Bioadhesive ultrasound for long-term continuous imaging of diverse organs

Flexible, biodegradable ultrasonic wireless electrotherapy device based on highly self-aligned piezoelectric biofilms

Biodegradable piezoelectric devices hold great promise in on-demand transient bioelectronics. Existing piezoelectric biomaterials, however, remain obstacles to the development of such devices due to difficulties in large-scale crystal orientation alignment and weak piezoelectricity. Here, we present a strategy for the synthesis of optimally orientated, self-aligned piezoelectric γ-glycine/polyvinyl alcohol (γ-glycine/PVA) films via an ultrasound-assisted process, guided by density functional theory. The first-principles calculations reveal that the negative piezoelectric effect of γ-glycine originates from the stretching and compression of glycine molecules induced by hydrogen bonding interactions. The synthetic γ-glycine/PVA films exhibit a piezoelectricity of 10.4 picocoulombs per newton and an ultrahigh piezoelectric voltage coefficient of 324 × 10-3 volt meters per newton. The biofilms are further developed into flexible, bioresorbable, wireless piezo-ultrasound electrotherapy devices, which are demonstrated to shorten wound healing by ~40% and self-degrade in preclinical wound models. These encouraging results offer reliable approaches for engineering piezoelectric biofilms and developing transient bioelectronics.

Active biointegrated living electronics for managing inflammation

Seamless interfaces between electronic devices and biological tissues stand to revolutionize disease diagnosis and treatment. However, biological and biomechanical disparities between synthetic materials and living tissues present challenges at bioelectrical signal transduction interfaces. We introduce the active biointegrated living electronics (ABLE) platform, encompassing capabilities across the biogenic, biomechanical, and bioelectrical properties simultaneously. The living biointerface, comprising a bioelectronics layout and a Staphylococcus epidermidis-laden hydrogel composite, enables multimodal signal transduction at the microbial-mammalian nexus. The extracellular components of the living hydrogels, prepared through thermal release of naturally occurring amylose polymer chains, are viscoelastic, capable of sustaining the bacteria with high viability. Through electrophysiological recordings and wireless probing of skin electrical impedance, body temperature, and humidity, ABLE monitors microbial-driven intervention in psoriasis.

Pediatric Monitoring Technologies and Congenital Heart Disease: A Systematic Review

Outpatient monitoring of infants with congenital heart disease has been shown to significantly reduce rates of mortality in the single ventricle population. Despite the accelerating development of miniaturized biosensors and electronics, and a growing market demand for at-home monitoring devices, the application of these technologies to infants and children is significantly delayed compared with the development of devices for adults. This article aims to review the current landscape of available monitoring technologies and devices for pediatric patients to describe the gap between technologies and clinical needs with the goal of progressing development of clinically and scientifically validated pediatric monitoring devices.

Noninvasive imaging-guided ultrasonic neurostimulation with arbitrary 2D patterns and its application for high-quality vision restoration

Retinal degeneration, a leading cause of irreversible low vision and blindness globally, can be partially addressed by retina prostheses which stimulate remaining neurons in the retina. However, existing electrode-based treatments are invasive, posing substantial risks to patients and healthcare providers. Here, we introduce a completely noninvasive ultrasonic retina prosthesis, featuring a customized ultrasound two-dimensional array which allows for simultaneous imaging and stimulation. With synchronous three-dimensional imaging guidance and auto-alignment technology, ultrasonic retina prosthesis can generate programmed ultrasound waves to dynamically and precisely form arbitrary wave patterns on the retina. Neuron responses in the brain's visual center mirrored these patterns, evidencing successful artificial vision creation, which was further corroborated in behavior experiments. Quantitative analysis of the spatial-temporal resolution and field of view demonstrated advanced performance of ultrasonic retina prosthesis and elucidated the biophysical mechanism of retinal stimulation. As a noninvasive blindness prosthesis, ultrasonic retina prosthesis could lead to a more effective, widely acceptable treatment for blind patients. Its real-time imaging-guided stimulation strategy with a single ultrasound array, could also benefit ultrasound neurostimulation in other diseases.

The AI Future of Emergency Medicine

In the coming years, artificial intelligence (AI) and machine learning will likely give rise to profound changes in the field of emergency medicine, and medicine more broadly. This article discusses these anticipated changes in terms of 3 overlapping yet distinct stages of AI development. It reviews some fundamental concepts in AI and explores their relation to clinical practice, with a focus on emergency medicine. In addition, it describes some of the applications of AI in disease diagnosis, prognosis, and treatment, as well as some of the practical issues that they raise, the barriers to their implementation, and some of the legal and regulatory challenges they create.

Lead-free dual-frequency ultrasound implants for wireless, biphasic deep brain stimulation

Ultrasound-driven bioelectronics could offer a wireless scheme with sustainable power supply; however, current ultrasound implantable systems present critical challenges in biocompatibility and harvesting performance related to lead/lead-free piezoelectric materials and devices. Here, we report a lead-free dual-frequency ultrasound implants for wireless, biphasic deep brain stimulation, which integrates two developed lead-free sandwich porous 1-3-type piezoelectric composite elements with enhanced harvesting performance in a flexible printed circuit board. The implant is ultrasonically powered through a portable external dual-frequency transducer and generates programmable biphasic stimulus pulses in clinically relevant frequencies. Furthermore, we demonstrate ultrasound-driven implants for long-term biosafety therapy in deep brain stimulation through an epileptic rodent model. With biocompatibility and improved electrical performance, the lead-free materials and devices presented here could provide a promising platform for developing implantable ultrasonic electronics in the future.

Miniaturized therapeutic systems for ultrasound-modulated drug delivery to the central and peripheral nervous system

Ultrasound is a promising technology to address challenges in drug delivery, including limited drug penetration across physiological barriers and ineffective targeting. Here we provide an overview of the significant advances made in recent years in overcoming technical and pharmacological barriers using ultrasound-assisted drug delivery to the central and peripheral nervous system. We commence by exploring the fundamental principles of ultrasound physics and its interaction with tissue. The mechanisms of ultrasonic-enhanced drug delivery are examined, as well as the relevant tissue barriers. We highlight drug transport through such tissue barriers utilizing insonation alone, in combination with ultrasound contrast agents (e.g., microbubbles), and through innovative particulate drug delivery systems. Furthermore, we review advances in systems and devices for providing therapeutic ultrasound, as their practicality and accessibility are crucial for clinical application.

