Regional and correlative sweat analysis using high-throughput microfluidic sensing patches toward decoding sweat

A personalized model and optimization strategy for estimating blood glucose concentrations from sweat measurements

BACKGROUND AND OBJECTIVE

Diabetes is one of the four leading causes of death worldwide, necessitating daily blood glucose monitoring. While sweat offers a promising non-invasive alternative for glucose monitoring, its application remains limited due to the low to moderate correlation between sweat and blood glucose concentrations, which has been obtained until now by assuming a linear relationship. This study proposes a novel model-based strategy to estimate blood glucose concentrations from sweat samples, setting the stage for non-invasive glucose monitoring through sweat-sensing technology.

METHODS

We first developed a pharmacokinetic glucose transport model that describes the glucose transport from blood to sweat. Secondly, we designed a novel optimization strategy leveraging the proposed model to solve the inverse problem and infer blood glucose levels from measured glucose concentrations in sweat. To this end, the pharmacokinetic model parameters with the highest sensitivity were also optimized so as to achieve a personalized estimation. Our strategy was tested on a dataset composed of 108 samples from healthy volunteers and diabetic patients.

RESULTS

Our glucose transport model improves over the state-of-the-art in estimating sweat glucose concentrations from blood levels (higher accuracy, p<0.001). Additionally, our optimization strategy effectively solved the inverse problem, yielding a Pearson correlation coefficient of 0.98 across all 108 data points, with an average root-mean-square-percent-error of 12%±8%. This significantly outperforms the best sweat-blood glucose correlation reported in the existing literature (0.75).

CONCLUSION

Our innovative optimization strategy, also leveraging more accurate modeling, shows promising results, paving the way for non-invasive blood glucose monitoring and, possibly, improved diabetes management.

Revolutionizing biosensing with wearable microneedle patches: innovations and applications

Wearable microneedle (MN) patches have emerged as a transformative platform for biosensing, offering a minimally invasive and user-friendly approach to real-time health monitoring and disease diagnosis. Primarily designed to access interstitial fluid (ISF) through shallow skin penetration, MNs enable precise and continuous sampling of biomarkers such as glucose, lactate, and electrolytes. Additionally, recent innovations have integrated MN arrays with microfluidic and porous structures to support sweat-based analysis, where MNs act as structural or functional components in hybrid wearable systems. This review explores the design, fabrication, and functional integration of MNs into wearable devices, highlighting advances in multi-analyte detection, wireless data transmission, and self-powered sensing. Challenges related to material biocompatibility, sensor stability, scalability, and user variability are addressed, alongside emerging opportunities in microfluidics, artificial intelligence, and soft materials. Overall, MN-based biosensing platforms are poised to redefine personalized healthcare by enabling dynamic, decentralized, and accessible health monitoring.

From population-based to personalized laboratory medicine: continuous monitoring of individual laboratory data with wearable biosensors

Monitoring individuals' laboratory data is essential for assessing their health status, evaluating the effectiveness of treatments, predicting disease prognosis and detecting subclinical conditions. Currently, monitoring is performed intermittently, measuring serum, plasma, whole blood, urine and occasionally other body fluids at predefined time intervals. The ideal monitoring approach entails continuous measurement of concentration and activity of biomolecules in all body fluids, including solid tissues. This can be achieved through the use of biosensors strategically placed at various locations on the human body where measurements are required for monitoring. High-tech wearable biosensors provide an ideal, noninvasive, and esthetically pleasing solution for monitoring individuals' laboratory data. However, despite significant advances in wearable biosensor technology, the measurement capacities and the number of different analytes that are continuously monitored in patients are not yet at the desired level. In this review, we conducted a literature search and examined: (i) an overview of the background of monitoring for personalized laboratory medicine, (ii) the body fluids and analytes used for monitoring individuals, (iii) the different types of biosensors and methods used for measuring the concentration and activity of biomolecules, and (iv) the statistical algorithms used for personalized data analysis and interpretation in monitoring and evaluation.

Biosensing approaches in body fluids using extended-gate-type organic field-effect transistor enzymatic sensors

Biomarkers in body fluids provide essential chemical information for examining health conditions; however, unlike conventional instrumental approaches, easy-to-use analytical methods have not yet been fully established. This review introduces extended-gate-type organic field-effect transistors (OFETs) as biosensor platforms for real-sample analysis. OFETs are electronic devices that show switching profiles when gate voltages are applied. Therefore, the gate electrode of OFET functions as a sensing unit combined with appropriate molecular recognition materials. Owing to their signal amplification properties, OFETs enable sensitive biosensing. The extended-gate surfaces are easily functionalized with enzymatic layers using chemical modification, and these surfaces provide a high discrimination ability for specific biomarkers from their analogs. This review presents the designs of the extended-gate structures (i.e., integrated and separated styles) and their enzymatic layers and includes their actual sensing performance.

Design Principles of Flexible Substrates and Polymer Electrolytes for Flexible Zinc Ion Batteries

Flexible ZIBs are gaining significant attention as a cost-effective and inherently safe energy storage technology with promising applications in next-generation flexible and wearable devices. The rising demand for flexible electronics has spurred the advancement of flexible batteries. However, the widespread adoption of liquid electrolytes in zinc-ion batteries has been hindered by persistent challenges, including liquid leakage, water evaporation, and parasitic water-splitting reactions, which pose significant obstacles to commercialization. Free-standing flexible substrates and solid-state polymer electrolytes are key to enhancing the energy density, ionic conductivity, power density, mechanical strength, and flexibility of ZIBs. Herein, this review highlights recent progress and strategies for developing high-efficiency flexible ZIBs as energy storage systems, focusing on advancements in flexibility (transitioning from rigid to flexible), electrolytes (shifting from liquid to solid), adaptability (from non-portable to portable designs), and the transition from laboratory research to practical industrial applications. Critical assessments of advanced modification approaches for flexible substrates and solid-state electrolytes are presented, emphasizing their role in achieving safe, flexible, stretchable, wearable, and self-healing ZIBs. Finally, future research directions and development strategies for designing effective solid-state polymer electrolytes and flexible substrates for next-generation flexible ZIBs are discussed.

Liquid Bridge Cutting Valves for Microfluidic Passive Distribution and Sequential Reaction

In bioanalysis, precisely isolating liquid reactions in distinct systems or at different temporal sequences is vital for ensuring accurate results devoid of crosstalk. However, passive liquid isolation is unattainable through existing microfluidic valves. Here, liquid bridge cutting valves (LBCVs) are introduced to automatically segregate liquids by establishing airlocks, offering an innovative microfluidic structure for liquid distribution. The principle of liquid bridge breakup is studied and applied to the design of LBCVs. Additionally, monolithic chips connecting units with LBCVs in different topologies facilitate sequential sampling and reactions, achieving the detection of sweat glucose and lactate in wearable applications, as well as cortisol ELISA on the chips. As a missing puzzle piece of microfluidic elements in liquid separation, LBCVs can be seamlessly integrated with maturing microfluidic structures, creating a lab-on-a-chip device to enable complex fluid manipulation for individual healthcare monitoring and clinical scenarios.

