sensitivity for micro-motion sensing within a broad bandwidth. We developed a mechanical frequency-division multiplexing mechanism for MMR, in which the measured micro-motion signal is mechanically modulated in non-overlapping frequency bands and reconstructed by a computational multi-channel demodulation approach. The maximum sensitivity of MMR is improved by two orders of magnitude compared to conventional mechanics-guided mechanoreceptors, and its bandwidth with high sensitivity is extendable towards both low-frequency and high-frequency ranges in 0-12 kHz through tuning the local resonance of each individual sensing cell. The MMR is a promising candidate for highly sensitive and broadband micro-motion sensing that was previously inaccessible for mechanics-guided mechanoreceptors, opening pathways towards spatio-temporal sensing, remote-vibration monitoring and smart-driving assistance.

A soft, bioinspired artificial lymphatic system for interactive ascites transfer

Low-flow removal of refractory ascites is critical to treating cirrhosis and digestive system tumor, and thus, commercial ascites pump emerged lately. The rigid structure of clinically available pumps rises complication rate and lack of flow rate monitoring hinders early warning of abnormalities. Herein, a soft artificial system was proposed inspired by lymph for interactive ascites transfer with great biocompatibility. The implantable system is composed of pump cavity, valves and tubes, which are soft and flexible made by silica gel. Therefore, the system possesses similar modulus to tissues and can naturally fit surrounding tissues. The cavity with magnetic tablet embedded is driven by extracorporeal magnetic field. Subsequently, the system can drain ascites with a top speed of 23 mL min-1, much higher than that of natural lymphatic system and state-of-art devices. Moreover, integrated flexible sensors enable wireless, real-time flow rate monitoring, serving as proof of treatment adjustment, detection and locating of malfunction at early stage. The liver function of experimental objects was improved, and no severe complications occurred for 4 weeks, which proved its safety and benefit to treatment. This artificial lymphatic system can serve as a bridge to recovery and pave the way for further clinical research.

Magnetically assisted soft milli-tools for occluded lumen morphology detection

Methodologies based on intravascular imaging have revolutionized the diagnosis and treatment of endovascular diseases. However, current methods are limited in detecting, i.e., visualizing and crossing, complicated occluded vessels. Therefore, we propose a miniature soft tool comprising a magnet-assisted active deformation segment (ADS) and a fluid drag-driven segment (FDS) to visualize and cross the occlusions with various morphologies. First, via soft-bodied deformation and interaction, the ADS could visualize the structure details of partial occlusions with features as small as 0.5 millimeters. Then, by leveraging the fluidic drag from the pulsatile flow, the FDS could automatically detect an entry point selectively from severe occlusions with complicated microchannels whose diameters are down to 0.2 millimeters. The functions have been validated in both biologically relevant phantoms and organs ex vivo. This soft tool could help enhance the efficacy of minimally invasive medicine for the diagnosis and treatment of occlusions in various circulatory systems.

Conformal in-ear bioelectronics for visual and auditory brain-computer interfaces

Brain-computer interfaces (BCIs) have attracted considerable attention in motor and language rehabilitation. Most devices use cap-based non-invasive, headband-based commercial products or microneedle-based invasive approaches, which are constrained for inconvenience, limited applications, inflammation risks and even irreversible damage to soft tissues. Here, we propose in-ear visual and auditory BCIs based on in-ear bioelectronics, named as SpiralE, which can adaptively expand and spiral along the auditory meatus under electrothermal actuation to ensure conformal contact. Participants achieve offline accuracies of 95% in 9-target steady state visual evoked potential (SSVEP) BCI classification and type target phrases successfully in a calibration-free 40-target online SSVEP speller experiment. Interestingly, in-ear SSVEPs exhibit significant 2nd harmonic tendencies, indicating that in-ear sensing may be complementary for studying harmonic spatial distributions in SSVEP studies. Moreover, natural speech auditory classification accuracy can reach 84% in cocktail party experiments. The SpiralE provides innovative concepts for designing 3D flexible bioelectronics and assists the development of biomedical engineering and neural monitoring.

