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

For the past few years, sweat analysis for health monitoring has attracted increasing attention benefiting from wearable technology. In related research, the sensitive detection of uric acid (UA) in sweat with complex composition based on surface-enhanced Raman spectroscopy (SERS) for the diagnosis of gout is still a significant challenge. Herein, we report a visualized and intelligent wearable sweat platform for SERS detection of UA in sweat. In this wearable platform, the spiral channel consisted of colorimetric paper with Ag nanowires (AgNWs) that could capture sweat for SERS measurement. With the help of photos from a smartphone, the pH value and volume of sweat could be quantified intelligently based on the image recognition technique. To diagnose gout, SERS spectra of human sweat with UA are collected in this wearable intelligent platform and analyzed by artificial intelligence (AI) algorithms. The results indicate that the artificial neural network (ANN) algorithm exhibits good identification of gout with high accuracy at 97%. Our work demonstrates that SERS-AI in a wearable intelligent sweat platform could be a feasible strategy for diagnosis of gout, which expands research on sweat analysis for comfortable and noninvasive health monitoring.

Thread-based microfluidic colorimetric sensors have been deemed a potential tool that may be incorporated into textiles for non-invasive sweat analysis. Nevertheless, their poor performance significantly limits their practical uses in sweat glucose detection down to 20 μM. Herein, a microfluidic glucose sensing device containing a salt-responsive thread is developed for the highly sensitive detection of glucose in human sweat. By grafting a zwitterionic polymer brush-which could react to ionic strength by changing the conformation of the polymer chains from the collapsing state to the stretching state-onto the cotton thread, the salt-responsive thread was created. Compared to the pristine cotton thread, the modified thread has better ion-capture capabilities, a more noticeable swelling effect, and a higher ability to absorb water. These enable a significant enrichment of glucose when the saline solution passes through it. The salt-responsive thread was employed to construct a thread/paper-based microfluidic sensing device for the monitoring of glucose in artificial sweat, exhibiting a sensitivity of -0.255 μM -1 and a detection limit of 14.7 μM. In comparison to the pristine cotton thread-based device, the performance is significantly superior. Using a hydrophobic fabric and salt-responsive threads, a glucose-sensing headband was prepared for on-body sweat glucose monitoring. With the use of a smartphone-based image analysis system, the headband can detect the concentration of glucose in a volunteer's perspiration. Using the thread-based salt-responsive zwitterionic polymer brush might offer a novel approach to creating wearable sweat sensors with extremely high sensitivity.

Cortisol hormone imbalances can be detected through non-invasive sweat monitoring using field-effect transistor (FET) biosensors, which provide rapid and sensitive detection. However, challenges like skin compatibility and integration with sweat collection have hindered FET biosensors as wearable sensing platforms. In this study, we present an integrated wearable sticker for real-time cortisol detection based on an extended-gate AlGaN/GaN high electron mobility transistor (HEMT) combined with a soft bottom substrate and flexible channel for sweat collection. The developed devices exhibit excellent linearity ( R 2 = 0.990) and a high sensitivity of 1.245 μA dec -1 for cortisol sensing from 1 nM to 100 μM in high-ionic-strength solution, with successful cortisol detection demonstrated using authentic human sweat samples. Additionally, the chip's microminiature design effectively reduces bending impact during the wearable process of traditional soft binding sweat sensors. The extendedgate structure design of the HEMT chip enhances both width-to-length ratio and active sensing area, resulting in an exceptionally low detection limit of 100 fM. Futhermore, due to GaN material's inherent stability, this device exhibits long-term stability with sustained performance within a certain attenuation range even after 60 days. These stickers possess small, lightweight, and portable features that enable real-time cortisol detection within 5 minutes through direct sweat collection. The application of this technology holds great potential in the field of personal health management, facilitating users to conveniently monitor their mental and physical conditions.