Permanent fluidic magnets for liquid bioelectronics

Brownian motion allows microscopically dispersed nanoparticles to be stable in ferrofluids, as well as causes magnetization relaxation and prohibits permanent magnetism. Here we decoupled the particle Brownian motion from colloidal stability to achieve a permanent fluidic magnet with high magnetization, flowability and reconfigurability. The key to create such permanent fluidic magnets is to maintain a stable magnetic colloidal fluid by using non-Brownian magnetic particles to self-assemble a three-dimensional oriented and ramified magnetic network structure in the carrier fluid. This structure has high coercivity and permanent magnetization, with long-term magnetization stability. We establish a scaling theory model to decipher the permanent fluid magnet formation criteria and formulate a general assembly guideline. Further, we develop injectable and retrievable permanent-fluidic-magnet-based liquid bioelectronics for highly sensitive, self-powered wireless cardiovascular monitoring. Overall, our findings highlight the potential of permanent fluidic magnets as an ultrasoft material for liquid devices and systems, from bioelectronics to robotics.

Transcranial volumetric imaging using a conformal ultrasound patch

Accurate and continuous monitoring of cerebral blood flow is valuable for clinical neurocritical care and fundamental neurovascular research. Transcranial Doppler (TCD) ultrasonography is a widely used non-invasive method for evaluating cerebral blood flow1, but the conventional rigid design severely limits the measurement accuracy of the complex three-dimensional (3D) vascular networks and the practicality for prolonged recording2. Here we report a conformal ultrasound patch for hands-free volumetric imaging and continuous monitoring of cerebral blood flow. The 2 MHz ultrasound waves reduce the attenuation and phase aberration caused by the skull, and the copper mesh shielding layer provides conformal contact to the skin while improving the signal-to-noise ratio by 5 dB. Ultrafast ultrasound imaging based on diverging waves can accurately render the circle of Willis in 3D and minimize human errors during examinations. Focused ultrasound waves allow the recording of blood flow spectra at selected locations continuously. The high accuracy of the conformal ultrasound patch was confirmed in comparison with a conventional TCD probe on 36 participants, showing a mean difference and standard deviation of difference as -1.51 ± 4.34 cm s-1, -0.84 ± 3.06 cm s-1 and -0.50 ± 2.55 cm s-1 for peak systolic velocity, mean flow velocity, and end diastolic velocity, respectively. The measurement success rate was 70.6%, compared with 75.3% for a conventional TCD probe. Furthermore, we demonstrate continuous blood flow spectra during different interventions and identify cascades of intracranial B waves during drowsiness within 4 h of recording.

Curved and Annular Diaphragm Coupled Piezoelectric Micromachined Ultrasonic Transducers for High Transmit Biomedical Applications

In this paper, we present a novel three-dimensional (3D) coupled configuration of piezoelectric micromachined ultrasound transducers (pMUTs) by combing a curved and an annular diaphragm for transmit performance optimization in biomedical applications. An analytical equivalent circuit model (EQC) is developed with varied excitation methods to incorporate the acoustic-structure coupling of the curved and annular diaphragm-coupled pMUTs (CAC-pMUTs). The model-derived results align well with the reference simulated by the finite element method (FEM). Using this EQC model, we optimize the key design parameters of the CAC-pMUTs in order to improve the output sound pressure, including the width of the annular membrane, the thickness of the passive layer, and the phase difference of the driving voltage. In the anti-phase mode, the designed CAC-pMUTs demonstrate a transmit efficiency 285 times higher than that of single annular pMUTs. This substantial improvement underscores the potential of CAC-pMUTs for large array applications.

A Dynamic Ultrasound Phantom with Tissue-Mimicking Mechanical and Acoustic Properties

Tissue-mimicking phantoms are valuable tools that aid in improving the equipment and training available to medical professionals. However, current phantoms possess limited utility due to their inability to precisely simulate multiple physical properties simultaneously, which is crucial for achieving a system understanding of dynamic human tissues. In this work, novel materials design and fabrication processes to produce various tissue-mimicking materials (TMMs) for skin, adipose, muscle, and soft tissue at a human scale are developed. Target properties (Young's modulus, density, speed of sound, and acoustic attenuation) are first defined for each TMM based on literature. Each TMM recipe is developed, associated mechanical and acoustic properties are characterized, and the TMMs are confirmed to have comparable mechanical and acoustic properties with the corresponding human tissues. Furthermore, a novel sacrificial core to fabricate a hollow, ellipsoid-shaped bladder phantom complete with inlet and outlet tubes, which allow liquids to flow through and expand this phantom, is adopted. This dynamic bladder phantom with realistic mechanical and acoustic properties to human tissues in combination with the developed skin, soft tissue, and subcutaneous adipose tissue TMMs, culminates in a human scale torso tank and electro-mechanical system that can be systematically utilized for characterizing various medical imaging devices.

Bioadhesive interface for marine sensors on diverse soft fragile species

Marine animals equipped with sensors provide vital information for understanding their ecophysiology and collect oceanographic data on climate change and for resource management. Existing methods for attaching sensors to marine animals mostly rely on invasive physical anchors, suction cups, and rigid glues. These methods can suffer from limitations, particularly for adhering to soft fragile marine species such as squid and jellyfish, including slow complex operations, unreliable fixation, tissue trauma, and behavior changes of the animals. However, soft fragile marine species constitute a significant portion of ocean biomass (>38.3 teragrams of carbon) and global commercial fisheries. Here we introduce a soft hydrogel-based bioadhesive interface for marine sensors that can provide rapid (time <22 s), robust (interfacial toughness >160 J m-2), and non-invasive adhesion on various marine animals. Reliable and rapid adhesion enables large-scale, multi-animal sensor deployments to study biomechanics, collective behaviors, interspecific interactions, and concurrent multi-species activity. These findings provide a promising method to expand a burgeoning research field of marine bio-sensing from large marine mammals and fishes to small, soft, and fragile marine animals.

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.

