Advances in Wireless,Batteryless,Implantable Electronics for Real‑Time,Continuous Physiological Monitoring

This review summarizes recent progress in developing wireless,batteryless,fully implantable biomedical devices for real-time continuous physiological signal monitoring,focusing on advancing human health care.Design considerations,such as biological constraints,energy sourcing,and wireless communication,are discussed in achieving the desired performance of the devices and enhanced interface with human tissues.In addition,we review the recent achievements in materials used for developing implantable systems,emphasizing their importance in achieving multi-functionalities,biocompatibility,and hemocompatibility.The wireless,batteryless devices offer minimally invasive device insertion to the body,enabling portable health monitoring and advanced disease diagnosis.Lastly,we summarize the most recent practical applications of advanced implantable devices for human health care,highlighting their potential for immediate commercialization and clinical uses.

Implantable Electrochemical Microsensors for In Vivo Monitoring of Animal Physiological Information

In vivo monitoring of animal physiological information plays a crucial role in promptly alerting humans to potential diseases in animals and aiding in the exploration of mechanisms underlying human diseases.Currently,implantable electrochemical microsensors have emerged as a prominent area of research.These microsensors not only fulfill the technical requirements for monitoring animal physiological information but also offer an ideal platform for integration.They have been extensively studied for their ability to monitor animal physiological information in a minimally invasive manner,characterized by their bloodless,painless features,and exceptional performance.The development of implantable electrochemical microsensors for in vivo monitoring of animal physiological information has witnessed significant scientific and technological advancements through dedicated efforts.This review commenced with a comprehensive discussion of the construction of microsensors,including the materials utilized and the methods employed for fabrication.Following this,we proceeded to explore the various implantation technologies employed for electrochemical microsensors.In addition,a comprehensive overview was provided of the various applications of implantable electrochemical microsensors,specifically in the monitoring of diseases and the investigation of disease mechanisms.Lastly,a concise conclusion was conducted on the recent advancements and significant obstacles pertaining to the practical implementation of implantable electrochemical microsensors.

Semi-implantable device based on multiplexed microfilament electrode cluster for continuous monitoring of physiological ions

Modern medicine is increasingly interested in advanced sensors to detect and analyze biochemical indicators.Ion sensors based on potentiometric methods are a promising platform for monitoring physiological ions in biological subjects.Current semi-implantable devices are mainly based on single-parameter detection.Miniaturized semi-implantable electrodes for multiparameter sensing have more restrictions on the electrode size due to biocompatibility considerations,but reducing the electrode surface area could potentially limit electrode sensitivity.This study developed a semi-implantable device system comprising a multiplexed microfilament electrode cluster(MMEC)and a printed circuit board for real-time monitoring of intra-tissue K^(+),Ca^(2+),and Na^(+)concentrations.The electrode surface area was less important for the potentiometric sensing mechanism,suggesting the feasibility of using a tiny fiber-like electrode for potentiometric sensing.The MMEC device exhibited a broad linear response(K^(+):2–32 mmol/L;Ca^(2+):0.5–4 mmol/L;Na^(+):10–160 mmol/L),high sensitivity(about 20–45 mV/decade),temporal stability(>2weeks),and good selectivity(>80%)for the above ions.In vitro detection and in vivo subcutaneous and brain experiment results showed that the MMEC system exhibits good multi-ion monitoring performance in several complex environments.This work provides a platform for the continuous real-time monitoring of ion fluctuations in different situations and has implications for developing smart sensors to monitor human health.

Superelastic Radiative Cooling Metafabric for Comfortable Epidermal Electrophysiological Monitoring

Epidermal electronics with superb passive-cooling capabilities are of great value for both daytime outdoor dressing comfort and low-carbon economy. Herein, a multifunctional and skinattachable electronic is rationally developed on a porous all-elastomer metafabric for efficient passive daytime radiative cooling(PDRC) and human electrophysiological monitoring. The cooling characteristics are realized through the homogeneous impregnation of polytetrafluoroethylene microparticles in the styrene–ethylene–butylene–styrene fibers, and the rational regulation of microporosity in SEBS/PTFE metafabrics, thus synergistically backscatter ultraviolet–visible–near-infrared light(maximum reflectance over 98.0%) to minimize heat absorption while efficiently emit human-body midinfrared radiation to the sky. As a result, the developed PDRC metafabric achieves approximately 17℃ cooling effects in an outdoor daytime environment and completely retains its passive cooling performance even under 50% stretching. Further, high-fidelity electrophysiological monitoring capability is also implemented in the breathable and skin-conformal metafabric through liquid metal printing, enabling the accurate acquisition of human electrocardiograph, surface electromyogram, and electroencephalograph signals for comfortable and lengthy health regulation. Hence, the fabricated superelastic PDRC metafabric opens a new avenue for the development of body-comfortable electronics and low-carbon wearing technologies.