Wearable electrochemical sensors have shown potential for personal health monitoring due to their ability to detect biofluids non-invasively at the molecular level. Smart fibers with high flexibility and comfort are currently ideal for fabricating electrochemical sensors, but little research has focused on fluid transport at the human-machine interface, which is of great significance for continuous and stable monitoring and skin comfort. Here, we report an electrochemical sensing fiber with a special core-sheath structure, whose outer layer is wound by nanofibers with a hierarchical Fermat helix structure which has excellent moisture conductivity, and the inner layer is based on CNT fibers covered by three-dimensional reduced graphene oxide folds which have good sensing properties after modification of active materials such as enzymes and selective membranes. This kind of fiber enables efficient sweat capture, and thus only 0.1 μL of sweat is required to activate the device, and it responds very quickly (1.5 s). The fibers were further integrated into a garment to build a wireless sweat detection system, enabling stable monitoring of six physiological markers in sweat (glucose, lactate, Na + , K + , Ca 2+ , and pH). This work provides a feasible proposal for future personalized medicine and the construction of "smart sensing garments".

Systems for capture, storage and analysis of eccrine sweat can provide insights into physiological health status, quantify losses of water, electrolytes, amino acids and/or other essential species, and identify exposures to adverse environmental species or illicit drugs. Recent advances in materials and device designs serve as the basis for skin-compatible classes of microfluidic platforms and in situ colorimetric assays for precise assessments of sweat rate, sweat loss and concentrations of wide-ranging types of biomarkers in sweat. This paper presents a set of findings that enhances the performance of these systems through the use of microfluidic networks, integrated valves and microscale optical cuvettes formed by three dimensional printing in hard/soft hybrid materials systems, for accurate spectroscopic and fluorometric assays. Field studies demonstrate the capability of these microcuvette systems to evaluate the concentrations of copper, chloride, and glucose in sweat, along with the pH of sweat, with laboratory-grade accuracy and sensitivity.

Sweat pH is an important indicator for diagnosing disease states, such as cystic fibrosis. However, conventional pH sensors are composed of large brittle mechanical parts and need additional instruments to read signals. These pH sensors have limitations for practical wearable applications. In this study, we propose wearable colorimetric sweat pH sensors based on curcumin and thermoplastic-polyurethane (C-TPU) electrospun-fibers to diagnose disease states by sweat pH monitoring. This sensor aids in pH monitoring by changing color in response to chemical structure variation from enol to di-keto form via H-atom separation. Its chemical structure variation changes the visible color due to light absorbance and reflectance changes. Furthermore, it can rapidly and sensitively detect sweat pH due to its superior permeability and wettability. By O 2 plasma activation and thermal pressing, this colorimetric pH sensor can be easily attached to various fabric substrates such as swaddling and patient clothing via surface modification and mechanical interlocking of C-TPU. Furthermore, the diagnosable clothing is durable and reusable enough to neutral washing conditions due to the reversible pH colorimetric sensing performance by restoring the enol form of curcumin. This study contributes to the development of smart diagnostic clothing for cystic fibrosis patients who require continuous sweat pH monitoring.

During the corona virus disease 2019 (COVID-19) pandemic period, rapid screening of covid-19 patients has been of great interest by developing a fluorescent sensor for complexation with nonanal, which is a marker for Covid-19 detection in sweat. Solid phase micro-extraction gas chromatography-mass spectrometry (SPME GC-MS) was initially used to quantify nonanal in armpit sweat samples based on an external calibration curve. A sample containing a nonanal content above the threshold of 1.04 μL is expected to be COVID-19 positive with a sensitivity and specificity of 87% and 89%, respectively, validated by comparison with RT-PCR results. For more practical applications, helicene dye-encapsulated ethyl cellulose, namely EC@dyeNH, was applied to screen 140 sweat samples collected from the foreheads of volunteers. The mixed sensor and sweat solution droplets were then visualized and imaged under blacklight. The COVID-19 positive droplets exhibited yellow fluorescence emission, the brightness of which could be measured by using ImageJ in the grey scale. With the optimum color intensity of >73 for positive results, the screening performance was observed with a sensitivity and specificity of 96% and 93%, respectively. The overall test time of this method is approximately less than 15 min. This alternative method offers a promising practical screening approach for the diagnosis of COVID-19 in sweat.

A wearable sweat sensor, which could continuously monitor biomolecules related to the human physiological state, is emerging as a promising piece of health surveillance equipment. However, current sensors cannot simultaneously achieve a detection performance that equates to that of traditional sensors and satisfactory mechanical strength. Herein, a wearable sweat sensor with excellent detection performance and mechanical stability is designed and fabricated. Based on the integration of laser-induced graphene electrodes and a screen printing technique, this wearable sweat sensor could realize both the separate and simultaneous detection of uric acid (UA), tyrosine (Tyr), and ascorbic acid (AA) with high sensitivity. Good UA sensing performance in artificial sweat could be maintained even after 20 000 bends. In addition, the sensor can operate well in the wearing state or in a complex bovine whole blood sample. For the detection of human sweat, the changes in UA concentration after a purine-rich meal are continuously monitored and the results are in accordance with the corresponding serum UA detection results tested with a commercial serum UA meter. These results suggest its application potential in health monitoring for both gout patients and healthy humans.