Skin-Inspired All-Natural Biogel for Bioadhesive Interface

Natural material-based hydrogels are considered ideal candidates for constructing robust bio-interfaces due to their environmentally sustainable nature and biocompatibility. However, these hydrogels often encounter limitations such as weak mechanical strength, low water resistance, and poor ionic conductivity. Here, inspired by the role of natural moisturizing factor (NMF) in skin, a straightforward yet versatile strategy is proposed for fabricating all-natural ionic biogels that exhibit high resilience, ionic conductivity, resistance to dehydration, and complete degradability, without necessitating any chemical modification. A well-balanced combination of gelatin and sodium pyrrolidone carboxylic acid (an NMF compound) gives rise to a significant enhancement in the mechanical strength, ionic conductivity, and water retention capacity of the biogel compared to pure gelatin hydrogel. The biogel manifests temperature-controlled reversible fluid-gel transition properties attributed to the triple-helix junctions of gelatin, which enables in situ gelation on diverse substrates, thereby ensuring conformal contact and dynamic compliance with curved surfaces. Due to its salutary properties, the biogel can serve as an effective and biocompatible interface for high-quality and long-term electrophysiological signal recording. These findings provide a general and scalable approach for designing natural material-based hydrogels with tailored functionalities to meet diverse application needs.

Interdisciplinary-Inspired Smart Antibacterial Materials and Their Biomedical Applications

The discovery of antibiotics has saved millions of lives, but the emergence of antibiotic-resistant bacteria has become another problem in modern medicine. To avoid or reduce the overuse of antibiotics in antibacterial treatments, stimuli-responsive materials, pathogen-targeting nanoparticles, immunogenic nano-toxoids, and biomimetic materials are being developed to make sterilization better and smarter than conventional therapies. The common goal of smart antibacterial materials (SAMs) is to increase the antibiotic efficacy or function via an antibacterial mechanism different from that of antibiotics in order to increase the antibacterial and biological properties while reducing the risk of drug resistance. The research and development of SAMs are increasingly interdisciplinary because new designs require the knowledge of different fields and input/collaboration from scientists in different fields. A good understanding of energy conversion in materials, physiological characteristics in cells and bacteria, and bactericidal structures and components in nature are expected to promote the development of SAMs. In this review, the importance of multidisciplinary insights for SAMs is emphasized, and the latest advances in SAMs are categorized and discussed according to the pertinent disciplines including materials science, physiology, and biomimicry.

Closely Packed Stretchable Ultrasound Array Fabricated with Surface Charge Engineering for Contactless Gesture and Materials Detection

Communication with hand gestures plays a significant role in human-computer interaction by providing an intuitive and natural way for humans to communicate with machines. Ultrasound-based devices have shown promising results in contactless hand gesture recognition without requiring physical contact. However, it is challenging to fabricate a densely packed wearable ultrasound array. Here, a stretchable ultrasound array is demonstrated with closely packed transducer elements fabricated using surface charge engineering between pre-charged 1-3 Lead Zirconate Titanate (PZT) composite and thin polyimide film without using a microscope. The array exhibits excellent ultrasound properties with a wide bandwidth (≈57.1%) and high electromechanical coefficient (≈0.75). The ultrasound array can decipher gestures up to 10 cm in distance by using a contactless triboelectric module and identify materials from the time constant of the exponentially decaying impedance based on their triboelectric properties by utilizing the electrostatic induction phase. The newly proposed metric of the areal-time constant is material-specific and decreases monotonically from a highly positive human body (1.13 m2 s) to negatively charged polydimethylsiloxane (PDMS) (0.02 m2 s) in the triboelectric series. The capability of the closely packed ultrasound array to detect material along with hand gesture interpretation provides an additional dimension in the next-generation human-robot interaction.

Ultrasonic detection method based on flexible capillary water column arrays coupling

Conventional water immersion ultrasonic testing faces limitations due to factors such as environmental conditions, workpiece dimensions, corrosion, and resource wastage. Contact-based coupling methods, which employ coupling media or specific coupling structures, offer a convenient approach to coupling acoustic waves and reduce signal attenuation. However, these methods are time-sensitive and lack adaptability to uneven surfaces, particularly when dealing with workpieces featuring subtle undulations, resulting in significant signal decay. This paper presents an ultrasonic coupling method based on a flexible capillary water column array. By employing a stable and flexible water column array within the micro-channels as the coupling medium, stable contact-based transmission of ultrasonic signals is achieved. The influence of water column array unit dimensions and array structures is explored through theoretical analysis and experimentation, demonstrating lower energy attenuation compared to reductions in water column area. Notably, the tests revealed the method's adaptability at oblique angles below 20°, which surpasses the performance of submerged detection at similar angles. This research presents an innovative and stable approach for contact-based ultrasonic coupling testing, particularly in scenarios involving dynamic contact scanning between ultrasonic waves and workpieces.

Flexible large-area ultrasound arrays for medical applications made using embossed polymer structures

With the huge progress in micro-electronics and artificial intelligence, the ultrasound probe has become the bottleneck in further adoption of ultrasound beyond the clinical setting (e.g. home and monitoring applications). Today, ultrasound transducers have a small aperture, are bulky, contain lead and are expensive to fabricate. Furthermore, they are rigid, which limits their integration into flexible skin patches. New ways to fabricate flexible ultrasound patches have therefore attracted much attention recently. First prototypes typically use the same lead-containing piezo-electric materials, and are made using micro-assembly of rigid active components on plastic or rubber-like substrates. We present an ultrasound transducer-on-foil technology based on thermal embossing of a piezoelectric polymer. High-quality two-dimensional ultrasound images of a tissue mimicking phantom are obtained. Mechanical flexibility and effective area scalability of the transducer are demonstrated by functional integration into an endoscope probe with a small radius of 3 mm and a large area (91.2×14 mm2) non-invasive blood pressure sensor.

