Expert consensus on the clinical application of totally implantable venous access devices in the upper arm(2022 Edition)

With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.

Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.

Gut-targeted therapies for type 2 diabetes mellitus: A review

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance.The global prevalence of T2DM has reached epidemic proportions,affecting approximately 463 million adults worldwide in 2019.Current treatments for T2DM include lifestyle modifications,oral antidiabetic agents,and insulin therapy.However,these therapies may carry side effects and fail to achieve optimal glycemic control in some patients.Therefore,there is a growing interest in the role of gut microbiota and more gut-targeted therapies in the management of T2DM.The gut microbiota,which refers to the community of microorganisms that inhabit the human gut,has been shown to play a crucial role in the regulation of glucose metabolism and insulin sensitivity.Alterations in gut microbiota composition and diversity have been observed in T2DM patients,with a reduction in beneficial bacteria and an increase in pathogenic bacteria.This dysbiosis may contribute to the pathogenesis of the disease by promoting inflammation and impairing gut barrier function.Several gut-targeted therapies have been developed to modulate the gut microbiota and improve glycemic control in T2DM.One potential approach is the use of probio-tics,which are live microorganisms that confer health benefits to the host when administered in adequate amounts.Several randomized controlled trials have demonstrated that certain probiotics,such as Lactobacillus and Bifidobacterium species,can improve glycemic control and insulin sensitivity in T2DM patients.Mechanisms may include the production of short-chain fatty acids,the improvement of gut barrier function,and the reduction of inflammation.Another gut-targeted therapy is fecal microbiota transplantation(FMT),which involves the transfer of fecal material from a healthy donor to a recipient.FMT has been used successfully in the treatment of Clostridioides difficile infection and is now being investigated as a potential therapy for T2DM.A recent randomized controlled trial showed that FMT from lean donors improved glucose metabolism and insulin sensitivity in T2DM patients with obesity.However,FMT carries potential risks,including transmission of infectious agents and alterations in the recipient's gut microbiota that may be undesirable.In addition to probiotics and FMT,other gut-targeted therapies are being investigated for the management of T2DM,such as prebiotics,synbiotics,and postbiotics.Prebiotics are dietary fibers that promote the growth of beneficial gut bacteria,while synbiotics combine probiotics and prebiotics.Postbiotics refer to the metabolic products of probiotics that may have beneficial effects on the host.The NIH SPARC program,or the Stimulating Peripheral Activity to Relieve Conditions,is a research initiative aimed at developing new therapies for a variety of health conditions,including T2DM.The SPARC program focuses on using electrical stimulation to activate peripheral nerves and organs,in order to regulate glucose levels in the body.The goal of this approach is to develop targeted,non-invasive therapies that can help patients better manage their diabetes.One promising area of research within the SPARC program is the use of electrical stimulation to activate the vagus nerve,which plays an important role in regulating glucose metabolism.Studies have shown that vagus nerve stimulation can improve insulin sensitivity and lower blood glucose levels in patients with T2DM.Gut-targeted therapies,such as probiotics and FMT,have shown potential for improving glycemic control and insulin sensitivity in T2DM patients.However,further research is needed to determine the optimal dose,duration,and safety of these therapies.

Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty

AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.

Geriatric issues in patients with or being considered for implanted cardiac rhythm devices: a case-based review

1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in the heart including fibrosis in the atrial and ventricular myocardium and conduction system,scar tissue from myocardial infarction or other cardiomyopathic processes,increased inflammatory cytokines and changes to ion channels are just some of the factors that predispose older adults to arrhythmias.^([2]).