Sweat, as a sample that includes a lot of biochemical information, is good for non-invasive monitoring. In recent years, there have been an increasing number of studies on in situ monitoring of sweat. However, there are still some challenges for the continuous analysis of samples. As a hydrophilic, easy-to-process, environmentally friendly, inexpensive and easily accessible material, paper is an ideal substrate material for making in situ sweat analysis microfluidics. This review introduces the development of paper as a sweat analysis microfluidic substrate material, focusing on the advantages of the structural characteristics of paper, trench design and equipment integration applications to expand the design and research ideas for the development of in situ sweat detection technology.

Simultaneous access to different biofluids enables an accurate analysis of multiple analytes, leading to a precision diagnosis and appropriate medication. Additionally, establishing a relationship between various markers in different biofluids and their correlation to biomarkers in blood allows the development of an algorithmic approach, which aids non-invasive diagnosis through single parameter monitoring. However, the main bottleneck that exists in multiple biofluid analyses for its clinical implementation is the requirement of an advanced microfluidic coupled device design, which empowers simultaneous collection and monitoring. To tackle this challenge, an epidermal wearable bio-fluidic patch that facilitates simultaneous on-demand extraction, sampling, and storage of sweat and interstitial fluid (ISF) together with monitoring of their corresponding counterions is presented. The clean room free development of a biofluidic patch is realized through 3D integration of laser patterned optimized microfluidic structures, a low-cost screen-printed stimulation module, and a potentiometric chloride (Cl - ) and calcium (Ca 2+ ) ion sensing module for adequate dual biofluid sampling and analysis. The developed Cl - and Ca 2+ ion-selective sensors exhibit good repeatability, selectivity, acceptable stability, and sensitivity. The proof-of-concept demonstration of the fabricated patch for simultaneous dual-sampling, storage, and monitoring of the sweat Cl - and ISF Ca 2+ on a healthy volunteer during different periods of the day leverages its potential in real-time personalized healthcare clinical usages. Furthermore, the patch's electronic interface and use of wireless transmission facilitates a point-of-care non-invasive lab-on-skin application for monitoring the health status of individuals.

Soft, skin-interfaced microfluidic platforms are capable of capturing, storing, and assessing sweat chemistry and total sweat loss, which provides essential insight into human physiological health. However, sweat loss from the outlet of the microfluidic devices often leads to deviation of the measured concentration of the biomarker or electrolyte from the actual value. Here, we introduce hydrophobic valves at the junction of the chamber and the microfluidic channel as a new chamber design to reduce sweat evaporation. Because the advancing front of the liquid in the hydrophilic microchannel is blocked by the hydrophobic valve, the fluid flows into the chambers, forms the initial meniscus, and completely fills the chambers along the initial meniscus. Fluid dynamic modeling and numerical simulations provide critical insights into the sweat sampling mechanism into the chambers. With significantly reduced evaporation and contamination, the sweat sample can be easily stored for a long time for later analysis when in situ analysis is limited. Additionally, the design with multiple chambers can allow sequential generation of sweat collection at different times for long-term analysis. The in situ real-time measurements of the sweat loss and pH value analysis from the human subject demonstrate the practical utility of the devices in collecting, storing, and analyzing the sweat generated from sweat glands on the skin.

With the rapid growth and appearance of novel psychoactive substances (NPS) onto the global drug market, the need for alternative screening methodologies for implementation within clinical environments is substantial. The immunoassay methods currently in use are inadequate for this new drug trend with the potential for misdiagnosis and subsequent administration of incorrect patient treatment increased. This contribution illustrates a strong proof-of-concept for the use of electrochemiluminescence (ECL) as a screening methodology for NPS within biological fluids, using the hallucinogen scopolamine as a model compound. A low cost, easy-to-use and portable sensor has been developed and successfully employed for the detection of scopolamine at clinically relevant concentrations within a variety of biological matrices, including human pooled serum, urine, artificial saliva and sweat, without any prior sample preparation required. Moreover, assessment of the sensor's potential as a point-of-care wearable device was performed with sample collection from the surface of skin, demonstrating its capability for the qualitative identification of scopolamine despite collection of only minimal volumes off the skins surface. The developed sensor described herein exhibits a strong proof-of-concept for the employment of such ECL sensors as point-of-care devices, where the sensors ease of use and removal of time-consuming and complex sample preparation methods will ultimately increase its usability by physicians, widening the avenues where ECL sensors could be employed.