Recent Advances in Flexible Piezoresistive Arrays: Materials, Design, and Applications

Spatial distribution perception has become an important trend for flexible pressure sensors, which endows wearable health devices, bionic robots, and human-machine interactive interfaces (HMI) with more precise tactile perception capabilities. Flexible pressure sensor arrays can monitor and extract abundant health information to assist in medical detection and diagnosis. Bionic robots and HMI with higher tactile perception abilities will maximize the freedom of human hands. Flexible arrays based on piezoresistive mechanisms have been extensively researched due to the high performance of pressure-sensing properties and simple readout principles. This review summarizes multiple considerations in the design of flexible piezoresistive arrays and recent advances in their development. First, frequently used piezoresistive materials and microstructures are introduced in which various strategies to improve sensor performance are presented. Second, pressure sensor arrays with spatial distribution perception capability are discussed emphatically. Crosstalk is a particular concern for sensor arrays, where mechanical and electrical sources of crosstalk issues and the corresponding solutions are highlighted. Third, several processing methods are also introduced, classified as printing, field-assisted and laser-assisted fabrication. Next, the representative application works of flexible piezoresistive arrays are provided, including human-interactive systems, healthcare devices, and some other scenarios. Finally, outlooks on the development of piezoresistive arrays are given.

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.

Emerging sensing and modeling technologies for wearable and cuffless blood pressure monitoring

Cardiovascular diseases (CVDs) are a leading cause of death worldwide. For early diagnosis, intervention and management of CVDs, it is highly desirable to frequently monitor blood pressure (BP), a vital sign closely related to CVDs, during people's daily life, including sleep time. Towards this end, wearable and cuffless BP extraction methods have been extensively researched in recent years as part of the mobile healthcare initiative. This review focuses on the enabling technologies for wearable and cuffless BP monitoring platforms, covering both the emerging flexible sensor designs and BP extraction algorithms. Based on the signal type, the sensing devices are classified into electrical, optical, and mechanical sensors, and the state-of-the-art material choices, fabrication methods, and performances of each type of sensor are briefly reviewed. In the model part of the review, contemporary algorithmic BP estimation methods for beat-to-beat BP measurements and continuous BP waveform extraction are introduced. Mainstream approaches, such as pulse transit time-based analytical models and machine learning methods, are compared in terms of their input modalities, features, implementation algorithms, and performances. The review sheds light on the interdisciplinary research opportunities to combine the latest innovations in the sensor and signal processing research fields to achieve a new generation of cuffless BP measurement devices with improved wearability, reliability, and accuracy.

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.

Balloon Catheter-Integrated Piezoelectric Micropyramid Arrays for Measuring Vascular Stiffness

Atherosclerosis is one of the severe cardiovascular diseases in which blood vessels lose elasticity and the lumen narrows. If atherosclerosis worsens, it commonly leads to acute coronary syndrome (ACS) due to the rupture of vulnerable plaque or aortic aneurysm. As the mechanical properties of vascular tissues vary from their conditions, measuring the vascular stiffness of an inner blood vessel wall may be applied to the accurate diagnosis of atherosclerotic symptoms. Therefore, early mechanical detection of vascular stiffness is highly needed for immediate medical attention for ACS. Even with conventional examination methods such as intravascular ultrasonography and optical coherence tomography, several limitations still remain that make it difficult to directly determine the mechanical properties of the vascular tissue. As piezoelectric materials convert mechanical energy to electricity without an external power source, a piezoelectric nanocomposite could be utilized as a balloon catheter-integrated mechanical sensor on its surface. Here, we present piezoelectric nanocomposite micropyramid balloon catheter (p-MPB) arrays for measuring vascular stiffness. We study the structural characterization and feasibility of p-MPB as endovascular sensors by conducting finite element method analyses. Also, multifaceted piezoelectric voltages are measured by compression/release tests, in vitro vascular phantom tests, and ex vivo porcine heart tests to confirm that the p-MPB sensor properly operates in blood vessels.

Technology Roadmap for Flexible Sensors

Humans rely increasingly on sensors to address grand challenges and to improve quality of life in the era of digitalization and big data. For ubiquitous sensing, flexible sensors are developed to overcome the limitations of conventional rigid counterparts. Despite rapid advancement in bench-side research over the last decade, the market adoption of flexible sensors remains limited. To ease and to expedite their deployment, here, we identify bottlenecks hindering the maturation of flexible sensors and propose promising solutions. We first analyze challenges in achieving satisfactory sensing performance for real-world applications and then summarize issues in compatible sensor-biology interfaces, followed by brief discussions on powering and connecting sensor networks. Issues en route to commercialization and for sustainable growth of the sector are also analyzed, highlighting environmental concerns and emphasizing nontechnical issues such as business, regulatory, and ethical considerations. Additionally, we look at future intelligent flexible sensors. In proposing a comprehensive roadmap, we hope to steer research efforts towards common goals and to guide coordinated development strategies from disparate communities. Through such collaborative efforts, scientific breakthroughs can be made sooner and capitalized for the betterment of humanity.