Remote monitoring of implantable cardioverters defibrillators:a comparison of acceptance between octogenarians and younger patients

Background Remote monitoring(RM)is increasingly employed for all types of cardiac implantable devices(CIED).However,there are only limited data on the acceptance of RM by the elderly.The aim of our study was to ascertain how octogenarians assess RM technologies compared to younger,presumably technically more literate patients,and what concerns or technical problems the system presents to both groups of patients.Methods The trial was designed as a descriptive,register-based single-center study.The study population consisted of all consecutive patients≥80 years of age(group A,n=94)and all consecutive patients aged≤40 years(group B,n=71),who had undergone implantation of an implantable cardioverter-defibrillator(ICD)between the years of 2009 and 2018 and were using a Home Monitoring?(HM,Biotronik,Berlin,Germany)system.All patients fulfilling entry criteria were approached with a request to participate in the survey.Results A total of 85(90.4%)and 65(91.5%)valid surveys were obtained for groups A and B,respectively.Ninety-two percent of patients in both groups(P=0.903)were satisfied with the limited number of planned ambulatory follow-ups(i.e.,once a year).All patients in both groups(100%)reported that they were satisfied with the HM system,and 97%and 94%of patients in Groups A and B,respectively,ranked it highly beneficial(P=0.68).A significant proportion of patients in both groups were completely unaware of any health-related benefits associated with the use of the HM system(42%in Group A vs.49%in Group B,P=0.4).Among the most frequently reported personal benefits of HM were a sense of safety and security and savings on travel expenses and time.5%and 9%of patients in Groups A and B,respectively,reported that usage of HM caused them some degree of psychological stress(P=0.27).Nearly all patients in both groups reported receiving information on HM from their doctor after ICD implantation.None of Group A reported receiving information from a nurse either before or after ICD implantation,while 14%of Group B patients reported receiving information from a nurse after,but not before ICD implantation.Seven and 51%(P<0.0001)of patients in Group A and B,respectively,sought additional information about HM post-discharge.Conclusions The HM system received good marks and was much appreciated,even in patients over 80 years of age.The level of acceptance and potential psychological stress resulting from RM technology appears to be about the same in older patients as in younger patients.The majority of octogenarians either did not fully understand the clinical benefits of the system or mistakenly thought that the HM system was a substitute for emergency 24-h surveillance.These results highlight the need for better patient education relative to RM technology,with one option being to delegate more of this educational process to specially trained nurses.

Risk profiles and outcomes of patients receiving antibacterial cardiovascular implantable electronic device envelopes:A retrospective analysis

BACKGROUND Cardiovascular implantable electronic devices(CIEDs)are implanted in an increasing number of patients each year,which has led to an increase in the risk of CIED infection.Antibacterial CIED envelopes locally deliver antibiotics to the implant site over a short-term period and have been shown to reduce the risk of implant site infection.These envelopes are derived from either biologic or nonbiologic materials.There is a paucity of data examining patient risk profiles and outcomes from using these envelope materials in the clinical setting and comparing these results to patients receiving no envelope with their CIED implantation.AIM To evaluate risk profiles and outcomes of patients who underwent CIED procedures with an antibacterial envelope or no envelope.METHODS After obtaining Internal Review Board approval,the records of consecutive patients who underwent a CIED implantation procedure by a single physician between March 2017 and December 2019 were retrospectively collected from our hospital.A total of 248 patients within this period were identified and reviewed through 12 mo of follow up.The CIED procedures used either no envelope(n=57),a biologic envelope(CanGaroo®,Aziyo Biologics)that was pre-hydrated by the physician with vancomycin and gentamicin(n=89),or a non-biologic envelope(Tyrx^(TM),Medtronic)that was coated with a resorbable polymer containing the drug substances rifampin and minocycline by the manufacturer(n=102).Patient selection for receiving either no envelope or an envelope(and which envelope to use)was determined by the treating physician.Statistical analyses were performed between the 3 groups(CanGaroo,Tyrx,and no envelope),and also between the No Envelope and Any Envelope groups by an independent,experienced biostatistician.RESULTS On average,patients who received any envelope(biologic or non-biologic)were younger(70.7±14.0 vs 74.9±10.6,P=0.017),had a greater number of infection risk factors(81.2%vs 49.1%,P<0.001),received more high-powered devices(37.2%vs 5.8%,P=0.004),and were undergoing more reoperative procedures(47.1%vs 0.0%,P<0.001)than patients who received no envelope.Between the two envelopes,biologic envelopes tended to be used more often in higher risk patients(84.3%vs 78.4%)and reoperative procedures(62.9%vs 33.3%)than non-biologic envelopes.The rate of CIED implant site pocket infection was low(any envelope 0.5%vs no envelope 0.0%)and was statistically equivalent between the two envelope groups.Other reported adverse events(lead dislodgement,lead or pocket revision,device migration or erosion,twiddler’s syndrome,and erythema/fever)were low and statistically equivalent between groups(biologic 2.2%,non-biologic 3.9%,no envelope 1.8%).CONCLUSION CIED infection rates for biologic and non-biologic antibacterial envelopes are similar.Antibacterial envelopes may benefit patients who are higher risk for infection,however additional studies are warranted to confirm this.