Flexible Conformally Bioadhesive MXene Hydrogel Electronics for Machine Learning-Facilitated Human-Interactive Sensing

Wearable epidermic electronics assembled from conductive hydrogels are attracting various research attention for their seamless integration with human body for conformally real-time health monitoring, clinical diagnostics and medical treatment, and human-interactive sensing. Nevertheless, it remains a tremendous challenge to simultaneously achieve conformally bioadhesive epidermic electronics with remarkable self-adhesiveness, reliable ultraviolet (UV) protection ability, and admirable sensing performance for high-fidelity epidermal electrophysiological signals monitoring, along with timely photothermal therapeutic performances after medical diagnostic sensing, as well as efficient antibacterial activity and reliable hemostatic effect for potential medical therapy. Herein, a conformally bioadhesive hydrogel-based epidermic sensor, featuring superior self-adhesiveness and excellent UV-protection performance, is developed by dexterously assembling conducting MXene nanosheets network with biological hydrogel polymer network for conformally stably attaching onto human skin for high-quality recording of various epidermal electrophysiological signals with high signal-to-noise ratios (SNR) and low interfacial impedance for intelligent medical diagnosis and smart human-machine interface. Moreover, a smart sign language gesture recognition platform based on collected electromyogram (EMG) signals is designed for hassle-free communication with hearing-impaired people with the help of advanced machine learning algorithms. Meanwhile, the bioadhesive MXene hydrogel possesses reliable antibacterial capability, excellent biocompatibility, and effective hemostasis properties for promising bacterial-infected wound bleeding.

E-Tattoos: Toward Functional but Imperceptible Interfacing with Human Skin

The human body continuously emits physiological and psychological information from head to toe. Wearable electronics capable of noninvasively and accurately digitizing this information without compromising user comfort or mobility have the potential to revolutionize telemedicine, mobile health, and both human-machine or human-metaverse interactions. However, state-of-the-art wearable electronics face limitations regarding wearability and functionality due to the mechanical incompatibility between conventional rigid, planar electronics and soft, curvy human skin surfaces. E-Tattoos, a unique type of wearable electronics, are defined by their ultrathin and skin-soft characteristics, which enable noninvasive and comfortable lamination on human skin surfaces without causing obstruction or even mechanical perception. This review article offers an exhaustive exploration of e-tattoos, accounting for their materials, structures, manufacturing processes, properties, functionalities, applications, and remaining challenges. We begin by summarizing the properties of human skin and their effects on signal transmission across the e-tattoo-skin interface. Following this is a discussion of the materials, structural designs, manufacturing, and skin attachment processes of e-tattoos. We classify e-tattoo functionalities into electrical, mechanical, optical, thermal, and chemical sensing, as well as wound healing and other treatments. After discussing energy harvesting and storage capabilities, we outline strategies for the system integration of wireless e-tattoos. In the end, we offer personal perspectives on the remaining challenges and future opportunities in the field.

Monitoring homeostasis with ultrasound

An implant could allow at-home monitoring of deep-tissue changes after surgery.

Ultra-Broadband Flexible Thin-Film Sensor for Sound Monitoring and Ultrasonic Diagnosis

Small-scale and flexible acoustic probes are more desirable for exquisite objects like human bodies and complex-shaped components than conventional rigid ones. Herein, a thin-film flexible acoustic sensor (FA-TES) that can detect ultra-broadband acoustic signals in multiple applications is proposed. The device consists of two thin copper-coated polyvinyl chloride films, which are stimulated by acoustic waves and contact each other to generate the triboelectric signal. Interlocking nanocolumn arrays fabricated on the friction surfaces are regarded as a highly adaptive spacer enabling this device to respond to ultra-broadband acoustic signals (100 Hz-4 MHz) and enhance sensor sensitivity for film weak vibration. Benefiting from the characteristics of high shape adaptability and ultrawide response range, the FA-TES can precisely sense human physiological sounds and voice (≤10 kHz) for laryngeal health monitoring and interaction in real-time. Moreover, the FA-TES flexibly arranged on a 3D-printed vertebra model can effectively and accurately diagnose the inner defect by ultrasonic testing (≥1 MHz). It envisions that this work can provide new ideas for flexible acoustic sensor designs and optimize real-time acoustic detections of human bodies and complex components.

A fully integrated wearable ultrasound system to monitor deep tissues in moving subjects

Recent advances in wearable ultrasound technologies have demonstrated the potential for hands-free data acquisition, but technical barriers remain as these probes require wire connections, can lose track of moving targets and create data-interpretation challenges. Here we report a fully integrated autonomous wearable ultrasonic-system-on-patch (USoP). A miniaturized flexible control circuit is designed to interface with an ultrasound transducer array for signal pre-conditioning and wireless data communication. Machine learning is used to track moving tissue targets and assist the data interpretation. We demonstrate that the USoP allows continuous tracking of physiological signals from tissues as deep as 164 mm. On mobile subjects, the USoP can continuously monitor physiological signals, including central blood pressure, heart rate and cardiac output, for as long as 12 h. This result enables continuous autonomous surveillance of deep tissue signals toward the internet-of-medical-things.

Insights into Materials, Physics, and Applications in Flexible and Wearable Acoustic Sensing Technology

Sound plays a crucial role in the perception of the world. It allows to communicate, learn, and detect potential dangers, diagnose diseases, and much more. However, traditional acoustic sensors are limited in their form factors, being rigid and cumbersome, which restricts their potential applications. Recently, acoustic sensors have made significant advancements, transitioning from rudimentary forms to wearable devices and smart everyday clothing that can conform to soft, curved, and deformable surfaces or surroundings. In this review, the latest scientific and technological breakthroughs with insightful analysis in materials, physics, design principles, fabrication strategies, functions, and applications of flexible and wearable acoustic sensing technology are comprehensively explored. The new generation of acoustic sensors that can recognize voice, interact with machines, control robots, enable marine positioning and localization, monitor structural health, diagnose human vital signs in deep tissues, and perform organ imaging is highlighted. These innovations offer unique solutions to significant challenges in fields such as healthcare, biomedicine, wearables, robotics, and metaverse. Finally, the existing challenges and future opportunities in the field are addressed, providing strategies to advance acoustic sensing technologies for intriguing real-world applications and inspire new research directions.

Development of an Automated Ultrasound Signal Indicator of Lung Interstitial Syndrome

OBJECTIVES

The number and distribution of lung ultrasound (LUS) imaging artifacts termed B-lines correlate with the presence of acute lung disease such as infection, acute respiratory distress syndrome (ARDS), and pulmonary edema. Detection and interpretation of B-lines require dedicated training and is machine and operator-dependent. The goal of this study was to identify radio frequency (RF) signal features associated with B-lines in a cohort of patients with cardiogenic pulmonary edema. A quantitative signal indicator could then be used in a single-element, non-imaging, wearable, automated lung ultrasound sensor (LUSS) for continuous hands-free monitoring of lung fluid.