Flexible Triboelectric Tactile Sensor Based on a Robust MXene/Leather Film for Human-Machine Interaction

With the rapid development of Internet of Things (IoT) technology in recent years, self-actuated sensor systems without an external power supply such as flexible triboelectric nanogenerator (TENG)-based strain sensors have received wide attention due to their simple structure and self-powered active sensing properties. However, to satisfy the practical applications of human wearable biointegration, flexible TENGs impose higher requirements for establishing a balance between material flexibility and good electrical properties. In this work, the strength of the MXene/substrate interface was greatly improved by utilizing leather with a unique surface structure as the substrate material, resulting in a mechanically strong and electrically conductive MXene film. Due to the natural fiber structure of the leather surface, the surface of the MXene film with a rough structure was obtained, which improved the electrical output performance of the TENG. The electrode output voltage of MXene film on leather based on single-electrode TENG can reach 199.56 V and the maximum output power density can reach 0.469 mW/cm². Combined with laser-assisted technology, the efficient array preparation of MXene and graphene was achieved and applied to various human-machine interface (HMI) applications.

Self-folding soft-robotic chains with reconfigurable shapes and functionalities

Magnetic continuum soft robots can actively steer their tip under an external magnetic field, enabling them to effectively navigate in complex in vivo environments and perform minimally invasive interventions. However, the geometries and functionalities of these robotic tools are limited by the inner diameter of the supporting catheter as well as the natural orifices and access ports of the human body. Here, we present a class of magnetic soft-robotic chains (MaSoChains) that can self-fold into large assemblies with stable configurations using a combination of elastic and magnetic energies. By pushing and pulling the MaSoChain relative to its catheter sheath, repeated assembly and disassembly with programmable shapes and functions are achieved. MaSoChains are compatible with state-of-the-art magnetic navigation technologies and provide many desirable features and functions that are difficult to realize through existing surgical tools. This strategy can be further customized and implemented for a wide spectrum of tools for minimally invasive interventions.

Intelligent Soft Sweat Sensors for the Simultaneous Healthcare Monitoring and Safety Warning

Intelligent monitoring human physiological information in real time raises the demand for skin-integrated electronics, as which is a flexible format and can be mounted onto the curved human skin for noninvasive healthcare monitoring. The biofluid such as sweat from skin contains abundant biomarkers reflecting body health conditions. Here, a skin-integrated sweat monitor with six biosensors embedded for the detection of NH₄ ⁺ , Na⁺ , glucose, pH, skin impedance, and surface temperature is described, which could decode the information in the fresh sweat generated during exercising. Furthermore, the system also includes an innovative safety warning mechanism, which is based on a miniaturized actuator to provide mechanical stimuli, and coupled with six changeable colors light emitting diodes corresponding to the six biosensors for providing simultaneous safety alarming to users. The self-developed microfluidics system with a hydrophilic surface allows to enhance the sweat collection rate. Meanwhile, microfluidic filters can reduce the interruption of skin debris during biosignal monitoring. These state-of-art biosensors can real-time monitor health related signals with excellent linearity and specificity. The skin-integrated sweat monitor system exhibits a great potential in human healthcare monitoring and medical treatment.

Advanced thermal sensing techniques for characterizing the physical properties of skin

Measurements of the thermal properties of the skin can serve as the basis for a noninvasive, quantitative characterization of dermatological health and physiological status. Applications range from the detection of subtle spatiotemporal changes in skin temperature associated with thermoregulatory processes, to the evaluation of depth-dependent compositional properties and hydration levels, to the assessment of various features of microvascular/macrovascular blood flow. Examples of recent advances for performing such measurements include thin, skin-interfaced systems that enable continuous, real-time monitoring of the intrinsic thermal properties of the skin beyond its superficial layers, with a path to reliable, inexpensive instruments that offer potential for widespread use as diagnostic tools in clinical settings or in the home. This paper reviews the foundational aspects of the latest thermal sensing techniques with applicability to the skin, summarizes the various devices that exploit these concepts, and provides an overview of specific areas of application in the context of skin health. A concluding section presents an outlook on the challenges and prospects for research in this field.