Optimization of Bio-Implantable Power Transmission Efficiency Based on Input Impedance

Recently,the inductive coupling link is the most robust method for powering implanted biomedical devices,such as micro-system stimulators,cochlear implants,and retinal implants.This research provides a novel theoretical and mathematical analysis to optimize the inductive coupling link efficiency driven by efficient proposed class-E power amplifiers using high and optimum input impedance.The design of the coupling link is based on two pairs of aligned,single-layer,planar spiral circular coils with a proposed geometric dimension,operating at a resonant frequency of 13.56 MHz.Both transmitter and receiver coils are small in size.Implanted device resistance varies from 200Ωto 500Ωwith 50Ωof stepes.When the conventional load resistance of power amplifiers is 50Ω,the efficiency is 45%;when the optimum resonant load is 41.89Ωwith a coupling coefficient of 0.087,the efficiency increases to 49%.The efficiency optimization is reached by calculating the matching network for the external LC tank of the transmitter coil.The proposed design may be suitable for active implantable devices.

Recent advances of implantable systems and devices in cancer therapy and sensing

Malignant tumors have the capability to metastasize and colonize,meaning that they can spread to other organs and tissues,distributing metastatic focus and are hard to target.Although significant advances have been made in cancer treatment,it remains one of the leading causes of death around the globe.In recent years,new-emerging implantable systems and devices have been developed to tackle the challenge of metastatic tumors.In this review,implantable systems for suppressing tumors and preventing tumor recurrence are reported.In particular,we emphasize the responsive drug delivery systems and the external field assisted catalytic therapy for tumor treatment,as well as implantable biosensors for tumor microenvironment monitoring.We also conclude the open challenges and future perspectives of implantable systems and devices for cancer therapy and sensing.

Implantable and biodegradable closed‐loop devices for autonomous electrotherapy

Implantable electronic devices as a valuable biomedical tool are used to treat chronic diseases.However,traditional pacemakers exist a serious risk of complications.A biodegradable,closed‐loop sensor‐actuator system is developed for cardiac rhythm monitoring.This system could achieve autonomous electrotherapy.

A bio-instructive parylene-based conformal coating suppresses thrombosis and intimal hyperplasia of implantable vascular devices

Implantable vascular devices are widely used in clinical treatments for various vascular diseases. However, current approved clinical implantable vascular devices generally have high failure rates primarily due to their surface lacking inherent functional endothelium. Here, inspired by the pathological mechanisms of vascular device failure and physiological functions of native endothelium, we developed a new generation of bioactive parylene (poly(p-xylylene))-based conformal coating to address these challenges of the vascular devices. This coating used a polyethylene glycol (PEG) linker to introduce an endothelial progenitor cell (EPC) specific binding ligand LXW7 (cGRGDdvc) onto the vascular devices for preventing platelet adhesion and selectively capturing endogenous EPCs. Also, we confirmed the long-term stability and function of this coating in human serum. Using two vascular disease-related large animal models, a porcine carotid artery interposition model and a porcine carotid artery-jugular vein arteriovenous graft model, we demonstrated that this coating enabled rapid generation of self-renewable “living” endothelium on the blood contacting surface of the expanded polytetrafluoroethylene (ePTFE) grafts after implantation. We expect this easy-to-apply conformal coating will present a promising avenue to engineer surface properties of “off-the-shelf” implantable vascular devices for long-lasting performance in the clinical settings.