METHODS

In this prospective study a 10-zone LUS exam was performed in 16 participants, including 12 patients admitted with acute cardiogenic pulmonary edema (mean age 60 ± 12 years) and 4 healthy controls (mean age 44 ± 21). Overall,160 individual LUS video clips were recorded. The LUS exams were performed with a phased array probe driven by an open-platform ultrasound system with simultaneous RF signal collection. RF data were analyzed offline for candidate B-line indicators based on signal amplitude, temporal variability, and frequency spectrum; blinded independent review of LUS images for the presence or absence of B-lines served as ground truth. Predictive performance of the signal indicators was determined with receiving operator characteristic (ROC) analysis with k-fold cross-validation.

RESULTS

Two RF signal features-temporal variability of signal amplitude at large depths and at the pleural line-were strongly associated with B-line presence. The sensitivity and specificity of a combinatorial indicator were 93.2 and 58.5%, respectively, with cross-validated area under the ROC curve (AUC) of 0.91 (95% CI = 0.80-0.94).

CONCLUSION

A combinatorial signal indicator for use with single-element non-imaging LUSS was developed to facilitate continuous monitoring of lung fluid in patients with respiratory illness.

Wearable bioadhesive ultrasound shear wave elastography

Acute liver failure (ALF) is a critical medical condition defined as the rapid development of hepatic dysfunction. Conventional ultrasound elastography cannot continuously monitor liver stiffness over the course of rapidly changing diseases for early detection due to the requirement of a handheld probe. In this study, we introduce wearable bioadhesive ultrasound elastography (BAUS-E), which can generate acoustic radiation force impulse (ARFI) to induce shear waves for the continuous monitoring of modulus changes. BAUS-E contains 128 channels with a compact design with only 24 mm in the azimuth direction for comfortable wearability. We further used BAUS-E to continuously monitor the stiffness of in vivo rat livers with ALF induced by d-galactosamine over 48 hours, and the stiffness change was observed within the first 6 hours. BAUS-E holds promise for clinical applications, particularly in patients after organ transplantation or postoperative care in the intensive care unit (ICU).

Physiological sensing system integrated with vibration sensor and frequency gel dampers inspired by spider

Recent advances in bioelectronics in mechanical and electrophysiological signal detection are remarkable, but there are still limitations because they are inevitably affected by environmental noise and motion artifacts. Thus, we develop a gel damper-integrated crack sensor inspired by the vibration response of the viscoelastic cuticular pad and slit organs in a spider. Benefitting from the specific crack structure design, the sensor possesses excellent sensing behaviors, including a low detection limit (0.05% strain), ultrafast response ability (3.4 ms) and superior durability (>300 000 cycles). Such typical low-amplitude fast response properties allow the ability to accurately perceive vibration frequency and waveform. In addition, the gel damper exhibits frequency-dependent dynamic mechanical behavior that results in improved stability and reliability of signal acquisition by providing shock resistance and isolating external factors. They effectively attenuate external motion artifacts and low-frequency mechanical noise, resulting in cleaner and more reliable signal acquisition. When the gel damper is combined with the crack-based vibration sensor, the integrated sensor exhibits superior anti-interference capability and frequency selectivity, demonstrating its effectiveness in extracting genuine vocal vibration signals from raw voice recordings. The integration of damping materials with sensors offers an efficient approach to improving signal acquisition and signal quality in various applications.

SonoTransformers: Transformable acoustically activated wireless microscale machines

Shape transformation, a key mechanism for organismal survival and adaptation, has gained importance in developing synthetic shape-shifting systems with diverse applications ranging from robotics to bioengineering. However, designing and controlling microscale shape-shifting materials remains a fundamental challenge in various actuation modalities. As materials and structures are scaled down to the microscale, they often exhibit size-dependent characteristics, and the underlying physical mechanisms can be significantly affected or rendered ineffective. Additionally, surface forces such as van der Waals forces and electrostatic forces become dominant at the microscale, resulting in stiction and adhesion between small structures, making them fracture and more difficult to deform. Furthermore, despite various actuation approaches, acoustics have received limited attention despite their potential advantages. Here, we introduce "SonoTransformer," the acoustically activated micromachine that delivers shape transformability using preprogrammed soft hinges with different stiffnesses. When exposed to an acoustic field, these hinges concentrate sound energy through intensified oscillation and provide the necessary force and torque for the transformation of the entire micromachine within milliseconds. We have created machine designs to predetermine the folding state, enabling precise programming and customization of the acoustic transformation. Additionally, we have shown selective shape transformable microrobots by adjusting acoustic power, realizing high degrees of control and functional versatility. Our findings open new research avenues in acoustics, physics, and soft matter, offering new design paradigms and development opportunities in robotics, metamaterials, adaptive optics, flexible electronics, and microtechnology.

A physicochemical-sensing electronic skin for stress response monitoring

Approaches to quantify stress responses typically rely on subjective surveys and questionnaires. Wearable sensors can potentially be used to continuously monitor stress-relevant biomarkers. However, the biological stress response is spread across the nervous, endocrine, and immune systems, and the capabilities of current sensors are not sufficient for condition-specific stress response evaluation. Here we report an electronic skin for stress response assessment that non-invasively monitors three vital signs (pulse waveform, galvanic skin response and skin temperature) and six molecular biomarkers in human sweat (glucose, lactate, uric acid, sodium ions, potassium ions and ammonium). We develop a general approach to prepare electrochemical sensors that relies on analogous composite materials for stabilizing and conserving sensor interfaces. The resulting sensors offer long-term sweat biomarker analysis of over 100 hours with high stability. We show that the electronic skin can provide continuous multimodal physicochemical monitoring over a 24-hour period and during different daily activities. With the help of a machine learning pipeline, we also show that the platform can differentiate three stressors with an accuracy of 98.0%, and quantify psychological stress responses with a confidence level of 98.7%.

