Multilayer fabrication of durable catheter-deployable soft robotic sensor arrays for efficient left atrial mapping

A Durable Metalgel Maintaining 3×106 S∙M‒1 Conductivity under 1 000 000 Stretching Cycles

Conductive elastomers are in high demand for emerging fields such as wearable electronics and soft robotics. However, it remains unavailable to realize the desired metal-level conductivity after extensive stretching cycles, which is a necessity for the above promising application. Here, a new material is presented that employs an elastic, homogeneous, and dense waterborne polyurethane network to immobilize the liquid metal continuum via electrostatic interactions. This new design enables the liquid metal continuum to deform synchronously and reversibly with the polymer network, preserving its conductive structure and significantly enhancing durability. The resulting durable metalgel exhibits conductivity of 3 × 106 S∙m-1, which remains stable after 1 000 000 stretching cycles. This work overcomes the performance limitations of current conductive elastomers and unlocks new opportunities for cutting-edge applications in wearable technology and robotics.

A soft multimodal optoelectronic array interface for multiparametric mapping of heart function in vivo

Multiparametric investigation of cardiac physiology is crucial for the diagnosis and therapy of heart disease. However, no method exists to simultaneously map multiple parameters that govern cardiac (patho)physiology from beating hearts in vivo. Here, we present a cardiac sensing platform that addresses this challenge, functioning with a wireless interface. Advanced fabrication and assembling strategies enable the heterogeneous integration of transparent microelectrodes, light-emitting diodes, photodiodes, and optical filters into a multilayer array structure on soft substrates. The microelectrodes exhibit superior electrochemical performance for measuring electrical potentials and excellent transparency for co-localized fluorescence measurement. The device shows excellent biocompatibility and records the fluorescence of calcium reporter with performance comparable to imaging cameras. Multiparametric in vivo mapping of electrical excitation, calcium dynamics, and their combined effects on cardiac excitation-contraction coupling is demonstrated during normal rhythm, arrhythmia, and treatment. This technology offers potential widespread use in cardiac research to support scientific discoveries and advance clinical life-saving diagnostics and therapies.

Deployable electronics with enhanced fatigue resistance for crumpling and tension

Highly packable and deployable electronics offer a variety of advantages in electronics and robotics by facilitating spatial efficiency. These electronics must endure extreme folding during packaging and tension to maintain a rigid structure in the deployment state. Here, we present foldable and robustly deployable electronics inspired by Plantago, characterized by their tolerance to folding and tension due to integration of tough veins within thin leaf. The primary design approach for these electronics involves a high resistance to folding and tension, achieved through a thin multilayered electronic composite, which manages the neutral axis and incorporates tough Kevlar. The fabricated electronics can be folded up to 750,000 times without malfunctions and endure pulling an object 6667 times heavier than itself without stretching. Such robust electronics can be used as a deployable robot with sensor arrays, demonstrating practical applicability, as it maintains their mechanical and electrical properties during inflation from the packaged state.

Design, Testing, and Validation of a Soft Robotic Sensor Array Integrated with Flexible Electronics for Mapping Cardiac Arrhythmias

Cardiac mapping is a crucial procedure for diagnosing and treating cardiac arrhythmias. Still, current clinical techniques face limitations including insufficient electrode coverage, poor conformability to complex heart chamber geometries, and high costs. This study explores the design, testing, and validation of a 64-electrode soft robotic catheter that addresses these challenges in cardiac mapping. A dual-layer flexible printed circuit board (PCB) was designed and integrated with sensors into a soft robotic sensor array (SRSA) assembly. Design considerations included flex PCB layout, routing, integration, conformity to heart chambers, sensor placement, and catheter durability. Rigorous SRSA in vitro testing evaluated the burst/leakage pressure, block force for electrode contact, mechanical integrity, and environmental resilience. For in vivo validation, a porcine model was used to demonstrate the successful deployment, conformability, and acquisition of electrograms in both the ventricles and atria. This catheter-deployable SRSA represents a meaningful step towards translating the integration of soft robotic actuators and stretchable electronics for clinical use, showcasing the unique mechanical and electrical performance that these designs enable. The high-density electrode array enabled rapid 2 s data acquisition with detailed spatial and temporal resolution, as illustrated by the clear and consistent cardiac signals recorded across all electrodes. The future of this work will lie in enabling high-density, anatomically conformable devices for detailed cardiac mapping to guide ablation therapy and other interventions.