Electrophoretic digital colorimetry integrated with electrochemical sweat sensor

Recent advancements in wearable sweat sensors, which use standardized electrochemical and colorimetric mechanisms, offer holistic representation of health status for users. However, the constraints of standardized sweat sensors present ongoing challenges to realization of personalized health management. This study presents an electrocolorimetric (EC) platform that enables the reversible and multiple-time use of colorimetric data visualization using electrophoretic display (EPD). This platform represents the application of low-power EPD in epidermal sweat sensor, evaluated through CIELAB-based methodology which is the first systematic evaluation tool of wearable display performance. Moreover, our platform has been demonstrated in human exercise trials for its ability to detect the lactate threshold (LT). This digital colorimetric system has the potential to play a pivotal role by integrating various health monitoring biomarkers. While providing real-time, continuous, and adjustable range information with high sensitivity, this platform validates its extensive probability as a next-generation wearable epidermal sensor.

Worth your sweat: wearable microfluidic flow rate sensors for meaningful sweat analytics

Wearable microfluidic sweat sensors could play a major role in the future of monitoring health and wellbeing. Sweat contains biomarkers to monitor health and hydration status, and it can provide information on drug intake, making it an interesting non-invasive alternative to blood. However, sweat is not created in excess, and this requires smart sweat collection strategies to handle small volumes. Microfluidic solutions are commonly employed which use capillary action or evaporation to drive flow. In current literature about sweat analytics, the emphasis lies predominantly on developing the sensors for measuring the composition of sweat. Yet, solely measuring sweat composition does not suffice, because the composition varies due to inter- and intra-individual differences in sweat rate. The measurement of sweat rate is thus crucial for enabling a reliable interpretation and standardisation of this data. Recently, more wearable sweat sensors, also integrating a means of measuring flow, have been developed. This manuscript reviews state-of-the-art sweat collection strategies and flow rate measuring techniques. Generally, flow rate measurements are performed by impedimetric or capacitive methods. However, these techniques can be impaired due to limited lifetime and signal interference from changing ionic contents in sweat. Discrete measurement techniques, such as impedance measurements of an advancing fluid front with interdigitated electrodes, calorimetric and colorimetric techniques can be very reliable, because they selectively measure flow. However, one should take the available size, intended application and compatibility with other sensors into account. Overall, accurate flow rate sensors integrated in reliable microfluidic sweat sensor platforms will enable the standardisation of sweat measurements to unlock the potential of sweat analytics in advancing physiological research, personalized diagnostics and treatment of diseases.

Nanozyme-based wearable biosensors for application in healthcare

Recent years have witnessed tremendous advances in wearable sensors, which play an essential role in personalized healthcare for their ability for real-time sensing and detection of human health information. Nanozymes, capable of mimicking the functions of natural enzymes and addressing their limitations, possess unique advantages such as structural stability, low cost, and ease of mass production, making them particularly beneficial for constructing recognition units in wearable biosensors. In this review, we aim to delineate the latest advancements in nanozymes for the development of wearable biosensors, focusing on key developments in nanozyme immobilization strategies, detection technologies, and biomedical applications. The review also highlights the current challenges and future perspectives. Ultimately, it aims to provide insights for future research endeavors in this rapidly evolving area.

Hydrogen-Bonded Organic Framework Films Integrated with Wavy Structured Design for Wearable Bioelectronics

The integration of hydrogen-bonded organic frameworks (HOFs) with flexible electronic technologies offers a promising strategy for monitoring detailed health information, owing to their inherent porosity, excellent biocompatibility, and tunable catalytic capabilities. However, their application in wearable and real-time health monitoring remains largely unexplored, primarily due to the mechanical mismatch between the traditionally fragile HOFs particles and the softness of human skin. Herein, this study demonstrates an epidermal biosensor that maintains reliable sensing capability even under extreme deformation and complex environmental conditions by integrating HOFs films with wavy bioelectrodes. This wearable biosensor demonstrates ultrasensitive detection capabilities, with a limit of detection of 49.64 nM, and accurately measures nutritional content in sweat while conforming to curved skin surfaces. The sensor's performance is comparable to those obtained using high-performance liquid chromatography (HPLC). More strikingly, scratched HOFs films can be regenerated through a simple solvent rinsing process, enabling their reuse in the fabrication of new biosensors and offering a significant advantage over conventional sensing materials. This work has the potential to inspire the development of more flexible electronic devices, leveraging the structural adaptability and diversity of HOFs for personalized healthcare applications and real-time health monitoring.

Laser-Induced Graphene Electrodes for Flexible pH Sensors

In the growing field of personalized medicine, non-invasive wearable devices and sensors are valuable diagnostic tools for the real-time monitoring of physiological and biokinetic signals. Among all the possible multiple (bio)-entities, pH is important in defining health-related biological information, since its variations or alterations can be considered the cause or the effect of disease and disfunction within a biological system. In this work, an innovative (bio)-electrochemical flexible pH sensor was proposed by realizing three electrodes (working, reference, and counter) directly on a polyimide (Kapton) sheet through the implementation of CO2 laser writing, which locally converts the polymeric sheet into a laser-induced graphene material (LIG electrodes), preserving inherent mechanical flexibility of Kapton. A uniform distribution of nanostructured PEDOT:PSS was deposited via ultrasonic spray coating onto an LIG working electrode as the active material for pH sensing. With a pH-sensitive PEDOT coating, this flexible sensor showed good sensitivity defined through a linear Nernstian slope of (75.6 ± 9.1) mV/pH, across a pH range from 1 to 7. We demonstrated the capability to use this flexible pH sensor during dynamic experiments, and thus concluded that this device was suitable to guarantee an immediate response and good repeatability by measuring the same OCP values in correspondence with the same pH applied.

Applied body-fluid analysis by wearable devices

Wearable sensors are a recent paradigm in healthcare, enabling continuous, decentralized, and non- or minimally invasive monitoring of health and disease. Continuous measurements yield information-rich time series of physiological data that are holistic and clinically meaningful. Although most wearable sensors were initially restricted to biophysical measurements, the next generation of wearable devices is now emerging that enable biochemical monitoring of both small and large molecules in a variety of body fluids, such as sweat, breath, saliva, tears and interstitial fluid. Rapidly evolving data analysis and decision-making technologies through artificial intelligence has accelerated the application of wearables around the world. Although recent pilot trials have demonstrated the clinical applicability of these wearable devices, their widespread adoption will require large-scale validation across various conditions, ethical consideration and sociocultural acceptance. Successful translation of wearable devices from laboratory prototypes into clinical tools will further require a comprehensive transitional environment involving all stakeholders. The wearable device platforms must gain acceptance among different user groups, add clinical value for various medical indications, be eligible for reimbursements and contribute to public health initiatives. In this Perspective, we review state-of-the-art wearable devices for body-fluid analysis and their translation into clinical applications, and provide insight into their clinical purpose.