Interface-Stabilized Fiber Sensor for Real-Time Monitoring of Amniotic Fluid During Pregnancy

Diseases in pregnancy endanger millions of fetuses worldwide every year. The onset of these diseases can be early warned by the dynamic abnormalities of biochemicals in amniotic fluid, thus requiring real-time monitoring. However, when continuously penetrated by detection devices, the amnion is prone to loss of robustness and rupture, which is difficult to regenerate. Here, an interface-stabilized fiber sensor is presented for real-time monitoring of biochemical dynamics in amniotic fluid during pregnancy. The sensor is seamlessly integrated into the amnion through tissue adhesion, amniotic regeneration, and uniform stress distribution, posing no risk to the amniotic fluid environment. The sensor demonstrates a response performance of less than 0.3% fluctuation under complex dynamic conditions and an accuracy of more than 98% from the second to the third trimester. By applying it to early warning of diseases such as intrauterine hypoxia, intrauterine infection, and fetal growth restriction, fetal survival increases to 95% with timely intervention.

An Emerging Era: Conformable Ultrasound Electronics

Conformable electronics are regarded as the next generation of personal healthcare monitoring and remote diagnosis devices. In recent years, piezoelectric-based conformable ultrasound electronics (cUSE) have been intensively studied due to their unique capabilities, including nonradiative monitoring, soft tissue imaging, deep signal decoding, wireless power transfer, portability, and compatibility. This review provides a comprehensive understanding of cUSE for use in biomedical and healthcare monitoring systems and a summary of their recent advancements. Following an introduction to the fundamentals of piezoelectrics and ultrasound transducers, the critical parameters for transducer design are discussed. Next, five types of cUSE with their advantages and limitations are highlighted, and the fabrication of cUSE using advanced technologies is discussed. In addition, the working function, acoustic performance, and accomplishments in various applications are thoroughly summarized. It is noted that application considerations must be given to the tradeoffs between material selection, manufacturing processes, acoustic performance, mechanical integrity, and the entire integrated system. Finally, current challenges and directions for the development of cUSE are highlighted, and research flow is provided as the roadmap for future research. In conclusion, these advances in the fields of piezoelectric materials, ultrasound transducers, and conformable electronics spark an emerging era of biomedicine and personal healthcare.

Ultrasound technology assisted colloidal nanocrystal synthesis and biomedical applications

Non-invasive and high spatiotemporal resolution mythologies for the diagnosis and treatment of disease in clinical medicine promote the development of modern medicine. Ultrasound (US) technology provides a non-invasive, real-time, and cost-effective clinical imaging modality, which plays a significant role in chemical synthesis and clinical translation, especially in in vivo imaging and cancer therapy. On the one hand, the US treatment is usually accompanied by cavitation, leading to high temperature and pressure, so-called "hot spot", playing a significant role in sonochemical-based colloidal synthesis. Compared with the classical nucleation synthetic method, the sonochemical synthesis strategy presents high efficiency for the fabrication of colloidal nanocrystals due to its fast nucleation and growth procedure. On the other hand, the US is attractive for in vivo and medical treatment, with applications increasing with the development of novel contrast agents, such as the micro and nano bubbles, which are widely used in neuromodulation, with which the US can breach the blood-brain barrier temporarily and safely, opening a new door to neuromodulation and therapy. In terms of cancer treatment, sonodynamic therapy and US-assisted synergetic therapy show great effects against cancer and sonodynamic immunotherapy present unparalleled potentiality compared with other synergetic therapies. Further development of ultrasound technology can revolutionize both chemical synthesis and clinical translation by improving efficiency, precision, and accessibility while reducing environmental impact and enhancing patient care. In this paper, we review the US-assisted sonochemical synthesis and biological applications, to promote the next generation US technology-assisted applications.

High Performance Wearable Ultrasound as a Human-Machine Interface for Wrist and Hand Kinematic Tracking

OBJECTIVE

Non-invasive human machine interfaces (HMIs) have high potential in medical, entertainment, and industrial applications. Traditionally, surface electromyography (sEMG) has been used to track muscular activity and infer motor intention. Ultrasound (US) has received increasing attention as an alternative to sEMG-based HMIs. Here, we developed a portable US armband system with 24 channels and a multiple receiver approach, and compared it with existing sEMG- and US-based HMIs on movement intention decoding.

METHODS

US and motion capture data was recorded while participants performed wrist and hand movements of four degrees of freedom (DoFs) and their combinations. A linear regression model was used to offline predict hand kinematics from the US (or sEMG, for comparison) features. The method was further validated in real-time for a 3-DoF target reaching task.

RESULTS

In the offline analysis, the wearable US system achieved an average [Formula: see text] of 0.94 in the prediction of four DoFs of the wrist and hand while sEMG reached a performance of [Formula: see text]= 0.60. In online control, the participants achieved an average 93% completion rate of the targets.

CONCLUSION

When tailored for HMIs, the proposed US A-mode system and processing pipeline can successfully regress hand kinematics both in offline and online settings with performances comparable or superior to previously published interfaces.

SIGNIFICANCE

Wearable US technology may provide a new generation of HMIs that use muscular deformation to estimate limb movements. The wearable US system allowed for robust proportional and simultaneous control over multiple DoFs in both offline and online settings.

Biomimetic Wearable Sensors: Emerging Combination of Intelligence and Electronics

Owing to the advancement of interdisciplinary concepts, for example, wearable electronics, bioelectronics, and intelligent sensing, during the microelectronics industrial revolution, nowadays, extensively mature wearable sensing devices have become new favorites in the noninvasive human healthcare industry. The combination of wearable sensing devices with bionics is driving frontier developments in various fields, such as personalized medical monitoring and flexible electronics, due to the superior biocompatibilities and diverse sensing mechanisms. It is noticed that the integration of desired functions into wearable device materials can be realized by grafting biomimetic intelligence. Therefore, herein, the mechanism by which biomimetic materials satisfy and further enhance system functionality is reviewed. Next, wearable artificial sensory systems that integrate biomimetic sensing into portable sensing devices are introduced, which have received significant attention from the industry owing to their novel sensing approaches and portabilities. To address the limitations encountered by important signal and data units in biomimetic wearable sensing systems, two paths forward are identified and current challenges and opportunities are presented in this field. In summary, this review provides a further comprehensive understanding of the development of biomimetic wearable sensing devices from both breadth and depth perspectives, offering valuable guidance for future research and application expansion of these devices.