Breathable Electronic Skins for Daily Physiological Signal Monitoring

With the aging of society and the increase in people’s concern for personal health,long-term physiological signal monitoring in daily life is in demand.In recent years,electronic skin(e-skin)for daily health monitoring applications has achieved rapid development due to its advantages in high-quality physiological signals monitoring and suitability for system integrations.Among them,the breathable e-skin has developed rapidly in recent years because it adapts to the long-term and high-comfort wear requirements of monitoring physiological signals in daily life.In this review,the recent achievements of breathable e-skins for daily physiological monitoring are systematically introduced and discussed.By dividing them into breathable e-skin electrodes,breathable e-skin sensors,and breathable e-skin systems,we sort out their design ideas,manufacturing processes,performances,and applications and show their advantages in long-term physiological signal monitoring in daily life.In addition,the development directions and challenges of the breathable e-skin are discussed and prospected.

Intraoperative neurophysiological monitoring in spinal surgery

Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%.Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials,and remedial measures to improve the prognosis.

Evolution and Role of Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Surgery: A 2-Year Series from Saudi Arabia

Introduction: Despite recent advances in neuroimaging and microsurgical techniques, surgical resection of spinal cord tumours remains a challenge. However, the evolution with advances and refinement of neurophysiological equipment and methodologies, intra-operative neurophysiolo- gical monitoring (IONM) is now regarded as an essential adjunct to the surgical management of intramedullary spinal cord tumours. This study aims to report our preliminary experience with IONM and emphasise its effective role of achieving maximum tumour resection and minimising neurological injury. Methods: This is a retrospective study performed at our institution between July 2012 and August 2013. It included a cohort of 6 consecutive patients presented with intramedullary spinal cord tumours. Their mean age was 26 years (range, 4 months - 37 years), all were males, and the mean follow up was 11.6 months. Results: We combined the use of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in spinal cord surgery. SSEPs are monitored during the incision of the dorsal midline of the spinal cord and this was used in two of our patients and MEPs were used as an essential monitoring during the tumour resection. In addition, we used free-running electromyography (EMG) and muscle MEPs (mMEPs) during tumour resection. Four of our patients (two with ependymoma, one with ganglioglioma, and one with pilocytic astrocytoma) had complete tumour resection and two patients (pilocytic and diffuse astrocytoma) had IONM changes during surgery and had partial tumour resection. At 6-month follow up all our patients had made a good recovery with no new neurological sequelae. Conclusion: This small series and literature review is presented to add and improve the understanding of IONM in intramedullary spinal cord procedures and to reinforce the importance of IONM in optimising tumour resection and neurological outcome. Our series confirm that without D-wave monitoring, free-running EMG and MEP monitoring during tumour resection remain an important adjunct. We also draw attention to the fact that changes in the free-running EMG occur before any changes in the MEPs are noted.

Surgical strategies for peripheral nerve schwannoma based on the intraoperative neurophysiological monitoring

Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiological monitoring(INM)technique and to decrease the risk of postoperative neurological deficits in the management of these schwannomas.Materials and methods:A retrospective study was conducted on 92 cases of peripheral nerve microsurgery performed,using the INM technique.We also made the classification for peripheral nerve schwannomas into two types according to operative findings and proceeded corresponding surgical strategies.Results:All tumors were removed completely under microscopy and INM.Three patients developed residual neurological deficits at final follow-up.There were different results about temporary(18/92,19.6%)and permanent(3/92,3.3%)neurological deficits.The incidence of temporary and permanent neurological deficits in type II group was significantly higher than that in type I group(p<0.01).The incidence of permanent neurological deficits in larger size tumors was significantly higher than that of smaller size(p<0.01).Conclusions:We made the classification for peripheral nerve schwannomas according to operative findings based on INM that is helpful to our surgical strategies.Intracapsular enucleation was the preferred strategy with satisfactory results and low risk of nerve injury.The size and location of tumors seem to be related to the risk of fascicular injury.

Interventional therapy for intracranial aneurysms under neuroelectrophysiological monitoring

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm underwent neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential( SSEP) ,brainstem

Protocol for electrophysiological monitoring of carotid endarterectomies

Near zero stroke rates can be achieved in carotid endarterectomy （CEA） surgery with selective shunting and electrophysiological neuromonitoring.though false negative rates as high as 40% have been reported.We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers,and determine if other factors could contribute to the differences in reports.Processed and raw beta band （12.5-30 Hz） electroencephalogram （EEG） and median and tibial nerve somatosensory evoked potentials （SSEP） were monitored in 668 CEA cases at six surgical centers.A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol.A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases.No patient showed signs of a cerebral infarct after surgery.Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols.We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate.