A Passive Perspiration Inspired Wearable Platform for Continuous Glucose Monitoring

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

Noninvasive Monitoring of Glycemia Level in Diabetic Patients by Wearable Advanced Biosensors

We report on the possibility of noninvasive diabetes monitoring through continuous analysis of sweat. The prediction of the blood glucose level in diabetic patients is possible on the basis of their sweat glucose content due to the positive correlation discovered. The ratio between the blood glucose and sweat glucose concentrations for a certain diabetic subject is stable within weeks, excluding requirements for frequent blood probing. The glucose variations in sweat display allometric (non-linear) dependence on those in blood, allowing more precise blood glucose estimation. Selective (avoiding false-positive responses) and sensitive (sweat glucose is on average 30-50 times lower) detection is possible with biosensors based on the glucose oxidase enzyme coupled with a Prussian Blue transducer. Reliable glucose detection in just secreted sweat would allow noninvasive monitoring of the glycemia level in diabetic patients.

Multifunctional nanomaterials for smart wearable diabetic healthcare devices

Wearable diabetic healthcare devices have attracted great attention for real-time continuous glucose monitoring (CGM) using biofluids such as tears, sweat, saliva, and interstitial fluid via noninvasive ways. In response to the escalating global demand for CGM, these devices enable proactive management and intervention of diabetic patients with incorporated drug delivery systems (DDSs). In this context, multifunctional nanomaterials can trigger the development of innovative sensing and management platforms to facilitate real-time selective glucose monitoring with remarkable sensitivity, on-demand drug delivery, and wireless power and data transmission. The seamless integration into wearable devices ensures patient's compliance. This comprehensive review evaluates the multifaceted roles of these materials in wearable diabetic healthcare devices, comparing their glucose sensing capabilities with conventionally available glucometers and CGM devices, and finally outlines the merits, limitations, and prospects of these devices. This review would serve as a valuable resource, elucidating the intricate functions of nanomaterials for the successful development of advanced wearable devices in diabetes management.

An in silico design method of a peptide bioreceptor for cortisol using molecular modelling techniques

Cortisol is established as a reliable biomarker for stress prompting intensified research in developing wearable sensors to detect it via eccrine sweat. Since cortisol is present in sweat in trace quantities, typically 8-140 ng/mL, developing such biosensors necessitates the design of bioreceptors with appropriate sensitivity and selectivity. In this work, we present a systematic biomimetic methodology and a semi-automated high-throughput screening tool which enables rapid selection of bioreceptors as compared to ab initio design of peptides via computational peptidology. Candidate proteins from databases are selected via molecular docking and ranked according to their binding affinities by conducting automated AutoDock Vina scoring simulations. These candidate proteins are then validated via full atomistic steered molecular dynamics computations including umbrella sampling to estimate the potential of mean force using GROMACS version 2022.6. These explicit molecular dynamic calculations are carried out in an eccrine sweat environment taking into consideration the protein dynamics and solvent effects. Subsequently, we present a candidate baseline peptide bioreceptor selected as a contiguous sequence of amino acids from the selected protein binding pocket favourably interacting with the target ligand (i.e., cortisol) from the active binding site of the proteins and maintaining its tertiary structure. A unique cysteine residue introduced at the N-terminus allows orientation-specific surface immobilization of the peptide onto the gold electrodes and to ensure exposure of the binding site. Comparative binding affinity simulations of this peptide with the target ligand along with commonly interfering species e.g., progesterone, testosterone and glucose are also presented to demonstrate the validity of this proposed peptide as a candidate baseline bioreceptor for future cortisol biosensor development.

Hybrid Integration of Wearable Devices for Physiological Monitoring

Wearable devices can provide timely, user-friendly, non- or minimally invasive, and continuous monitoring of human health. Recently, multidisciplinary scientific communities have made significant progress regarding fully integrated wearable devices such as sweat wearable sensors, saliva sensors, and wound sensors. However, the translation of these wearables into markets has been slow due to several reasons associated with the poor system-level performance of integrated wearables. The wearability consideration for wearable devices compromises many properties of the wearables. Besides, the limited power capacity of wearables hinders continuous monitoring for extended duration. Furthermore, peak-power operations for intensive computations can quickly create thermal issues in the compact form factor that interfere with wearability and sensor operations. Moreover, wearable devices are constantly subjected to environmental, mechanical, chemical, and electrical interferences and variables that can invalidate the collected data. This generates the need for sophisticated data analytics to contextually identify, include, and exclude data points per multisensor fusion to enable accurate data interpretation. This review synthesizes the challenges surrounding the wearable device integration from three aspects in terms of hardware, energy, and data, focuses on a discussion about hybrid integration of wearable devices, and seeks to provide comprehensive guidance for designing fully functional and stable wearable devices.

Skin-interfaced microfluidic biosensors for colorimetric measurements of the concentrations of ketones in sweat

Ketones, such as beta-hydroxybutyrate (BHB), are important metabolites that can be used to monitor for conditions such as diabetic ketoacidosis (DKA) and ketosis. Compared to conventional approaches that rely on samples of urine or blood evaluated using laboratory techniques, processes for monitoring of ketones in sweat using on-body sensors offer significant advantages. Here, we report a class of soft, skin-interfaced microfluidic devices that can quantify the concentrations of BHB in sweat based on simple and low-cost colorimetric schemes. These devices combine microfluidic structures and enzymatic colorimetric BHB assays for selective and accurate analysis. Human trials demonstrate the broad applicability of this technology in practical scenarios, and they also establish quantitative correlations between the concentration of BHB in sweat and in blood. The results represent a convenient means for managing DKA and aspects of personal nutrition/wellness.

Polymeric silk fibroin hydrogel as a conductive and multifunctional adhesive for durable skin and epidermal electronics

Silk fibroin (SF)-based hydrogels are promising multifunctional adhesive candidates for real-world applications in tissue engineering, implantable bioelectronics, artificial muscles, and artificial skin. However, developing conductive SF-based hydrogels that are suitable for the micro-physiological environment and maintain their physical and chemical properties over long periods of use remains challenging. Herein, we developed an ion-conductive SF hydrogel composed of glycidyl methacrylate silk fibroin (SilMA) and bioionic liquid choline acylate (ChoA) polymer chains, together with the modification of acrylated thymine (ThyA) and adenine (AdeA) functional groups. The resulting polymeric ion-conductive SF composite hydrogel demonstrated high bioactivity, strong adhesion strength, good mechanical compliance, and stretchability. The formed hydrogel network of ChoA chains can coordinate with the ionic strength in the micro-physiological environment while maintaining the adaptive coefficient of expansion and stable mechanical properties. These features help to form a stable ion-conducting channel for the hydrogel. Additionally, the hydrogel network modified with AdeA and ThyA, can provide a strong adhesion to the surface of a variety of substrates, including wet tissue through abundant hydrogen bonding. The biocompatible and ionic conductive SF composite hydrogels can be easily prepared and incorporated into flexible skin or epidermal sensing devices. Therefore, our polymeric SF-based hydrogel has great potential and wide application to be an important component of many flexible electronic devices for personalized healthcare.