Multifunctional Fiber-Enabled Intelligent Health Agents

The application of wearable devices is promoting the development toward digitization and intelligence in the field of health. However, the current smart devices centered on human health have disadvantages such as weak perception, high interference degree, and unfriendly interaction. Here, an intelligent health agent based on multifunctional fibers, with the characteristics of autonomy, activeness, intelligence, and perceptibility enabling health services, is proposed. According to the requirements for healthcare in the medical field and daily life, four major aspects driven by intelligent agents, including health monitoring, therapy, protection, and minimally invasive surgery, are summarized from the perspectives of materials science, medicine, and computer science. The function of intelligent health agents is realized through multifunctional fibers as sensing units and artificial intelligence technology as a cognitive engine. The structure, characteristics, and performance of fibers and analysis systems and algorithms are reviewed, while discussing future challenges and opportunities in healthcare and medicine. Finally, based on the above four aspects, future scenarios related to health protection of a person's life are presented. Intelligent health agents will have the potential to accelerate the realization of precision medicine and active health.

Globefish-Inspired Balloon Catheter with Intelligent Microneedle Coating for Endovascular Drug Delivery

Balloon catheters exhibit important values in treating cardiovascular diseases, while their functions are still under improvements. Here, inspired by the thorn-hiding and deflating-inflating characteristics of globefish, intelligent balloon catheters decorated with invisible microneedles are presented for endovascular drug delivery to inhibit postintervention restenosis (PIRS). These microneedle balloon catheters (MNBCs) fabricated by dipping and rolling-assisted template replication contain three coating layers of sandwiched drug-carrying microneedles and black phosphorus (BP)-carrying gelatin. During the emplacement, the microneedles of MNBCs are hidden under the outermost gelatin protective layer, allowing smooth movements inside the blood vessel. After reaching the destination, the embedded BP converts near infrared (NIR) into heat, increases local temperature, and melts the gelatin layer, enabling the exposure and vascular penetration of the microneedles. Besides, as the innermost gelatin also melts, the microneedles can detach from the balloon catheter and be left inside the blood vessel for continuous drug release. Based on advantages of responsiveness, penetration capacity, and biosafety, it is demonstrated that the MNBCs behave satisfactorily in delivering rapamycin to inhibit abdominal aorta restenosis in rats. All these features indicate that these MNBCs are promising medical devices for clinical applications.

Wireless Flexible Magnetic Tactile Sensor with Super-Resolution in Large-Areas

Tactile recognition is among the basic survival skills of human beings, and advances in tactile sensor technology have been adopted in various fields, bringing benefits such as outstanding performance in manipulating objects and general human-robot interactions. However, promoting enhanced perception of the existing tactile sensors is limited by their sensor array arrangement and wire-connected design. Here we present a wireless flexible magnetic tactile sensor (FMTS) consisting of a multidirection magnetized flexible film (perception module) and a contactless Hall sensor (signal receiving module). The flexible magnetic film is composed of NdFeB microparticles and soft silicone elastomer microparticles, and it transfers the unambiguous transduction of external force position and magnitude into magnetic signals. Benefiting from the specific magnetization arrangement and clustering algorithm, only one Hall sensor is needed in FMTS to perceive the magnitude and position of the contact spot simultaneously with super-resolution (2.1 mm average error) on a large area (3600 mm²), and the effective working distance is also greatly extended (∼30 mm), allowing for the full softness and adaptability to diverse conditions. We anticipate that this design will promote the development of soft tactile sensors and their integration into human-robot interaction and humanoid robot perception.

In Situ Forming Epidermal Bioelectronics for Daily Monitoring and Comprehensive Exercise

Conventional epidermal bioelectronics usually do not conform well with natural skin surfaces and are susceptible to motion artifact interference, due to incompatible dimensions, insufficient adhesion, imperfect compliance, and usually require complex manufacturing and high costs. We propose in situ forming hydrogel electrodes or electronics (ISF-HEs) that can establish highly conformal interfaces on curved biological surfaces without auxiliary adhesions. The ISF-HEs also have favorable flexibility and soft compliance comparable to human skin (≈0.02 kPa^-1), which can stably maintain synchronous movements with deformed skins. Thus, the as-prepared ISF-HEs can accurately monitor large and tiny human motions with short response time (≈180 ms), good biocompatibility, and excellent performance. The as-obtained nongapped hydrogel electrode-skin interfaces achieve ultralow interfacial impedance (≈50 KΩ), nearly an order of magnitude lower than commercial Ag|AgCl electrodes as well as other reported dry and wet electrodes, regardless of the intrinsic micro-obstacles (wrinkles, hair) and skin deformation interference. Therefore, the ISF-HEs can collect high-quality electrocardiography and surface electromyography (sEMG) signals, with high signal-to-noise ratio (SNR ≈ 32.04 dB), reduced signal crosstalk, and minimized motion artifact interference. Simultaneously monitoring human motions and sEMG signals have also been implemented for the general exercise status assessment, such as the shooting competition in the Olympics. The as-prepared ISF-HEs can be considered as supplements/substitutes of conventional electrodes in percutaneously noninvasive monitoring of multifunctional physiological signals for health and exercise status.