Recent Techniques for Harvesting Energy from the Human Body

The human body contains a near-infinite supply of energy in chemical,thermal,and mechanical forms.However,the majority of implantable and wear-able devices are still operated by batteries,whose insufficient capacity and large size limit their lifespan and increase the risk of hazardous material leakage.Such energy can be used to exceed the battery power limits of implantable and wear-able devices.Moreover,novel materials and fabrication methods can be used to create various medical therapies and life-enhancing technologies.This review paper focuses on energy-harvesting technologies used in medical and health applications,primarily power collectors from the human body.Current approaches to energy harvesting from the bodies of living subjects for self-powered electronics are summarized.Using the human body as an energy source encompasses numer-ous topics:thermoelectric generators,power harvesting by kinetic energy,cardi-ovascular energy harvesting,and blood pressure.The review considers various perspectives on future research,which can provide a new forum for advancing new technologies for the diagnosis,treatment,and prevention of diseases by integrating different energy harvesters with advanced electronics.

Analysis of intellectual properties on animalderived regenerative, implantable medical devices

This article analyses and summarizes issues of intellectual property involved in animal-derived regenerative,implantable medical devices(ADRIMD)in order to better understand global trends in patent applications and disclosures,the legal status of patent families(i.e.sets of patents filed in various countries to protect a single invention),and International Patent Classification topics such as main assignee and core expertise.Analysis of research trends will enhance and inform the decision-making capacity of researchers,investors,government regulators and other stake-holders as they undertake to develop,deploy,invest in or regulate ADRIMD.

Feasibility of a Chronic Foreign Body Infection Model Studying the Influence of TiO2 Nanotube Layers on Bacterial Contamination

Bacterial infections on the surface of medical devices are a significant problem in therapeutic approach, especially when implants are used in the living. In cardiology, pacemaker generator pocket surfaces, made in titanium alloy can be colonized by pathogen microorganism. This contamination represents a major risk of sepsis, endocarditis and localized infections for patients. A way to limit this bacterial contamination is to modify the surface topography using nano-structuration process of the titanium alloy surface of the implanted devices. The aim of this study is to evaluate the influence of TiO2 nanotube layers on bacterial infection in the living, considering the feasibility of an animal model of chronic foreign body infection. TiO2 nanotube layers prepared by electrochemical anodization of Ti foil in 0.4 wt% hydrofluoric acid solution were implanted subcutaneously in Wistar rats. Three weeks after implantation, TiO2 implants were contaminated by a Staphylococcus epidermilis strain using two different concentrations at 106 and 108 colony forming unit (CFU) in order to induce a sufficient infection level and to avoid unwanted over infection consequences on rats health during the experiments. After 28 days in the living, 75% of nanotube layers initially submitted to the 108 CFU inoculum were contaminated while only 25% nanotube layers initially submitted to the 106 CFU inoculum remained infected. This significant result underlines the influence of TiO2 nanotube layers in decreasing the infection level. Our in vitro experiments showed that the synthesized TiO2 nanotubes indeed decreased the Staphylococcus epidermilis adhesion compared to unanodized Ti foil.

Clinical Course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcutaneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235 - 627) and 563 (95% confidence interval, 368 - 728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.

Metal-organic frameworks as functional materials for implantable flexible biochemical sensors

Metal-organic frameworks(MOFs)exhibit attractive properties such as highly accessible surface area,large porosity,tunable pore size,and built-in redox-active metal sites.They may serve as excellent candidates to construct implantable flexible devices for biochemical sensing due to their high thermal and solution stability.However,MOFs-based sensors have only been mostly reported for in-vitro chemical sensing,their use in implantable chemical sensing and combination with flexible electronics to achieve excellent mechanical compatibility with tissues and organs has rarely been summarized.This paper systematically reviews the biochemical sensors based on MOFs and discusses the feasibility to achieve implantable biochemical sensing through MOFs-based flexible electronics.The properties of MOFs and underlying mechanisms have been intrcxluced,followed by a summarization of different biochemical sensing applications.Strategies to integrate MOFs with flexible devices have been supplied from the standpoints of matching mechanics and compatible fabrication processes.Issues that should be addressed in developing flexible MOFs sensors and potential solutions have also been provided,followed by the perspective for future applications of flexible MOFs sensors.This paper may serve as a reference to offer potential guidelines for the development of flexible MOFs-based biochemical sensors that may benefit future applications in personal healthcare,disease diagnosis and treatment,and fundamental study of various biological processes.