Wearable and Implantable Soft Robots

Soft robotics presents innovative solutions across different scales. The flexibility and mechanical characteristics of soft robots make them particularly appealing for wearable and implantable applications. The scale and level of invasiveness required for soft robots depend on the extent of human interaction. This review provides a comprehensive overview of wearable and implantable soft robots, including applications in rehabilitation, assistance, organ simulation, surgical tools, and therapy. We discuss challenges such as the complexity of fabrication processes, the integration of responsive materials, and the need for robust control strategies, while focusing on advances in materials, actuation and sensing mechanisms, and fabrication techniques. Finally, we discuss the future outlook, highlighting key challenges and proposing potential solutions.

Origami-inspired soft fluidic actuation for minimally invasive large-area electrocorticography

Electrocorticography is an established neural interfacing technique wherein an array of electrodes enables large-area recording from the cortical surface. Electrocorticography is commonly used for seizure mapping however the implantation of large-area electrocorticography arrays is a highly invasive procedure, requiring a craniotomy larger than the implant area to place the device. In this work, flexible thin-film electrode arrays are combined with concepts from soft robotics, to realize a large-area electrocorticography device that can change shape via integrated fluidic actuators. We show that the 32-electrode device can be packaged using origami-inspired folding into a compressed state and implanted through a small burr-hole craniotomy, then expanded on the surface of the brain for large-area cortical coverage. The implantation, expansion, and recording functionality of the device is confirmed in-vitro and in porcine in-vivo models. The integration of shape actuation into neural implants provides a clinically viable pathway to realize large-area neural interfaces via minimally invasive surgical techniques.

Self-Assembly Enabled Printable Asymmetric Self-Insulated Stretchable Conductor for Human Interface

Soft and stretchable conductors with high electrical conductivity and tissue-like mechanical properties are crucial for both on-skin and implantable electronic devices. Liquid metal-based conductors hold great promise due to their metallic conductivity and minimal stiffness. However, the surface oxidation of liquid metal particles in polymeric matrices poses a challenge in forming a continuous pathway for highly conductive elastic composites. Here, it is reported a printable composite material based on liquid metal and conducting polymer that undergoes a self-assembly process, achieving high conductivity (2089 S cm-1) in the bottom surface while maintaining an insulated top surface, high stretchability (>800%), and a modulus akin to human skin tissue. This material is further applied to fabricate skin-interfaced strain sensors and electromyogram sensors through 3D printing.

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.

Design Optimization of a Hybrid-Driven Soft Surgical Robot with Biomimetic Constraints

The current study investigated the geometry optimization of a hybrid-driven (based on the combination of air pressure and tendon tension) soft robot for use in robot-assisted intra-bronchial intervention. Soft robots, made from compliant materials, have gained popularity for use in surgical interventions due to their dexterity and safety. The current study aimed to design a catheter-like soft robot with an improved performance by minimizing radial expansion during inflation and increasing the force exerted on targeted tissues through geometry optimization. To do so, a finite element analysis (FEA) was employed to optimize the soft robot's geometry, considering a multi-objective goal function that incorporated factors such as chamber pressures, tendon tensions, and the cross-sectional area. To accomplish this, a cylindrical soft robot with three air chambers, three tendons, and a central working channel was considered. Then, the dimensions of the soft robot, including the length of the air chambers, the diameter of the air chambers, and the offsets of the air chambers and tendon routes, were optimized to minimize the goal function in an in-plane bending scenario. To accurately simulate the behavior of the soft robot, Ecoflex 00-50 samples were tested based on ISO 7743, and a hyperplastic model was fitted on the compression test data. The FEA simulations were performed using the response surface optimization (RSO) module in ANSYS software, which iteratively explored the design space based on defined objectives and constraints. Using RSO, 45 points of experiments were generated based on the geometrical and loading constraints. During the simulations, tendon force was applied to the tip of the soft robot, while simultaneously, air pressure was applied inside the chamber. Following the optimization of the geometry, a prototype of the soft robot with the optimized values was fabricated and tested in a phantom model, mimicking simulated surgical conditions. The decreased actuation effort and radial expansion of the soft robot resulting from the optimization process have the potential to increase the performance of the manipulator. This advancement led to improved control over the soft robot while additionally minimizing unnecessary cross-sectional expansion. The study demonstrates the effectiveness of the optimization methodology for refining the soft robot's design and highlights its potential for enhancing surgical interventions.