Synergistic enhancement of wearable biosensor through Pt single-atom catalyst for sweat analysis

Real-time monitoring of biological markers in sweat is a valuable tool for health assessment. In this study, we have developed an innovative wearable biosensor for precise analysis of glucose in sweat during physical activities. The sensor is based on a single-atom catalyst of platinum (Pt) uniformly dispersed on tricobalt tetroxide (Co3O4) nanorods and reduced graphene oxide (rGO), featuring a unique three-dimensional nanostructure and excellent glucose electrocatalytic performance with a wide detection range of 1-800 μM. Additionally, density functional theory calculations have revealed the synergetic role of Pt active sites in the Pt single-atom catalyst (Co3O4/rGO/Pt) in glucose adsorption and electron transfer, thereby enhancing sensor performance. To enable application in wearable devices, we designed an S-shaped microfluidic chip and a point-of-care testing (POCT) device, both of which were validated for effectiveness through actual use by volunteers. This research provides valuable insights and innovative approaches for analyzing sweat glucose using wearable devices, contributing to the advancement of personalized healthcare.

Materials, Structure, and Interface of Stretchable Interconnects for Wearable Bioelectronics

Since wearable technologies for telemedicine have emerged to tackle global health concerns, the demand for well-attested wearable healthcare devices with high user comfort also arises. Skin-wearables for health monitoring require mechanical flexibility and stretchability for not only high compatibility with the skin's dynamic nature but also a robust collection of fine health signals from within. Stretchable electrical interconnects, which determine the device's overall integrity, are one of the fundamental units being understated in wearable bioelectronics. In this review, a broad class of materials and engineering methodologies recently researched and developed are presented, and their respective attributes, limitations, and opportunities in designing stretchable interconnects for wearable bioelectronics are offered. Specifically, the electrical and mechanical characteristics of various materials (metals, polymers, carbons, and their composites) are highlighted, along with their compatibility with diverse geometric configurations. Detailed insights into fabrication techniques that are compatible with soft substrates are also provided. Importantly, successful examples of establishing reliable interfacial connections between soft and rigid elements using novel interconnects are reviewed. Lastly, some perspectives and prospects of remaining research challenges and potential pathways for practical utilization of interconnects in wearables are laid out.

Flexible/Regenerative Nanosensor with Automatic Sweat Collection for Cytokine Storm Biomarker Detection

The real-time monitoring of low-concentration cytokines such as TNF-α in sweat can aid clinical physicians in assessing the severity of inflammation. The challenges associated with the collection and the presence of impurities can significantly impede the detection of proteins in sweat. This issue is addressed by incorporating a nanosphere array designed for automatic sweat transportation, coupled with a reusable sensor that employs a Nafion/aptamer-modified MoS2 field-effect transistor. The nanosphere array with stepwise wettability enables automatic collection of sweat and blocks impurities from contaminating the detection zone. This device enables direct detection of TNF-α proteins in undiluted sweat, within a detection range of 10 fM to 1 nM. The use of an ultrathin, ultraflexible substrate ensures stable electrical performance, even after up to 30 extreme deformations. The findings indicate that in clinical scenarios, this device could potentially provide real-time evaluation and management of patients' immune status via sweat testing.

Wireless Technologies in Flexible and Wearable Sensing: From Materials Design, System Integration to Applications

Wireless and wearable sensors attract considerable interest in personalized healthcare by providing a unique approach for remote, noncontact, and continuous monitoring of various health-related signals without interference with daily life. Recent advances in wireless technologies and wearable sensors have promoted practical applications due to their significantly improved characteristics, such as reduction in size and thickness, enhancement in flexibility and stretchability, and improved conformability to the human body. Currently, most researches focus on active materials and structural designs for wearable sensors, with just a few exceptions reflecting on the technologies for wireless data transmission. This review provides a comprehensive overview of the state-of-the-art wireless technologies and related studies on empowering wearable sensors. The emerging functional nanomaterials utilized for designing unique wireless modules are highlighted, which include metals, carbons, and MXenes. Additionally, the review outlines the system-level integration of wireless modules with flexible sensors, spanning from novel design strategies for enhanced conformability to efficient transmitting data wirelessly. Furthermore, the review introduces representative applications for remote and noninvasive monitoring of physiological signals through on-skin and implantable wireless flexible sensing systems. Finally, the challenges, perspectives, and unprecedented opportunities for wireless and wearable sensors are discussed.

Recent Trends of Bioanalytical Sensors with Smart Health Monitoring Systems: From Materials to Applications

Smart biosensors attract significant interest due to real-time monitoring of user health status, where bioanalytical electronic devices designed to detect various activities and biomarkers in the human body have potential applications in physical sign monitoring and health care. Bioelectronics can be well integrated by output signals with wireless communication modules for transferring data to portable devices used as smart biosensors in performing real-time diagnosis and analysis. In this review, the scientific keys of biosensing devices and the current trends in the field of smart biosensors, (functional materials, technological approaches, sensing mechanisms, main roles, potential applications and challenges in health monitoring) will be summarized. Recent advances in the design and manufacturing of bioanalytical sensors with smarter capabilities and enhanced reliability indicate a forthcoming expansion of these smart devices from laboratory to clinical analysis. Therefore, a general description of functional materials and technological approaches used in bioelectronics will be presented after the sections of scientific keys to bioanalytical sensors. A careful introduction to the established systems of smart monitoring and prediction analysis using bioelectronics, regarding the integration of machine-learning-based basic algorithms, will be discussed. Afterward, applications and challenges in development using these smart bioelectronics in biological, clinical, and medical diagnostics will also be analyzed. Finally, the review will conclude with outlooks of smart biosensing devices assisted by machine learning algorithms, wireless communications, or smartphone-based systems on current trends and challenges for future works in wearable health monitoring.