Microwave sensors based on microstrip antennas are promising as wearable devices because of their flexibility and wireless communication compatibility. However, their sensitivity is limited due to the reduced sensor size and the potential of biochemical monitoring needs to be explored. In this work, we present a new concept to enhance the microwave signals using nanostrip-based metamaterials. The introduction of the nanostrip structures was achieved by theory and simulations. Experiments prove their enhancement of the electric field and sensing response in the characteristic gigahertz (GHz) wave band. Ordered nanostrips were fabricated on a plastic substrate through a simple nanoscale printing approach. Glucose oxidase is directly doped into the nanostrips, which enables a flexible wearable enzymatic biosensor for glucose sensing. Sensing experiments demonstrated that the nanostrip biosensor gives excellent performance for glucose detection, including high sensitivity, fast response, low detection limit, high affinity, and low power consumption. The applicability of the nanostrip-based sensor as a wearable epidermal device for real-time noninvasive monitoring of glucose in sweat is verified as well.

Wearable biochemical sensors are of great interest nowadays due to their powerful potential in personalized medicine and continuous monitoring of human health. Thus, a great deal of effort has been put into the development of such sensors to enable real-time and non-invasive quantification of various chemical constituents in the human body such as sweat, saliva, and tears. Owing to the advances in materials science and mechanical engineering, wearable biochemical sensors have been developed to probe various biomarkers and have been subsequently considered as wearable electronic devices for practical applications. In this review, we present a broad overview on the recent advances in electrochemical wearable sensors towards various organic components and ions closely linked to human health. With an emphasis on materials and manufacturing technologies of the sensing electrodes, the research status is summarized, and the challenges and opportunities in this growing field are prospected.

Skin gas that contains volatile metabolites (volatilome) is emanated continuously and is thus expected to be suitable for non-invasive monitoring. The aim of this study was to investigate the relationship between the regional difference of sweat rate and skin volatilome distribution to identify the suitable site to monitor metabolisms. In this study, we developed a biofluorometric gas-imaging system (sniff-cam) based on nicotinamide adenine dinucleotide (NAD)-dependent alcohol dehydrogenase (ADH) to visualize transcutaneous ethanol (EtOH) distribution. The EtOH distribution was converted to a fluorescence distribution of reduced NAD with autofluorescence property. First, we optimized the solution volume and concentration of the oxidized NAD, which was a coenzyme of ADH. Owing to the optimization, a two-dimensional distribution of EtOH could be visualized from 0.05-10 ppm with good sensitivity and selectivity. Subsequently, transcutaneous EtOH imaging and measurement of sweat rate were performed at the palm, dorsum of hand, and wrist of participants who consumed alcohol. Transcutaneous EtOH from all skin parts was imaged using the sniff-cam; the concentrations initially increased until 30 min after drinking, followed by a gradual decrease. Although the determined peak EtOH concentrations of typical subjects were approximately 1100 ± 35 ppb (palm), which were higher than 720 ± 18 ppb (dorsum) and 620 ± 13 ppb (wrist), the results of sweat rate suggested that the dorsum of hand and the wrist were appropriate sites. Finally, the sniff-cam could visualize the individual difference of alcohol metabolism capacity originating from aldehyde dehydrogenase phenotype by imaging transcutaneous EtOH.