The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC

Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.

Anisotropically Conductive Hydrogels with Directionally Aligned PEDOT:PSS in a PVA Matrix

Electrical anisotropy, which is characterized by the efficient transmission of electrical signals in specific directions, is prevalent in both natural and engineered systems. However, traditional anisotropically conductive materials are often rigid and dry, thus limiting their utility in applications aiming for the seamless integration of various technologies with biological tissues. In the present study, we introduce a method for precisely controlling the microstructures of conductive and insulating polymers to create highly anisotropically conductive composite hydrogels. Our methodology involves combining aligned poly(vinyl alcohol) microfibrils, infused poly(3,4-ethylenedioxythiophene) polystyrenesulfonate, and sodium citrate precipitation to form dense, aligned conductive paths. This significantly enhances the electrical conductivity anisotropy (σ∥/σ⊥ ≈ 60.8) within these composite hydrogels.

The State-of-the-Art and Perspectives of Laser Ablation for Tumor Treatment

Tumors significantly impact individuals' physical well-being and quality of life. With the ongoing advancements in optical technology, information technology, robotic technology, etc., laser technology is being increasingly utilized in the field of tumor treatment, and laser ablation (LA) of tumors remains a prominent area of research interest. This paper presents an overview of the recent progress in tumor LA therapy, with a focus on the mechanisms and biological effects of LA, commonly used ablation lasers, image-guided LA, and robotic-assisted LA. Further insights and future prospects are discussed in relation to these aspects, and the paper proposed potential future directions for the development of tumor LA techniques.

Bioadhesive Technology Platforms

Bioadhesives have emerged as transformative and versatile tools in healthcare, offering the ability to attach tissues with ease and minimal damage. These materials present numerous opportunities for tissue repair and biomedical device integration, creating a broad landscape of applications that have captivated clinical and scientific interest alike. However, fully unlocking their potential requires multifaceted design strategies involving optimal adhesion, suitable biological interactions, and efficient signal communication. In this Review, we delve into these pivotal aspects of bioadhesive design, highlight the latest advances in their biomedical applications, and identify potential opportunities that lie ahead for bioadhesives as multifunctional technology platforms.

Ultrasonic neural regulation over two-dimensional graphene analog biomaterials: Enhanced PC12 cell differentiation under diverse ultrasond excitation

Two-dimensional (2D) biomaterials, with unique planar topology and quantum effect, have been widely recognized as a versatile nanoplatform for bioimaging, drug delivery and tissue engineering. However, during the complex application of nerve repair, in which inflammatory microenvironment control is imperative, the gentle manipulation and trigger of 2D biomaterials with inclusion and diversity is still challenging. Herein, inspired by the emerging clinical progress of ultrasound neuromodulation, we systematically studied ultrasound-excited 2D graphene analogues (graphene, graphene oxide, reduced graphene oxide (rGO) and carbon nitride) to explore their feasibility, accessibility, and adjustability for ultrasound-induced nerve repair in vitro. Quantitative observation of cell differentiation morphology demonstrates that PC12 cells added with rGO show the best compatibility and differentiation performance under the general ultrasound mode (0.5 w/cm2, 2 min/day) compared with graphene, graphene oxide and carbon nitride. Furthermore, the general condition can be improved by using a higher intensity of 0.7 w/cm2, but it cannot go up further. Later, ultrasonic frequency and duty cycle conditions were investigated to demonstrate the unique and remarkable inclusion and diversity of ultrasound over conventional electrical and surgical means. The pulse waveform with power of 1 MHz and duty cycle of 50 % may be even better, while the 3 MHz and 100 % duty cycle may not work. Overall, various graphene analog materials can be regarded as biosafe and accessible in both fundamental research and clinical ultrasound therapy, even for radiologists without material backgrounds. The enormous potential of diverse and personalized 2D biomaterials-based therapies can be expected to provide a new mode of ultrasound neuromodulation.

Ultrasound-activatable and skin-associated minimally invasive microdevices for smart drug delivery and diagnosis

Ultrasound-activatable and skin-associated minimally invasive microdevices (USMIMs) have garnered significant attention in the domains of smart drug delivery and biomedical diagnosis for on-demand healthcare, owing to their outstanding wearability, flexibility, and comfort. In this review, we present a comprehensive overview of the noteworthy advancements in USMIMs, with a specific focus on device design, potential applications, challenges, and future prospects. The classification of such microdevices primarily encompasses biointerfacing microsystems, including skin-perforable US-assisted microneedles (MNs), skin-attachable sonophoresis and their combination with microbubbles, as well as non-biointerfacing microsystems for drug delivery. Additionally, US-mediated and skin-attached microtransducers utilized in biomedical diagnosis are classified into imaging-related microtransducers, diagramming detection devices, and their combinative systems with applications on diverse signal detection. Besides, the review also highlights the challenges associated with USMIMs, focusing on aspects such as safety, environmental tolerance, wearability/comfortability, and personalization. Furthermore, it offers insights into future perspectives that address these challenges and discuss potential advancements in the field. It is firmly believed that the proposed USMIMs possess immense potential to significantly improve human lives in the near future.

Wet-Adaptive Electronic Skin

Skin electronics provides remarkable opportunities for non-invasive and long-term monitoring of a wide variety of biophysical and physiological signals that are closely related to health, medicine, and human-machine interactions. Nevertheless, conventional skin electronics fabricated on elastic thin films are difficult to adapt to the wet microenvironments of the skin: Elastic thin films are non-permeable, which block the skin perspiration; Elastic thin films are difficult to adhere to wet skin; Most skin electronics are difficult to work underwater. Here, a Wet-Adaptive Electronic Skin (WADE-skin) is reported, which consists of a next-to-skin wet-adhesive fibrous layer, a next-to-air waterproof fibrous layer, and a stretchable and permeable liquid metal electrode layer. While the electronic functionality is determined by the electrode design, this WADE-skin simultaneously offers superb stretchability, wet adhesion, permeability, biocompatibility, and waterproof property. The WADE-skin can rapidly adhere to human skin after contact for a few seconds and stably maintain the adhesion over weeks even under wet conditions, without showing any negative effect to the skin health. The use of WADE-skin is demonstrated for the stable recording of electrocardiogram during intensive sweating as well as underwater activities, and as the strain sensor for the underwater operation of virtual reality-mediated human-machine interactions.