Quantitative analysis of sweat evaporation loss in epidermal microfluidic patches

Sweat analysis is identified as a promising biochemical technique for the non-invasive assessment of human health status. Epidermal microfluidic patches are the predominant sweat sampling and sensing devices. However, the sweat stored inside the patches may suffer from evaporation loss of moisture, which can increase the concentration of biomarkers and cause the biochemical analysis results of sweat to deviate from the actual results. This study focuses on quantitatively analysing the sweat evaporation loss within epidermal microfluidic patches. Analytical models based on the dissolution diffusion mechanism and corresponding partial differential equations for the diffusion process were initially developed. The analytical solution of the equation was derived using the method of separation of variables, and the steady-state concentration distribution of water in the materials of microfluidic patches was calculated when considering the application of epidermal microfluidics. Evaporation losses of sweat through different paths were quantitatively calculated and analysed, including permeation through covers, diffusion along microchannels, and absorption by sidewalls. Then, experiments on the evaporation loss of sweat within microfluidic patches were conducted to validate the theoretical calculations and analytical results. At last, the design of the anti-evaporation structure for microfluidic patches was discussed. This study can provide theoretical and experimental references for the design of water-retention structures in epidermal microfluidic patches, which significantly enhances the overall reliability of sweat biochemical analysis results.

The challenges and promise of sweat sensing

The potential of monitoring biomarkers in sweat for health-related applications has spurred rapid growth in the field of wearable sweat sensors over the past decade. Some of the key challenges have been addressed, including measuring sweat-secretion rate and collecting sufficient sample volumes for real-time, continuous molecular analysis without intense exercise. However, except for assessment of cystic fibrosis and regional nerve function, the ability to accurately measure analytes of interest and their physiological relevance to health metrics remain to be determined. Although sweat is not a crystal ball into every aspect of human health, we expect sweat measurements to continue making inroads into niche applications involving active sweating, such as hydration monitoring for athletes and physical laborers and later for medical and casual health monitoring of relevant drugs and hormones.

Ultra-Sensitive and Stable Multiplexed Biosensors Array in Fully Printed and Integrated Platforms for Reliable Perspiration Analysis

Electrochemical biosensors have emerged as one of the promising tools for tracking human body physiological dynamics via non-invasive perspiration analysis. However, it remains a key challenge to integrate multiplexed sensors in a highly controllable and reproducible manner to achieve long-term reliable biosensing, especially on flexible platforms. Herein, a fully inkjet printed and integrated multiplexed biosensing patch with remarkably high stability and sensitivity is reported for the first time. These desirable characteristics are enabled by the unique interpenetrating interface design and precise control over active materials mass loading, owing to the optimized ink formulations and droplet-assisted printing processes. The sensors deliver sensitivities of 313.28 µA mm-1 cm-2 for glucose and 0.87 µA mm-1 cm-2 for alcohol sensing with minimal drift over 30 h, which are among the best in the literature. The integrated patch can be used for reliable and wireless diet monitoring or medical intervention via epidermal analysis and would inspire the advances of wearable devices for intelligent healthcare applications.

Fully Integrated Multiplexed Wristwatch for Real-Time Monitoring of Electrolyte Ions in Sweat

Considerable progress has already been made in sweat sensors based on electrochemical methods to realize real-time monitoring of biomarkers. However, realizing long-term monitoring of multiple targets at the atomic level remains extremely challenging, in terms of designing stable solid contact (SC) interfaces and fully integrating multiple modules for large-scale applications of sweat sensors. Herein, a fully integrated wristwatch was designed using mass-manufactured sensor arrays based on hierarchical multilayer-pore cross-linked N-doped porous carbon coated by reduced graphene oxide (NPCs@rGO-950) microspheres with high hydrophobicity as core SC, and highly selective monitoring simultaneously for K+, Na+, and Ca2+ ions in human sweat was achieved, exhibiting near-Nernst responses almost without forming an interfacial water layer. Combined with computed tomography, solid-solid interface potential diffusion simulation results reveal extremely low interface diffusion potential and high interface capacitance (598 μF), ensuring the excellent potential stability, reversibility, repeatability, and selectivity of sensor arrays. The developed highly integrated-multiplexed wristwatch with multiple modules, including SC, sensor array, microfluidic chip, signal transduction, signal processing, and data visualization, achieved reliable real-time monitoring for K+, Na+, and Ca2+ ion concentrations in sweat. Ingenious material design, scalable sensor fabrication, and electrical integration of multimodule wearables lay the foundation for developing reliable sweat-sensing systems for health monitoring.

Printable and flexible integrated sensing systems for wireless healthcare

The rapid development of wearable sensing devices and artificial intelligence has enabled portable and wireless tracking of human health, fulfilling the promise of digitalized healthcare applications. To achieve versatile design and integration of multi-functional modules including sensors and data transmission units onto various flexible platforms, printable technologies emerged as some of the most promising strategies. This review first introduces the commonly utilized printing technologies, followed by discussion of the printable ink formulations and flexible substrates to ensure reliable device fabrication and system integration. The advances of printable sensors for body status monitoring are then discussed. Moreover, the integration of wireless data transmission via printable approaches is also presented. Finally, the challenges in achieving printable sensing devices and wireless integrated systems with competitive performances are considered, so as to realize their practical applications for personalized healthcare.

Microfluidic Sensing Textile for Continuous Monitoring of Sweat Glucose at Rest

Wearable sweat sensors have received considerable attention due to their great potential for noninvasive continuous monitoring of an individual's health status applications. However, the low secretion rate and fast evaporation of sweat pose challenges in collecting sweat from sedentary individuals for noninvasive analysis of body physiology. Here, we demonstrate wearable textiles for continuous monitoring of sweat at rest using the combination of a heating element and a microfluidic channel to increase localized skin sweat secretion rates and combat sweat evaporation, enabling accurate and stable monitoring of trace amounts of sweat. The Janus sensing yarns with a glucose sensing sensitivity of 36.57 mA cm-2 mM-1 are embroidered into the superhydrophobic heated textile to collect sweat directionally, resulting in improved sweat collection efficiency of up to 96 and 75% retention. The device also maintains a highly durable sensing performance, even in dynamic deformation, recycling, and washing. The microfluidic sensing textile can be further designed into a wireless sensing system that enables sedentary-compatible sweat analysis for the continuous, real-time monitoring of body glucose levels at rest.

Adaptively resettable microfluidic patch for sweat rate and electrolytes detection

Skin-interfaced microfluidic patch has become a reliable device for sweat collection and analysis. However, the intractable problems of emptying the microchannel for reuse, and the channel's volumetric capacity limited by the size of the patch, directly hinder the practical application of sweat sensors. Herein, we report an adaptively resettable microfluidic sweat patch (Art-Sweat patch) capable of continuously monitoring both sweat rate (0.2-4.0 μL min-1) and total ionic charge concentration (10-200 mmol L-1). We develop a platform with a vertical and horizontal microchannel combined strategy, enabling repeatedly filling sweat and emptying the microchannel for autonomously resetting and detecting. The variation in the emptied volume is designed to be adaptively identified by the sensor, resulting in enhanced stability and an enlarged volumetric capacity of over 300 μL. By integrating with self-designed wireless transmission modules, the proposed Art-Sweat patch shows product-level wearability and high performance in monitoring variations in regional sweat rate and concentration for hydration status assessment.