Wearable Wireless Body Area Nodes for Remote Physiological Signal Monitoring System

Wearable remote health monitoring systems have gained significant prominence in the recent years due to their growth in technological advances. One form of the Wearable Physiological Monitoring System (WPMS) is the Wearable Body Area Networks (WBAN) used to monitor the health status of the wearer for long durations. The paper discusses a prototype WBAN based wearable physiological monitoring system to monitor physiological parameters such as Electrocardiogram (ECG) and Electroencephalogram (EEG) acquired using a textile electrode, Photoplethysmogram (PPG), Galvanic Skin Response (GSR), Blood Pressure derived from analysis of Pulse Transmit Time (PTT) and body temperature. The WBAN consists of three sensor nodes that are placed strategically to acquire the physiological signals and the sensor nodes communicate to a chest/wrist worn sink node also known as wearable data acquisition hardware. The sink node receives physiological data from the sensor nodes and is transmitted to a remote monitoring station. The remote monitoring station receives the raw data and it is processed to remove noises, such as power line interference, baseline wander and tremor in the signals and the information is extracted and displayed. The WBANs are designed using the ZigBee wireless communication modules to transmit and receive the data. At the remote monitoring station the physiological parameters such as heart rate, pulse rate, systolic, diastolic blood pressure, GSR and body temperature are continuously monitored from the wearer. The data acquired from the wearable monitoring system is statically validated using a qualified medical device on 34 subjects.

Application and management of continuous glucose monitoring in diabetic kidney disease

Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.

The role of intraoperative neurophysiological monitoring in intramedullary spinal cord tumor surgery

Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%.As they are located very deep and frequently cause postoperative neurological complications,surgical resection is difficult.In recent years,many surgeons have performed electrophysiological monitoring to effectively reduce the occurrence of post-operative neurological complications.Modern electrophysiological monitoring technology has advanced considerably,leading to the development of many monitoring methods,such as SSEPs,MEPs,DCM,and EMG,to monitor intramedullary tumors.However,electrophysiological monitoring in tumor resection is still being studied.In this article,we discussed the different monitoring methods and their role in monitoring intramedullary tumors by reviewing previous studies.Intratumorally tumors need to be monitored for a summary of the condition of the patient.Only by using various monitoring methods flexibly and through clear communication between surgeons and neurophysiological experts can good decisions be made during surgery and positive surgical results be achieved.

An integrated portable bio-monitoring system based on tough hydrogels for comprehensive detection of physiological activities

Advanced soft ion-conducting hydrogels have been developed rapidly in the integrated portable health monitoring equipment due to their higher sensitivity,sensory traits,tunable conductivity,and stretchability for physiological activities and personal healthcare detection.However,traditional hydrogel conductors are normally susceptible to large deformation and strong mechanical stress,which leads to inferior electro-mechanical stability for real application scenarios.Herein,a strong ionically conductive hydrogel(poly(vinyl alcohol)-boric acid-glycerol/sodium alginate-calcium chloride/electrolyte ions(PBG/SC/EI))was designed by engineering the covalently and ionically crosslinked networks followed by the salting-out effect to further enhance the mechanical strength and ionic conductivity of the hydrogel.Owing to the collective effects of the energy-dissipation mechanism and salting-out effect,the designed PBG/SC/EI with excellent structural integrity and robustness exhibits exceptional mechanical properties(elongation at break for 559.1%and tensile strength of 869.4 kPa)and high ionic conductivity(1.618 S·m^(-1)).As such,the PBG/SC/EI strain sensor features high sensitivity(gauge factor=2.29),which can effectively monitor various kinds of human motions(joint motions,facial micro-expression,faint respiration,and voice recognition).Meanwhile,the hydrogel-based Zn||MnO_(2)battery delivers a high capacity of 267.2 mAh·g^(-1)and a maximal energy density of 356.8 Wh·kg^(-1)associated with good cycle performance of 71.8%capacity retention after 8000 cycles.Additionally,an integrated bio-monitoring system with the sensor and Zn||MnO_(2)battery can accurately identify diverse physiological activities in a real-time and non-invasive way.This work presents a feasible strategy for designing high-performance conductive hydrogels for highly-reliable integrated bio-monitoring systems with excellent practicability.

Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.