Rapid and sensitive detection of drugs of abuse plays an important role in monitoring of drug use and treatment compliance. Sweat based drug analysis shows great advantages due to its non-invasive nature. However, most of the related methods developed to date are qualitative, slow, or costly, which significantly hinders their application in field use. Here we report rapid, sensitive, quantitative detection of drugs of abuse in sweat based on capillary arrays combined with competitive enzyme-linked immunosorbent assay. Using four common drugs of abuse, methadone, methamphetamine, amphetamine, and tetrahydrocannabinol, spiked in artificial sweat as a model system, we demonstrate rapid, quantitative, and multiplexed detection of the four drugs in ∼16 minutes with a low sweat volume (∼4 μL per analyte) and a large dynamic range (methadone: 0.0016 ng mL-1-1 ng mL-1; METH: 0.016 ng mL-1-25 ng mL-1; amphetamine: 0.005 ng mL-1-10 ng mL-1; THC: 0.02 ng mL-1-1000 ng mL-1). In addition, we show that the detection range can be tuned for different applications by adjusting the competitors' concentrations. Our work paves a way to develop an autonomous, portable, and cost-effective device for hospital testing, workplace drug-use screening, roadside testing, and patient monitoring in drug rehabilitation centers.

The operation of wearable epidermal biofuel cells is prone to rapid irreversible deactivation effects under dynamic sweat pH changes from neutral to acidic. We demonstrate that the encapsulation of lactate-oxidase (LOx) within a hydrophobic protective carbon-paste anode imparts unusually high stability during dynamically changing pH fluctuations and allows the BFC to continue harvesting the lactate bioenergy even after long exposures to acidic conditions. The unique power-recovery ability of the carbon-paste BFC after its failure in harsh pH is attributed to the protective action of the non-polar paste environment.

Owing to its high sensitivity, a solution-gated graphene transistor has rapidly emerged as a cutting edge technology in electrochemical sensing. In this work, composites of gold nanoparticles and reduced graphene oxide were synthesized on a glassy carbon electrode by using the electrodeposition method. A modified glassy carbon electrode was used as the gate electrode and assembled into the solution-gated graphene transistor device along with the graphene channel for a non-invasive glucose detection. The sensing mechanism was based on the change in current in the channel of the device caused by the addition of glucose, of which electro-oxidation on the surface of the gold nanoparticles and reduced graphene oxide led to a change in equivalent gate voltage, and consequently, affected the channel carrier concentration. The self-amplification effect of transistors was utilized in our sensors, which resulted in a detection limit that was 10 times lower than those of conventional electrochemical sensors. Compared to traditional enzymatic transistor sensors, the novel solution-gated graphene transistor nonenzymatic sensors based on gold nanoparticles and reduced graphene oxide demonstrated significant sensing advantages, such as a simple structure, wide linear range from 10 μM to 400 μM and 400 μM to 31 mM, and low detection limit down to 4 μM. The chemicals coexisting in human sweat e.g. sodium chloride, urea, and lactic acid imposed no distinct interference for the glucose detection. Therefore, we achieved a non-invasive detection of glucose in the artificial sweat samples with satisfactory sensing results. This work demonstrates an effective route for non-invasive glucose testing in practical clinical diagnosis by using nonenzymatic, solution-gated graphene transistor devices.

Chronobiology is defined as the temporal fluctuations occurring in the human physiology due to the circadian cycle. These fluctuations are good indicators of the functioning of the Hypothalamic-Pituitary-Adrenal axis (HPA axis) and can be tracked by using biomarkers: cortisol and DHEA. Low volume tracking systems will be beneficial for patients exposed to chronic stress, patients suffering from endocrine conditions manifested by circadian disruption and act as a lifestyle monitoring tool. The sensor system demonstrated in this work was an affinity-based system, characterized using EIS (Electrochemical Impedance Spectroscopy).The sensor can detect cortisol and DHEA in the physiologically relevant ranges i.e. 8-200 ng ml-1 and 2-131 ng ml-1 respectively. Thus, the senor is a non-invasive, label free, cost-effective solution for tracking chronobiology for circadian diagnostics.

Eccrine sweat is a rich and largely unexplored biofluid that contains a range of important biomarkers, from electrolytes, metabolites, micronutrients and hormones to exogenous agents, each of which can change in concentration with diet, stress level, hydration status and physiologic or metabolic state. Traditionally, clinicians and researchers have used absorbent pads and benchtop analyzers to collect and analyze the biochemical constituents of sweat in controlled, laboratory settings. Recently reported wearable microfluidic and electrochemical sensing devices represent significant advances in this context, with capabilities for rapid, in situ evaluations, in many cases with improved repeatability and accuracy. A limitation is that assays performed in these platforms offer limited control of reaction kinetics and mixing of different reagents and samples. Here, we present a multi-layered microfluidic device platform with designs that eliminate these constraints, to enable integrated enzymatic assays with demonstrations of in situ analysis of the concentrations of ammonia and ethanol in microliter volumes of sweat. Careful characterization of the reaction kinetics and their optimization using statistical techniques yield robust analysis protocols. Human subject studies with sweat initiated by warm-water bathing highlight the operational features of these systems.