A photoelectrochemical sensor based on In2O3/In2S3/ZnIn2S4 ternary Z-scheme heterojunction for ultrasensitive detection of dopamine in sweat

A novel ternary heterojunction material In2O3/In2S3/ZnIn2S4 was synthesized, and a photoelectrochemical sensor was fabricated for the non-invasive test of dopamine (DA) in sweat. In2O3 multihollow microtubules were synthesized and then In2S3 was formed on their surface to construct a type-I heterojunction between In2S3 and In2O3. ZnIn2S4 was further introduced to form a Z-scheme heterojunction between In2S3/ZnIn2S4. Under photoexcitation, the photogenerated holes of In2O3 transferred to the valence band of In2S3, superimposed with the holes produced by In2S3, leads to a significantly higher photocatalytic oxidation capacity of In2O3/In2S3/ZnIn2S4 ternary composites than that of In2O3/In2S3. The Z-scheme heterojunction accelerates the transfer of photogenerated electrons accumulated on the type-I heterojunction. In the presence of DA, it is rapidly oxidized into polydopamine (PDA) by In2O3/In2S3, and the benzoquinone groups of PDA compete for the photogenerated electrons to reduce the current in the external circuit, whereby DA determination is achieved. Owing to the combination of type-I and Z-scheme heterojunction, the sensor showed extremely high sensitivity, with a detection limit of 3.94 × 10-12 mol/L. It is one of the most sensitive methods for DA detection reported and has been applied to the determination of DA in human sweat.

A Bionic Skin for Health Management: Excellent Breathability, In Situ Sensing, and Big Data Analysis

Developing an intelligent wearable system is of great significance to human health management. An ideal health-monitoring patch should possess key characteristics such as high air permeability, moisture-wicking function, high sensitivity, and a comfortable user experience. However, such a patch that encompasses all these functions is rarely reported. Herein, an intelligent bionic skin patch for health management is developed by integrating bionic structures, nano-welding technology, flexible circuit design, multifunctional sensing functions, and big data analysis using advanced electrospinning technology. By controlling the preparation of nanofibers and constructing bionic secondary structures, the resulting nanofiber membrane closely resembles human skin, exhibiting excellent air/moisture permeability, and one-side sweat-wicking properties. Additionally, the bionic patch is endowed with a high-precision signal acquisition capabilities for sweat metabolites, including glucose, lactic acid, and pH; skin temperature, skin impedance, and electromyographic signals can be precisely measured through the in situ sensing electrodes and flexible circuit design. The achieved intelligent bionic skin patch holds great potential for applications in health management systems and rehabilitation engineering management. The design of the smart bionic patch not only provides high practical value for health management but also has great theoretical value for the development of the new generation of wearable electronic devices.

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

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

Fluorescence-Recovered Wearable Hydrogel Patch for In Vitro Detection of Glucose Based on Rare-Earth Nanoparticles

The physiological state of the human body can be indicated by analyzing the composition of sweat. In this research, a fluorescence-recovered wearable hydrogel patch has been designed and realized which can noninvasively monitor the glucose concentration in human sweat. Rare-earth nanoparticles (RENPs) of NaGdF4 doped with different elements (Yb, Er, and Ce) are synthesized and optimized for better luminescence in the near-infrared second (NIR-II) and visible region. In addition, RENPs are coated with CoOOH of which the absorbance has an extensive peak in the visible and NIR regions. The concentration of H2O2 in the environment can be detected by the fluorescence recovery degree of CoOOH-modified RENPs based on the fluorescence resonance energy transfer effect. For in vivo detection, the physiological state of oxidative stress at tumor sites can be visualized through its fluorescence in NIR-II with low background noise and high penetration depth. For the in vitro detection, CoOOH-modified RENP and glucose oxidase (GOx) were doped into a polyacrylamide hydrogel, and a patch that can emit green upconversion fluorescence under a 980 nm laser was prepared. Compared with the conventional electrochemical detection method, the fluorescence we presented has higher sensitivity and linear detection region to detect the glucose. This improved anti-interference sweat patch that can work in the dark environment was obtained, and the physiological state of the human body is conveniently monitored, which provides a new facile and convenient method to monitor the sweat status.

Interindividual- and blood-correlated sweat phenylalanine multimodal analytical biochips for tracking exercise metabolism

In situ monitoring of endogenous amino acid loss through sweat can provide physiological insights into health and metabolism. However, existing amino acid biosensors are unable to quantitatively assess metabolic status during exercise and are rarely used to establish blood-sweat correlations because they only detect a single concentration indicator and disregard sweat rate. Here, we present a wearable multimodal biochip integrated with advanced electrochemical electrodes and multipurpose microfluidic channels that enables simultaneous quantification of multiple sweat indicators, including phenylalanine and chloride, as well as sweat rate. This combined measurement approach reveals a negative correlation between sweat phenylalanine levels and sweat rates among individuals, which further enables identification of individuals at high metabolic risk. By tracking phenylalanine fluctuations induced by protein intake during exercise and normalizing the concentration indicator by sweat rates to reduce interindividual variability, we demonstrate a reliable method to correlate and analyze sweat-blood phenylalanine levels for personal health monitoring.

Skin-interfaced microfluidic sweat collection devices for personalized hydration management through thermal feedback

Non-electronic wearables that utilize skin-interfaced microfluidic technology have revolutionized the collection and analysis of human sweat, providing valuable biochemical information and indicating body hydration status. However, existing microfluidic devices often require constant monitoring of data during sweat assessment, thereby impeding the user experience and potentially missing anomalous physiological events, such as excessive sweating. Moreover, the complex manufacturing process hampers the scalability and large-scale production of such devices. Herein, we present a self-feedback microfluidic device with a unique dehydration reminder through a cost-effective "CAD-to-3D device" approach. It incorporates two independent systems for sweat collection and thermal feedback, including serpentine microchannels, reservoirs, petal-like bursting valves and heating chambers. The device operates by sequentially collecting sweat in the channels and reservoirs, and then activating thermal stimulators in the heating chambers through breaking the valves, initiating a chemical exothermic reaction. Human trials validate that the devices effectively alert users to potential dehydration by inducing skin thermal sensations triggered by sweat sampling. The proposed device offers facile scalability and customizable fabrication, and holds promise for managing hydration strategies in real-world scenarios, benefiting individuals engaged in sporting activities or exposed to high-temperature settings.