Progress in Probe-Based Sensing Techniques for In Vivo Diagnosis

Advancements in robotic surgery help to improve the endoluminal diagnosis and treatment with minimally invasive or non-invasive intervention in a precise and safe manner. Miniaturized probe-based sensors can be used to obtain information about endoluminal anatomy, and they can be integrated with medical robots to augment the convenience of robotic operations. The tremendous benefit of having this physiological information during the intervention has led to the development of a variety of in vivo sensing technologies over the past decades. In this paper, we review the probe-based sensing techniques for the in vivo physical and biochemical sensing in China in recent years, especially on in vivo force sensing, temperature sensing, optical coherence tomography/photoacoustic/ultrasound imaging, chemical sensing, and biomarker sensing.

Multicomponent and multifunctional integrated miniature soft robots

Miniature soft robots with elaborate structures and programmable physical properties could conduct micromanipulation with high precision as well as access confined and tortuous spaces, which promise benefits in medical tasks and environmental monitoring. To improve the functionalities and adaptability of miniature soft robots, a variety of integrated design and fabrication strategies have been proposed for the development of miniaturized soft robotic systems integrated with multicomponents and multifunctionalities. Combining the latest advancement in fabrication technologies, intelligent materials and active control methods enable these integrated robotic systems to adapt to increasingly complex application scenarios including precision medicine, intelligent electronics, and environmental and proprioceptive sensing. Herein, this review delivers an overview of various integration strategies applicable for miniature soft robotic systems, including semiconductor and microelectronic techniques, modular assembly based on self-healing and welding, modular assembly based on bonding agents, laser machining techniques, template assisted methods with modular material design, and 3D printing techniques. Emerging applications of the integrated miniature soft robots and perspectives for the future design of small-scale intelligent robots are discussed.

Wearable, wireless, multi-sensor device for monitoring tissue circulation after free-tissue transplantation: a multicentre clinical trial

Wearable sensors have seen remarkable recent technological developments, and their role in healthcare is expected to expand. Specifically, monitoring tissue circulation in patients who have undergone reconstructive surgery is critical because blood flow deficiencies must be rescued within hours or the transplant will fail due to thrombosis/haematoma within the artery or vein. We design a wearable, wireless, continuous, multipoint sensor to monitor tissue circulation. The system measures pulse waves, skin colour, and tissue temperature to reproduce physician assessment. Data are analysed in real time for patient risk using an algorithm. This multicentre clinical trial involved 73 patients who underwent transplant surgery and had their tissue circulation monitored until postoperative day 7. Herein, we show that the overall agreement rate between physician and sensor findings is 99.2%. In addition, the patient questionnaire results indicate that the device is easy to wear. The sensor demonstrates non-invasive, real-time, continuous, multi-point, wireless, and reliable monitoring for postoperative care. This wearable system can improve the success rate of reconstructive surgeries.

Low-cost gastrointestinal manometry via silicone-liquid-metal pressure transducers resembling a quipu

The evaluation of the tone and contractile patterns of the gastrointestinal (GI) tract via manometry is essential for the diagnosis of GI motility disorders. However, manometry is expensive and relies on complex and bulky instrumentation. Here we report the development and performance of an inexpensive and easy-to-manufacture catheter-like device for capturing manometric data across the dynamic range observed in the human GI tract. The device, which we designed to resemble the quipu-knotted strings used by Andean civilizations for the capture and transmission of information-consists of knotted piezoresistive pressure sensors made by infusing a liquid metal (eutectic gallium-indium) through thin silicone tubing. By exploring a range of knotting configurations, we identified optimal design schemes that led to sensing performances comparable to those of commercial devices for GI manometry, as we show for the sensing of GI motility in multiple anatomic sites of the GI tract of anaesthetized pigs. Disposable and customizable piezoresistive catheters may broaden the use of GI manometry in low-resource settings.