The rapid identification of human body fluids is meaningful for forensic casework. However, current methods suffer from several limitations such as poor sensitivity, time consumption and big sample consumption. Herein, we developed a mass spectrometry method to distinguish human body fluids (blood, semen, urine, sweat, and saliva) based on small molecular regions with no pretreatment, microliter sample consumption and high throughput. A highly sensitive and high salt-tolerance matrix N-(1-naphthyl)ethylenediamine dihydrochloride (NEDC) was used to efficiently detect metabolites in complex humoral environment. Some characteristic small metabolic molecules such as heme, hemin, creatinine, phosphate acid, uric acid, citric acid and lactic acid were identified and served as potential biomarkers to differentiate different body fluid types. Further principal component analysis (PCA) was performed to cluster the body fluid samples and three principal components allowed 75% clustering of all body fluid types. Blind testing revealed that nine out of ten unknown body fluid samples could be correctly classified into their corresponding group. This novel method can efficiently differentiate five body fluids with minimal interferences due to the storage time (less than 12 months) and carrier materials (cotton, fabric and tissue). The whole process from sampling to recording of mass spectra of body fluids can be finished in less than 10 minutes. We believe that this developed strategy has significant implications for rapid and effective human body fluid screening in forensic casework.

Point-of-care (POC) diagnostics have shown excellent potential in rapid biological analysis and health/disease monitoring. Here, we introduce a versatile, cost-effective, flexible, and wearable POC biomarker patch for effective sweat collection and health monitoring. We design and fabricate channels/patterns on filter paper using wax printing technology, which can direct sweat to collection and biomarker detection zones on the proposed platform. The detection zones are designed to measure the amount of collected sweat, in addition to measuring the sweat pH, and glucose (a potential diabetic biomarker), and lactate concentrations. It is significantly challenging to measure glucose in human sweat by colorimetric methods due to the extremely low glucose levels found in this medium. However, we overcame this issue by effectively engineering our wearable biosensor for optimal intake, storage, and evaporation of sweat. Our design concentrates the colorant (indicator) into a small detection zone and significantly increases the sensitivity for the sweat glucose sensing reactions. The device can thus detect glucose in physiological glucose concentration range of 50-300 μM. This cost-effective and wearable biosensor can provide instant in situ quantitative results for targets of interest, such as glucose, pH, and lactate, when coupled with the imaging and computing functionalities of smartphones. Meanwhile, it is also feasible to extract the air-dried sweat from the storage zone for further ex situ measurements of a broader portfolio of biomarkers, leading to applications of our wearable biosensor in personalized nutrition and medicine.

Sweat sensors introduced in recent years have targeted a variety of sweat features and biomarkers for non-invasive health monitoring. Amongst these targets, reliable monitoring of sweat rate is crucial due to its modulation of sweat analyte concentrations and its intrinsic significance to numerous medical and physiological health conditions. Here we present a sweat rate sensor structure comprising of electrodes with interdigitated fingers in a microfluidic channel. Each time the accumulating sweat impinges on an electrode finger, the sensor reports a jump in admittance that can be simply and efficiently counted to estimate sweat rate, overcoming selectivity limitations of previously reported sweat rate sensors. We further integrate an impedimetric sensor for measuring total ionic charge concentration and an electrochemical Na + sensor, together creating a multi-modal system for analyzing fluid and electrolyte secretion. We demonstrate how low analyte diffusion rates through this microfluidic device allow for multi-purpose sensor function, including utilizing the sweat rate sensor signal to corroborate total ionic sensor measurements. This cross-verification capability ensures data integrity in real time, satisfying a vital consideration for personalized healthcare technologies. We use the presented patch for continuous analysis of sweat rate, total ionic charge concentration, and Na + concentration during exercise, while demonstrating how multi-modal cross-verification brings new trust to sensor readings.