Effect of fluoroscopy frame rate on radiation exposure and in-hospital outcomes in cardiovascular implantable electronic device implantation procedures

Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.

A robust and transparent nanosilica-filled silicone rubber coating with synergistically enhanced mechanical properties and barrier performance

Implantable electronic devices(IEDs)are widely used by human beings to achieve medical treatment and diagnosis nowadays.However,ideal encapsulation of IEDs is still far from perfect as full prevention of body fluid diffusion into the coating remains unsolved.Herein,we develop a high-performance composite coating for IED encapsulation by introducing SiO_(2) nanoparticles into silicone rubber,which synergistically enhances mechanical properties and improves barrier performance.By fabricating composite coatings with different nanosilica contents,3%nanosilica is proved to be an optimal additive content with an excellent combination of improved fracture strength(from 2.5 MPa to 4.5 MPa),increased coating resistance(from 10^(4) to 10^(9) cm^(2))and ideal coating uniformity.Mechanical and electrochemical characterizations subsequently confirm substantially enhanced mechanical properties and barrier performance of the composite coating,which effectively resist crack propagation and impede penetrations of water and chloride ions through the coating.Theoretical calculations further uncover that modified SiO_(2) particles with enriched methyl groups endow a strong bridging effect to interact with silicone rubber monomer,which,together with anti-agglomeration property of methyl groups,contributes to a pronounced improvement in mechanical performance of nanosilica-filled silicone rubber.Benefitting from the enhanced mechanical and barrier properties,the as-fabricated nanosilica-filled silicone rubber demonstrates superior protection for the encapsulated circuits with a significantly improved lifetime(709.1 h)compared to that of circuits coated by pure silicone rubber(472.8 h)and bare circuit boards(1 h),which offers great values for packaging material design in future IED encapsulation.

A toolkit of thread-based microfluidics,sensors,and electronics for 3D tissue embedding for medical diagnostics

Threads,traditionally used in the apparel industry,have recently emerged as a promising material for the creation of tissue constructs and biomedical implants for organ replacement and repair.The wicking property and flexibility of threads also make them promising candidates for the creation of three-dimensional(3D)microfluidic circuits.In this paper,we report on thread-based microfluidic networks that interface intimately with biological tissues in three dimensions.We have also developed a suite of physical and chemical sensors integrated with microfluidic networks to monitor physiochemical tissue properties,all made from thread,for direct integration with tissues toward the realization of a thread-based diagnostic device(TDD)platform.The physical and chemical sensors are fabricated from nanomaterial-infused conductive threads and are connected to electronic circuitry using thread-based flexible interconnects for readout,signal conditioning,and wireless transmission.To demonstrate the suite of integrated sensors,we utilized TDD platforms to measure strain,as well as gastric and subcutaneous pH in vitro and in vivo.

Applications of nanogenerators for biomedical engineering and healthcare systems

The dream of human beings for long living has stimulated the rapid development of biomedical and healthcare equipment.However,conventional biomedical and healthcare devices have shortcomings such as short service life,large equipment size,and high potential safety hazards.Indeed,the power supply for conventional implantable device remains predominantly batteries.The emerging nanogenerators,which harvest micro/nanomechanical energy and thermal energy from human beings and convert into electrical energy,provide an ideal solution for self-powering of biomedical devices.The combination of nanogenerators and biomedicine has been accelerating the development of self-powered biomedical equipment.This article first introduces the operating principle of nanogenerators and then reviews the progress of nanogenerators in biomedical applications,including power supply,smart sensing,and effective treatment.Besides,the microbial disinfection and biodegradation performances of nanogenerators have been updated.Next,the protection devices have been discussed such as face mask with air filtering function together with real-time monitoring of human health from the respiration and heat emission.Besides,the nanogenerator devices have been categorized by the types of mechanical energy from human beings,such as the body movement,tissue and organ activities,energy from chemical reactions,and gravitational potential energy.Eventually,the challenges and future opportunities in the applications of nanogenerators are delivered in the conclusive remarks.