Costunolide ameliorates angiotensin II-induced atrial inflammation and fibrosis by regulating mitochondrial function and oxidative stress in mice: A possible therapeutic approach for atrial fibrillation

Atrial fibrillation (AF) is a cardiac disease characterized by disordered atrial electrical activity. Atrial inflammation and fibrosis are involved in AF progression. Costunolide (COS) is a sesquiterpene lactone containing anti-inflammatory and anti-fibrotic activities. This study aims to explore the underlying mechanisms by which COS protects against AF. Male C57BL/6 mice (8- to 10-week-old) were infused with angiotensin (Ang) II for 3 weeks. Meanwhile, different doses of COS (COS-L: 10 mg/kg, COS-H: 20 mg/kg) were administered to mice by intragastric treatment. The results showed irregular and rapid heart rates in Ang II-treated mice. Moreover, the levels of inflammatory cytokines and fibrotic factors were elevated in mice. COS triggered a reduction of Ang II-induced inflammation and fibrosis, which conferred a protective effect. Mechanistically, mitochondrial dysfunction with mitochondrial respiration inhibition and aberrant ATP levels were observed after Ang II treatment. Moreover, Ang-II-induced excessive reactive oxygen species caused oxidative stress, which was further aggravated by inhibiting Nrf2 nuclear translocation. Importantly, COS diminished these Ang-II-mediated effects in mice. In conclusion, COS attenuated inflammation and fibrosis in Ang-II-treated mice by alleviating mitochondrial dysfunction and oxidative stress. Our findings represent a potential therapeutic option for AF treatment.

Developing Pharmacological Therapies for Atrial Fibrillation Targeting Mitochondrial Dysfunction and Oxidative Stress: A Scoping Review

Atrial fibrillation (AF) is a cardiac arrhythmia caused by electrophysiological anomalies in the atrial tissue, tissue degradation, structural abnormalities, and comorbidities. A direct relationship exists between AF and altered mitochondrial activity resulting from membrane potential loss, contractile dysfunction, or decreased ATP levels. This review aimed to elucidate the role of mitochondrial oxidative mechanisms in AF pathophysiology, the impact of mitochondrial oxidative stress on AF initiation and perpetuation, and current therapies. This review followed the Preferred Reporting Items for Systematic Reviews and the Meta-Analysis Extension for Scoping Reviews. PubMed, Excerpta Medica Database, and Scopus were explored until June 2023 using "MESH terms". Bibliographic references to relevant papers were also included. Oxidative stress is an imbalance that causes cellular damage from excessive oxidation, resulting in conditions such as AF. An imbalance in reactive oxygen species production and elimination can cause mitochondrial damage, cellular apoptosis, and cardiovascular diseases. Oxidative stress and inflammation are intrinsically linked, and inflammatory pathways are highly correlated with the occurrence of AF. AF is an intricate cardiac condition that requires innovative therapeutic approaches. The involvement of mitochondrial oxidative stress in the pathophysiology of AF introduces novel strategies for clinical treatment.

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.

Untethered Soft Microrobots with Adaptive Logic Gates

Integrating adaptative logic computation directly into soft microrobots is imperative for the next generation of intelligent soft microrobots as well as for the smart materials to move beyond stimulus-response relationships and toward the intelligent behaviors seen in biological systems. Acquiring adaptivity is coveted for soft microrobots that can adapt to implement different works and respond to different environments either passively or actively through human intervention like biological systems. Here, a novel and simple strategy for constructing untethered soft microrobots based on stimuli-responsive hydrogels that can switch logic gates according to the surrounding stimuli of environment is introduced. Different basic logic gates and combinational logic gates are integrated into a microrobot via a straightforward method. Importantly, two kinds of soft microrobots with adaptive logic gates are designed and fabricated, which can smartly switch logic operation between AND gate and OR gate under different surrounding environmental stimuli. Furthermore, a same magnetic microrobot with adaptive logic gate is used to capture and release the specified objects through the change of the surrounding environmental stimuli based on AND or OR logic gate. This work contributes an innovative strategy to integrate computation into small-scale untethered soft robots with adaptive logic gates.