Tunnel, Infrastructure Convergences/Monitoring and Engineering Role

Worldwide we see that the construction industry is expanding, requiring new directions, new perspectives that can help reduce time, cost, and make transportation easy, safe, and affordable. For decades now, most of the large cities have completed their surface infrastructure. It has become urgent to address their issues for overpopulated cities where nowadays all infrastructure is overwhelmed, these issues must be addressed, solved and have vision to build underground infrastructure. Developed countries are focused on expanding their infrastructure for road systems, subway network, railway, storm, and sanitary systems. The emergency for underground infrastructure development requires more large-scale projects to be built and it is becoming more crucial building tunnels/underground structures for the future than ever before. Engineering focus, scientific searches are looking to develop their ideas for designing and delivering project underground, but government, agencies and engineers are concerned about the safety, durability, functionality, and the lifetime of this structures planned to be functional for decades. To address all this concerns this study provides information of how to identify the risk on tunnels and underground structures by capturing data from the beginning phases of construction, to analyze, evaluate and produce bulletins and engineering reports through convergences and monitoring. Convergences are the key factor on development of infrastructure underground as it is the only way to explore and analyze the rock mass disturbance during excavation. Convergences and monitoring in infrastructure are the safety coefficient for building underground, preventing accidents, and assessing real risks associated with tunnel/mine works and ensuring progress of the construction in underground structures. This study delves into the engineering role of convergence monitoring, during construction activities on project excavated using New Austrian Tunnelling method and Sequential Excavation Method. The primary objective of convergence monitoring is to gather critical information on ground movements and disturbances, thereby enhancing safety measures during tunnel construction. The monitoring process serves as an early warning system offering evidence of the real risks associated with underground infrastructure, bringing results and engineering data to be used for the design as key coefficient for structural design, type of material, type and strength of the concrete, rebars, concrete mix design. By using the convergence and monitoring system on underground infrastructure this study represents information that can contribute to risk assessment, structural analysis, and the lifetime of a project.

Risk Assessment of Hydrogen Peroxide Low- Temperature Plasma Sterilization Using Different Monitoring Methods

Objective:This study aims to evaluate the application value of biological monitoring and different types of chemical indicator cards in batch monitoring of hydrogen peroxide low-temperature plasma sterilization.The goal is to standardize the selection of loading conditions for this sterilization method and avoid positive biological monitoring results.Methods:Physical monitoring,Class I chemical indicator card monitoring,Class IV chemical indicator card monitoring,and biological monitoring were used to monitor the hydrogen peroxide low-temperature plasma sterilization process.The sterilization effect on instruments inside the Johnson&Johnson 100S plasma sterilizer was monitored and the qualification of various monitoring methods was compared.Results:The comparison showed that when non-standard or adsorption-prone packaging materials were used,the interception rate of biological monitoring and Class IV chemical indicator cards was significantly higher than that of physical monitoring and Class I chemical indicator cards.These methods more intuitively and effectively detected sterilization failures.Conclusion:Biological monitoring and Class IV chemical indicator cards are safe,fast,accurate,and easy to interpret in hydrogen peroxide low-temperature plasma sterilization,especially for monitoring instruments inside packages.They provide a reliable basis for the release of sterilized instrument packages.Identifying the reasons for positive biological monitoring results in hydrogen peroxide low-temperature plasma sterilization and taking effective measures promptly can minimize associated risks.

Review and Prospect of Research on Structural Health Monitoring Technology for Bridges

As a crucial infrastructure in the transport system,the safe operation of bridges is directly related to all aspects of people’s daily lives.The development of bridge structural health monitoring technology and its application play an important role in ensuring the safety and extending the service life of bridges.This paper carries out in-depth research and analysis on the related technology of bridge structural health monitoring.Firstly,the existing monitoring technologies at home and abroad are sorted out,and the advantages and problems of various methods are compared and analyzed,including nondestructive testing,stress measurement,vibration characteristic identification,and other commonly used monitoring technologies.Secondly,the key technologies and equipment in the bridge health monitoring system,such as sensor technology,data acquisition,and processing technology,are introduced in detail.Finally,the development trend in the field of bridge health monitoring is prospected from both theoretical research and technical application.In the future,with the development of emerging technologies such as big data,cloud computing,and the Internet of Things,it is expected that bridge health monitoring with intelligent and systematic features will be more widely applied to provide a stronger guarantee for the safe and efficient operation of bridges.

Wireless multisite sensing systems for continuous physiological monitoring

Respiratory diseases rank as the third leading cause of adult mortality[1],while cardiopulmonary and gastrointestinal issues are the primary cause of death within the first five years of a child’s life[2].The monitoring of cardiac,respiratory,and gastrointestinal sounds plays a vital role in routine care,as alterations or absence of these body sounds can serve as indicators of underlying diseases.