Ultrathin Fiber-Mesh Polymer Thermistors

Flexible sensors enable on-skin and in-body health monitoring, which require flexible thermal protection circuits to prevent overheating and operate the devices safely. Here, ultrathin fiber-mesh polymer positive temperature coefficient (PTC) thermistors via electrospinning are developed. The fiber-type thermistors are composed of acrylate polymer and carbon nanofibers. The fibrous composite materials are coated with a parylene to form a core-sheath structure, which improves the repeatability of temperature characteristics. Approximately 5 µm thick fiber-type thermistors exhibit an increase in the resistance by three orders of magnitude within ≈2 °C and repeatable temperature characteristics for up to 400 cycles. The mesh structure enables the thermistor layer to be ultra-lightweight and transparent; the mesh-type thermistor operates with a fiber density of 16.5 µg cm^-2 , whose fiber layer has a transmittance of more than 90% in the 400-800 nm region. By fabricating the mesh thermistor on a 1.4 µm thick substrate, the thermistor operates without degradation when wrapped around a 280 µm radius needle. Furthermore, the gas-permeable property is demonstrated by fabricating the fibrous thermistor on a mesh substrate. The proposed ultrathin mesh polymer PTC thermistors form the basis for on-skin and implantable devices that are equipped with overheat prevention.

Fluidic enabled bioelectronic implants: opportunities and challenges

Bioelectronic implants are increasingly facilitating novel strategies for clinical diagnosis and treatment. The integration of fluidic technologies into such implants enables new complementary routes for sensing and therapy alongside electrical interaction. Indeed, these two technologies, electrical and fluidic, can work synergistically in a bioelectronics implant towards the fabrication of a complete therapeutic platform. In this perspective article, the leading applications of fluidic enabled bioelectronic implants are highlighted and methods of operation and material choices are discussed. Furthermore, a forward-looking perspective is offered on emerging opportunities as well as critical materials and technological challenges.

Double-Sided Wearable Multifunctional Sensing System with Anti-interference Design for Human-Ambience Interface

Multifunctional sensing systems play important roles in a variety of applications, incluing health surveillance, intelligent prothetics, human-machine/ambinece interfaces, and many others. The richness of the signal and the decoupling among multiple parameters are essential for simultaneous, multimodal measurements. However, current multifunctional sensing fails to decouple interferences from various signals. Here, we propose a double-sided wearable system that both enables multifunctional sensing and avoids the interferences among multiple parameters. Specifically, the sensitivities of system modules to strain are controlled through customizing the pattern and morphology of sensing electrodes as well as the modification of active materials. Compensation of temperature drift and selection of sensing mechanisms ensure the thermal stability of the system. The encapsulation of modules resists the interferences of proximity, normal pressure, and gas molecules at the same time. A double-sided partition layout with serpentine interconnections reduces the effect of motion artifacts and ensures simultaneous operation of electrochemical-sensing modules. Cooperation among decoupled modules acts as the bridge between the perception of ambience changes and the timely feedback of the human body. In addition, to sense the signal at the interface, modules for energy harvesting and storage are also integrated into the system to broaden its application scenarios.

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.

Molecular Visual Sensing, Boolean Logic Computing, and Data Security Using a Droplet-Based Superwetting Paradigm

Inspired by information processing and logic operations of life, many artificial biochemical systems have been designed for applications in molecular information processing. However, encoding the binary synergism between matter, energy, and information in a superwetting system remains challenging. Herein, a superwetting paradigm was proposed for multifunctional applications including molecular visual sensing and data security on a superhydrophobic surface. A Triton X-100-encapsulated gelatin (TeG) hydrogel was prepared and selectively decomposed by trypsin, releasing the surfactant to decrease the surface tension of a droplet. Integrating the droplet with the superhydrophobic surface, the superwetting behavior was utilized for visual detection and information encoding. Interestingly, the proposed TeG hydrogel can function as an artificial gelneuron for molecular-level logic computing, where the combination of matters (superhydrophobic surface, trypsin, and leupeptin) acts as inputs to interact with energy (liquid surface tension and solid surface energy) and information (binary character), resulting in superwettability transitions (droplet surface tension, contact angle, rolling angle, and bounce) as outputs. Impressively, the TeG gelneuron can be further developed as molecular-level double cryptographic steganography to encode, encrypt, and hide specific information (including the maze escape route and content of the classical literature) due to its programmability, stimuli responsive ability, and droplet concealment. This study will encourage the development of advanced molecular paradigms and their applications, such as superwetting visual sensing, molecular computing, interaction, and data security.