Creating Stretchable Electronics from Dual Layer Flex-PCB for Soft Robotic Cardiac Mapping Catheters

The authors present in this study the development of a novel method for creating stretchable electronics from dual-layer flex printed circuit boards (flex-PCBs) as a platform for soft robotic sensor arrays (SRSAs) for cardiac voltage mapping applications. There is a crucial need for devices that utilize multiple sensors and provide high performance signal acquisition for cardiac mapping. Previously, our group demonstrated how single-layer flex-PCB can be postprocessed to create a stretchable electronic sensing array. In this work, a detailed fabrication process for creating a dual-layer multielectrode flex-PCB SRSA is presented, along with relevant parameters to achieve optimal postprocessing with a laser cutter. The dual-layer flex-PCB SRSA's ability to acquire electrical signals is demonstrated both in vitro as well as in vivo on a Leporine cardiac surface. These SRSAs could be extended into full-chamber cardiac mapping catheter applications. Our results show a significant contribution towards the scalable use of dual-layer flex-PCB for stretchable electronics.

Highly Integrated Multi-Material Fibers for Soft Robotics

Soft robots are envisioned as the next generation of safe biomedical devices in minimally invasive procedures. Yet, the difficulty of processing soft materials currently limits the size, aspect-ratio, manufacturing throughput, as well as, the design complexity and hence capabilities of soft robots. Multi-material thermal drawing is introduced as a material and processing platform to create soft robotic fibers imparted with multiple actuations and sensing modalities. Several thermoplastic and elastomeric material options for the fibers are presented, which all exhibit the rheological processing attributes for thermal drawing but varying mechanical properties, resulting in adaptable actuation performance. Moreover, numerous different fiber designs with intricate internal architectures, outer diameters of 700 µm, aspect ratios of 103 , and a fabrication at a scale of 10s of meters of length are demonstrated. A modular tendon-driven mechanism enables 3-dimensional (3D) motion, and embedded optical guides, electrical wires, and microfluidic channels give rise to multifunctionality. The fibers can perceive and autonomously adapt to their environments, as well as, probe electrical properties, and deliver fluids and mechanical tools to spatially distributed targets.

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.

Soft actuators for real-world applications

Inspired by physically adaptive, agile, reconfigurable and multifunctional soft-bodied animals and human muscles, soft actuators have been developed for a variety of applications, including soft grippers, artificial muscles, wearables, haptic devices and medical devices. However, the complex performance of biological systems cannot yet be fully replicated in synthetic designs. In this Review, we discuss new materials and structural designs for the engineering of soft actuators with physical intelligence and advanced properties, such as adaptability, multimodal locomotion, self-healing and multi-responsiveness. We examine how performance can be improved and multifunctionality implemented by using programmable soft materials, and highlight important real-world applications of soft actuators. Finally, we discuss the challenges and opportunities for next-generation soft actuators, including physical intelligence, adaptability, manufacturing scalability and reproducibility, extended lifetime and end-of-life strategies.

Artificial Intelligence of Things (AIoT) Enabled Virtual Shop Applications Using Self-Powered Sensor Enhanced Soft Robotic Manipulator

Rapid advancements of artificial intelligence of things (AIoT) technology pave the way for developing a digital-twin-based remote interactive system for advanced robotic-enabled industrial automation and virtual shopping. The embedded multifunctional perception system is urged for better interaction and user experience. To realize such a system, a smart soft robotic manipulator is presented that consists of a triboelectric nanogenerator tactile (T-TENG) and length (L-TENG) sensor, as well as a poly(vinylidene fluoride) (PVDF) pyroelectric temperature sensor. With the aid of machine learning (ML) for data processing, the fusion of the T-TENG and L-TENG sensors can realize the automatic recognition of the grasped objects with the accuracy of 97.143% for 28 different shapes of objects, while the temperature distribution can also be obtained through the pyroelectric sensor. By leveraging the IoT and artificial intelligence (AI) analytics, a digital-twin-based virtual shop is successfully implemented to provide the users with real-time feedback about the details of the product. In general, by offering a more immersive experience in human-machine interactions, the proposed remote interactive system shows the great potential of being the advanced human-machine interface for the applications of the unmanned working space.