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

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

Advances in Non-Electrochemical Sensing of Human Sweat Biomarkers: From Sweat Sampling to Signal Reading

Sweat, commonly referred to as the ultrafiltrate of blood plasma, is an essential physiological fluid in the human body. It contains a wide range of metabolites, electrolytes, and other biologically significant markers that are closely linked to human health. Compared to other bodily fluids, such as blood, sweat offers distinct advantages in terms of ease of collection and non-invasive detection. In recent years, considerable attention has been focused on wearable sweat sensors due to their potential for continuous monitoring of biomarkers. Electrochemical methods have been extensively used for in situ sweat biomarker analysis, as thoroughly reviewed by various researchers. This comprehensive review aims to provide an overview of recent advances in non-electrochemical methods for analyzing sweat, including colorimetric methods, fluorescence techniques, surface-enhanced Raman spectroscopy, and more. The review covers multiple aspects of non-electrochemical sweat analysis, encompassing sweat sampling methodologies, detection techniques, signal processing, and diverse applications. Furthermore, it highlights the current bottlenecks and challenges faced by non-electrochemical sensors, such as limitations and interference issues. Finally, the review concludes by offering insights into the prospects for non-electrochemical sensing technologies. By providing a valuable reference and inspiring researchers engaged in the field of sweat sensor development, this paper aspires to foster the creation of innovative and practical advancements in this domain.

Soft Epidermal Paperfluidics for Sweat Analysis by Ratiometric Raman Spectroscopy

The expanding interest in digital biomarker analysis focused on non-invasive human bodily fluids, such as sweat, highlights the pressing need for easily manufactured and highly efficient soft lab-on-skin solutions. Here, we report, for the first time, the integration of microfluidic paper-based devices (μPAD) and non-enhanced Raman-scattering-enabled optical biochemical sensing (Raman biosensing). Their integration merges the enormous benefits of μPAD, with high potential for commercialization and use in resource-limited settings, with biorecognition-element-free (but highly selective) optical Raman biosensing. The introduced thin (0.36 mm), ultra-lightweight (0.19 g), and compact footprint (3 cm2) opto-paperfluidic sweat patch is flexible, stretchable, and conforms, irritation-free, to hairless or minimally haired body regions to enable swift sweat collection. As a great advantage, this new bio-chemical sensory system excels through its absence of onboard biorecognition elements (bioreceptor-free) and omission of plasmonic nanomaterials. The proposed easy fabrication process is adaptable to mass production by following a fully sustainable and cost-effective process utilizing only basic tools by avoiding typically employed printing or laser patterning. Furthermore, efficient collection and transportation of precise sweat volumes, driven exclusively by the wicking properties of porous materials, shows high efficiency in liquid transportation and reduces biosensing latency by a factor of 5 compared to state-of-the-art epidermal microfluidics. The proposed unit enables electronic chip-free and imaging-less visual sweat loss quantification as well as optical biochemical analysis when coupled with Raman spectroscopy. We investigated the multimodal quantification of sweat urea and lactate levels ex vivo (with syntactic sweat including +30 sweat analytes on porcine skin) and achieved a linear dynamic range from 0 to 100 mmol/L during fully dynamic continuous flow characterization.

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

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

Perspiration permeable, textile embeddable microfluidic sweat sensor

Epidermal microfluidic devices are continuously being developed for efficient sweat collection and sweat rate detection. However, most microfluidic designs ignore the use of airtight/adhesive substrate will block the natural perspiration of the covered sweat pores, which will seriously affect normal sweat production and long-term wearable comfort. Herein, we present a Janus textile-embedded microfluidic sensor platform with high breathability and directional sweat permeability for synchronous sweat rate and total electrolyte concentration detection. The device consists of a hollowed-out serpentine microchannel with interdigital electrodes and Janus textile. The dual-mode signal of the sweat rate (0.2-4.0 μL min-1) and total ionic charge concentration (10-200 mmol L-1) can be obtained synchronously by decoupling conductance step signals generated when sweat flows through alternating interdigitated spokes at equal intervals in the microchannel. Meanwhile, the hollowed-out microchannel structure significantly reduces the coverage area of the sensor on the skin, and the Janus textile-embedded device ensures a comfortable skin/device interface (fewer sweat pores are blocked) and improves breathability (503.15 g m-2 d-1) and sweat permeability (directional liquid transportation) during long-term monitoring. This device is washable and reusable, which shows the potential to integrate with clothing and smart textile, and thus facilitate the practicality of wearable sweat sensors for personalized healthcare.

A highly electrocatalytic, stretchable, and breathable enzyme-free electrochemical patch based on electrospun fibers decorated with platinum nano pine needles for continuous glucose sensing in neutral conditions

Given the worldwide increase in diabetes, there is an urgent need for glucose sensors that can achieve the on-body detection of glucose concentration. With the development of nanomaterials and flexible electronics, wearable electrochemical enzyme-free glucose biosensors that can conveniently, continuously and stably monitor the glucose concentrations of diabetes patients without invasion and risk of infection are coming into focus. However, despite the enormous efforts toward wearable electrochemical enzyme-free glucose sensors, there have been limited achievements in developing a stretchable and breathable glucose sensor with high sensitivity, low detection limit, and excellent catalytic activity towards glucose oxidation in neutral media, to meet the need for continuous wearable glucose monitoring in scenarios such as the on-body detection of glucose in human sweat. Herein, we demonstrate a novel electrochemical enzyme-free glucose-sensing patch on the foundation of electrospun polyurethane (PU) fibrous mats to address some of the aforementioned challenges. The sensing patch was fabricated through a facile technology of electrospinning, followed by magnetron sputtering of gold (Au) to enable high conductivity. After that, ultrasonic-assisted electrodeposition was utilized to in situ introduce well-dispersed platinum nano pine needles along each fiber. Due to the good stretchability of PU materials, porous structure, and large specific surface area of electrochemical sites, the glucose-sensing patch promises merits such as good stretchability (performs well under 10% strain), high sensitivity (203.13 μA mM-1 cm-1), prominently low detection limit (14.77 μM), excellent selectivity, and efficient vapor permeability. Notably, the advanced hierarchical nanostructures with excellent catalytic activity towards glucose oxidation could be capable of detecting glucose in neutral conditions (pH = 7.4) without the assistance of enzymes. Given the facile fabrication methods and the integrated superior performances, this enzyme-free glucose-sensing patch could play a vital role in wearable glucose sensors.

Wearable Flexible Perspiration Biosensors Using Laser-Induced Graphene and Polymeric Tape Microfluidics

Wearable biosensors promise real-time measurements of chemicals in human sweat, with the potential for dramatic improvements in medical diagnostics and athletic performance through continuous metabolite and electrolyte monitoring. However, sweat sensing is still in its infancy, and questions remain about whether sweat can be used for medical purposes. Wearable sensors are focused on proof-of-concept designs that are not scalable for multisubject trials, which could elucidate the utility of sweat sensing for health monitoring. Moreover, many wearable sensors do not include the microfluidics necessary to protect and channel consistent and clean sweat volumes to the sensor surface or are not designed to be disposable to prevent sensor biofouling and inaccuracies due to repeated use. Hence, there is a need to produce low-cost and single-use wearable sensors with integrated microfluidics to ensure reliable sweat sensing. Herein, we demonstrate the convergence of laser-induced graphene (LIG) based sensors with soft tape polymeric microfluidics to quantify both sweat metabolites (glucose and lactate) and electrolytes (sodium) for potential hydration and fatigue monitoring. Distinct LIG-electrodes were functionalized with glucose oxidase and lactate oxidase for selective sensing of glucose and lactate across physiological ranges found in sweat with sensitivities of 26.2 and 2.47 × 10-3 μA mM-1 cm-2, detection limits of 8 and 220 μM, and linear response ranges of 0-1 mM and 0-32 mM, respectively. LIG-electrodes functionalized with a sodium-ion-selective membrane displayed Nernstian sensitivity of 58.8 mV decade-1 and a linear response over the physiological range in sweat (10-100 mM). The sensors were tested in a simulated sweating skin microfluidic system and on-body during cycling tests in a multisubject trial. Results demonstrate the utility of LIG integrated with microfluidics for real-time, continuous measurements of biological analytes in sweat and help pave the way for the development of personalized wearable diagnostic tools.