Artificial Intelligence-Powered Electronic Skin

Skin-interfaced electronics is gradually changing medical practices by enabling continuous and noninvasive tracking of physiological and biochemical information. With the rise of big data and digital medicine, next-generation electronic skin (e-skin) will be able to use artificial intelligence (AI) to optimize its design as well as uncover user-personalized health profiles. Recent multimodal e-skin platforms have already employed machine learning (ML) algorithms for autonomous data analytics. Unfortunately, there is a lack of appropriate AI protocols and guidelines for e-skin devices, resulting in overly complex models and non-reproducible conclusions for simple applications. This review aims to present AI technologies in e-skin hardware and assess their potential for new inspired integrated platform solutions. We outline recent breakthroughs in AI strategies and their applications in engineering e-skins as well as understanding health information collected by e-skins, highlighting the transformative deployment of AI in robotics, prosthetics, virtual reality, and personalized healthcare. We also discuss the challenges and prospects of AI-powered e-skins as well as predictions for the future trajectory of smart e-skins.

Bridging the Gap-Thermofluidic Designs for Precision Bioelectronics

Bioelectronics, the merging of biology and electronics, can monitor and modulate biological behaviors across length and time scales with unprecedented capability. Current bioelectronics research largely focuses on devices' mechanical properties and electronic designs. However, the thermofluidic control is often overlooked, which is noteworthy given the discipline's importance in almost all bioelectronics processes. It is believed that integrating thermofluidic designs into bioelectronics is essential to align device precision with the complexity of biofluids and biological structures. This perspective serves as a mini roadmap for researchers in both fields to introduce key principles, applications, and challenges in both bioelectronics and thermofluids domains. Important interdisciplinary opportunities for the development of future healthcare devices and precise bioelectronics will also be discussed.

Ultrasonic reporters of calcium for deep tissue imaging of cellular signals

Calcium imaging has enabled major biological discoveries. However, the scattering of light by tissue limits the use of standard fluorescent calcium indicators in living animals. To address this limitation, we introduce the first genetically encoded ultrasonic reporter of calcium (URoC). Based on a unique class of air-filled protein nanostructures called gas vesicles, we engineered URoC to produce elevated nonlinear ultrasound signal upon binding to calcium ions. With URoC expressed in mammalian cells, we demonstrate noninvasive ultrasound imaging of calcium signaling in vivo during drug-induced receptor activation. URoC brings the depth and resolution advantages of ultrasound to the in vivo imaging of dynamic cellular function and paves the way for acoustic biosensing of a broader variety of biological signals.

Dynamic diagnosis of metamaterials through laser-induced vibrational signatures

Mechanical metamaterials at the microscale exhibit exotic static properties owing to their engineered building blocks1-4, but their dynamic properties have remained substantially less explored. Their design principles can target frequency-dependent properties5-7 and resilience under high-strain-rate deformation8,9, making them versatile materials for applications in lightweight impact resistance10-12, acoustic waveguiding7,13 or vibration damping14,15. However, accessing dynamic properties at small scales has remained a challenge owing to low-throughput and destructive characterization8,16,17 or lack of existing testing protocols. Here we demonstrate a high-throughput, non-contact framework that uses MHz-wave-propagation signatures within a metamaterial to non-destructively extract dynamic linear properties, omnidirectional elastic information, damping properties and defect quantification. Using rod-like tessellations of microscopic metamaterials, we report up to 94% direction-dependent and rate-dependent dynamic stiffening at strain rates approaching 102 s-1, as well as damping properties three times higher than their constituent materials. We also show that frequency shifts in the vibrational response allow for characterization of invisible defects within the metamaterials and that selective probing allows for the construction of experimental elastic surfaces, which were previously only possible computationally. Our work provides a route for accelerated data-driven discovery of materials and microdevices for dynamic applications such as protective structures, medical ultrasound or vibration isolation.

A Review of Structure Engineering of Strain-Tolerant Architectures for Stretchable Electronics

Stretchable electronics possess significant advantages over their conventional rigid counterparts and boost game-changing applications such as bioelectronics, flexible displays, wearable health monitors, etc. It is, nevertheless, a formidable task to impart stretchability to brittle electronic materials such as silicon. This review provides a concise but critical discussion of the prevailing structural engineering strategies for achieving strain-tolerant electronic devices. Not only the more commonly discussed lateral designs of structures such as island-bridge, wavy structures, fractals, and kirigami, but also the less discussed vertical architectures such as strain isolation and elastoplastic principle are reviewed. Future opportunities are envisaged at the end of the paper.

One-Pot Preparation of Skin-Inspired Multifunctional Hybrid Hydrogel with Robust Wound Healing Capacity

Bioinspired hydrogels have demonstrated multiple superiorities over traditional wound dressings for wound healing applications. However, the fabrication of bioinspired hydrogel-based wound dressings with desired functionalities always requires multiple successive steps, time-consuming processes, and/or sophisticated protocols, plaguing their clinical applications. Here, a facile one-pot strategy is developed to prepare a skin-inspired multifunctional hydrogel within 30 min by incorporating elastin (an essential functional component of the dermal extracellular matrix), tannic acid, and chitosan into the covalently cross-linked poly(acrylamide) network through noncovalent interactions. The resulting hydrogel exhibits a Young's modulus (ca. 36 kPa) comparable to that of human skin, a high elongation-at-break (ca. 1550%), a satisfactory tensile strength (ca. 61 kPa), and excellent elastic self-restorability, enabling the hydrogel to synchronously and conformally deform with human skin when used as wound dressings. Importantly, the hydrogel displays a self-adhesive property to skin tissues with an appropriate bonding strength (ca. 55 kPa measured on intact porcine skin), endowing the hydrogel with the ability to rapidly self-adhere to intact human skin, sealing the wound surface and also easily being removed without residue left or trauma caused to the skin. The hydrogel also possesses remarkable antibacterial activity, antioxidant capability, and hemocompatibility. All of these collective beneficial properties enable the hydrogel to significantly accelerate the wound healing process, outperforming the commercial wound dressings.