Noninvasive Glucose Sensing In Vivo

Blood glucose monitoring is an essential aspect of disease management for individuals with diabetes. Unfortunately, traditional methods require collecting a blood sample and thus are invasive and inconvenient. Recent developments in minimally invasive continuous glucose monitors have provided a more convenient alternative for people with diabetes to track their glucose levels 24/7. Despite this progress, many challenges remain to establish a noninvasive monitoring technique that works accurately and reliably in the wild. This review encompasses the current advancements in noninvasive glucose sensing technology in vivo, delves into the common challenges faced by these systems, and offers an insightful outlook on existing and future solutions.

An autonomous wearable biosensor powered by a perovskite solar cell

Wearable sweat sensors can potentially be used to continuously and non-invasively monitor physicochemical biomarkers that contain information related to disease diagnostics and fitness tracking. However, the development of such autonomous sensors faces a number of challenges including achieving steady sweat extraction for continuous and prolonged monitoring, and addressing the high power demands of multifunctional and complex analysis. Here we report an autonomous wearable biosensor that is powered by a perovskite solar cell and can provide continuous and non-invasive metabolic monitoring. The device uses a flexible quasi-two-dimensional perovskite solar cell module that provides ample power under outdoor and indoor illumination conditions (power conversion efficiency exceeding 31% under indoor light illumination). We show that the wearable device can continuously collect multimodal physicochemical data - glucose, pH, sodium ions, sweat rate, and skin temperature - across indoor and outdoor physical activities for over 12 hours.

Opportunities and challenges for sweat-based monitoring of metabolic syndrome via wearable technologies

Metabolic syndrome is a prevalent condition in adults over the age of 65 and is a risk factor for developing cardiovascular disease and type II diabetes. Thus, methods to track the condition, prevent complications and assess symptoms and risk factors are needed. Here we discuss sweat-based wearable technologies as a potential monitoring tool for patients with metabolic syndrome. We describe several key symptoms that can be evaluated that could employ sweat patches to assess inflammatory markers, glucose, sodium, and cortisol. We then discuss the challenges with material property, sensor integration, and sensor placement and provide feasible solutions to optimize them. Together with a list of recommendations, we propose a pathway toward successfully developing and implementing reliable sweat-based technologies to monitor metabolic syndrome.

Metabolic syndrome is a risk factor for developing cardiovascular disease and type II diabetes. Lyzwinski, Elgendi and colleagues discuss the potential role of sweat-based wearable technologies for monitoring metabolic syndrome along with engineering challenges towards implementation and optimization

Direct Laser Writing of the Porous Graphene Foam for Multiplexed Electrochemical Sweat Sensors

Wearable electrochemical sensors provide means to detect molecular-level information from the biochemical markers in biofluids for physiological health evaluation. However, a high-density array is often required for multiplexed detection of multiple markers in complex biofluids, which is challenging with low-cost fabrication methods. This work reports the low-cost direct laser writing of porous graphene foam as a flexible electrochemical sensor to detect biomarkers and electrolytes in sweat. The resulting electrochemical sensor exhibits high sensitivity and low limit of detection for various biomarkers (e.g., the sensitivity of 6.49/6.87/0.94/0.16 μA μM^-1 cm^-2 and detection limit of 0.28/0.26/1.43/11.3 μM to uric acid/dopamine/tyrosine/ascorbic acid) in sweat. The results from this work open up opportunities for noninvasive continuous monitoring of gout, hydration status, and drug intake/overdose.

Integrated Device Based on a Sudomotor Nanomaterial for Sweat Detection

The compositions of sweat and blood are related. Therefore, sweat is an ideal noninvasive test body fluid that could replace blood for linear detection of many biomarkers, especially blood glucose. However, access to sweat samples remains limited to physical exercise, thermal stimulation, or electrical stimulation. Despite intensive research, a continuous, innocuous, and stable method for sweat stimulation and detection has not yet been developed. In this study, a nanomaterial for a sweat-stimulating gel based on the transdermal drug delivery system is presented, which transports acetylcholine chloride into the receptors of sweat glands to achieve the function of biological stimulation of skin sweating. The nanomaterial was applied to a suitable integrated sweat glucose detection device for noninvasive blood glucose monitoring. The total amount of evaporated sweat enabled by the nanomaterial is up to 35 μL·cm^-2 for 24 h, and the device detects up to 17.65 μM glucose under optimal conditions, showing stable performance regardless of the user's activity level. In addition, the in vivo test was performed and compared with several studies and products, which showed excellent detection performance and osmotic relationship. The nanomaterial and associated integrated device represent a significant advance in continuous passive sweat stimulation and noninvasive sweat glucose measurement for point-of-care applications.

Evolution of nanostructured skin patches towards multifunctional wearable platforms for biomedical applications

Recent advances in the field of skin patches have promoted the development of wearable and implantable bioelectronics for long-term, continuous healthcare management and targeted therapy. However, the design of electronic skin (e-skin) patches with stretchable components is still challenging and requires an in-depth understanding of the skin-attachable substrate layer, functional biomaterials and advanced self-powered electronics. In this comprehensive review, we present the evolution of skin patches from functional nanostructured materials to multi-functional and stimuli-responsive patches towards flexible substrates and emerging biomaterials for e-skin patches, including the material selection, structure design and promising applications. Stretchable sensors and self-powered e-skin patches are also discussed, ranging from electrical stimulation for clinical procedures to continuous health monitoring and integrated systems for comprehensive healthcare management. Moreover, an integrated energy harvester with bioelectronics enables the fabrication of self-powered electronic skin patches, which can effectively solve the energy supply and overcome the drawbacks induced by bulky battery-driven devices. However, to realize the full potential offered by these advancements, several challenges must be addressed for next-generation e-skin patches. Finally, future opportunities and positive outlooks are presented on the future directions of bioelectronics. It is believed that innovative material design, structure engineering, and in-depth study of fundamental principles can foster the rapid evolution of electronic skin patches, and eventually enable self-powered close-looped bioelectronic systems to benefit mankind.