Microfluidic flow rate sensors have constraints in both detection limits and dynamic range, and are not often easily integrated into lab-on-chip or wearable sensing systems. We constructed a flow rate sensor that easily couples to the outlet of a microfluidic channel, and measures the flow rate by temporarily shorting periodic droplets generated between two electrodes. The device was tested in a dynamic range as low as 25 nL min-1 and as high as 900 000 nL min-1 (36 000× range). It was tested to continuously operate up to ∼200 hours. The device is also simple to fabricate, requiring inexpensive parts, and is small enough to be integrated into wearable devices. The required input pressure is as low as 370 Pascals. An ultra-low flow rate application was demonstrated for wearable sweat biosensing where sweat generation rates (nL min-1 per gland) were accurately measured in human subjects. The digital nanoliter device provides real-time flow rates for sweat rates and may have other applications for low flow rates in microfluidic devices.

A wearable sweat biosensing device is demonstrated that stimulates sweat and continuously measures sweat ethanol concentrations at 25 s intervals, which is then correlated with blood ethanol during a >3 hour testing phase. The testing involves a baseline condition (no ethanol) followed by a rapid blood and sweat rise of ethanol (oral bolus), and finally, the physiological response of the body as ethanol concentrations return to baseline (metabolized). Data sets include multiple in vivo validation trials and careful in vitro characterization of the electrochemical enzymatic ethanol sensor against likely interferents. Furthermore, the data is analyzed through known pharmacokinetic models with a strong linear Pearson correlation of 0.9474-0.9996. The continuous nature of the data also allows analysis of blood-to-sweat lag times that range between 2.3 to 11.41 min for ethanol signal onset and 19.32 to 34.44 min for the overall pharmacokinetic curve lag time. This work represents a significant advance that builds upon a continuum of previous work. However, unresolved questions include operation for 24 hours or greater and with analytes beyond those commonly explored for sweat (electrolytes and metabolites). Regardless, this work validates that sweat biosensing can provide continuous and blood-correlated data in an integrated wearable device.

Sensing of lactate in perspiration provides a way to monitor health and control exercise. The volume of perspiration is miniscule, and the efficient collection of perspiration is desired for its effective sensing. We developed mesh-type enzymatic electrodes fabricated on textile meshes and integrated the meshes into an enzymatic biofuel cell. We tested them as self-powered lactate sensors for a small volume of lactate solution. A fluid-permeable enzymatic anode was fabricated based on an insulating textile mesh that was coated with carbon nanotubes (CNTs) and lactate oxidase. The anode was further coated with polyurethane to increase the linear range by limiting the diffusion of lactate while maintaining the advantages of the original textile mesh, such as flexibility, stretchability, and permeability. Permeability of the mesh-type lactate-oxidizing anode allowed a vertically stacked structure of the anode and a previously developed air-breathing cathode. This resulted in a small overall device size (1 cm2). The mesh-type sensor was tested using a small flow rate of lactate solution, and a moderate linearity of amperometric response for a wide concentration range (5 to ≥20 mM) was confirmed. The fluid-permeable anode and enzymatic biofuel cell show the potential of the sensor for continuous monitoring of lactate in perspiration on skin.

Implementation of wearable sweat sensors for continuous measurement of fluid based biomarkers (including electrolytes, metabolites and proteins) is an attractive alternative to common, yet intrusive and invasive, practices such as urine or blood analysis. Recent years have witnessed several key demonstrations of sweat based electrochemical sensing in wearable formats, however, there are still significant challenges and opportunities in this space for clinical acceptance, and thus mass implementation of these devices. For instance, there are inherent challenges in establishing direct correlations between sweat-based and gold-standard plasma-based biomarker concentrations for clinical decision-making. In addition, the wearable sweat monitoring devices themselves may exacerbate these challenges, as they can significantly alter sweat physiology (example, sweat rate and composition). Reported here is the demonstration of a fully integrated, wireless, wearable and flexible sweat sensing device for non-obtrusive and continuous monitoring of electrolytes during moderate to intense exertion as a metric for hydration status. The focus of this work is twofold: 1- design of a conformable fluidics systems to suit conditions of operation for sweat collection (to minimize sensor lag) with rapid removal of sweat from the sensing site (to minimize effects on sweat physiology). 2- integration of Na+ and K+ ion-selective electrodes (ISEs) with flexible microfluidics and low noise small footprint electronics components to enable wireless, wearable sweat monitoring. While this device is specific to electrolyte analysis during intense perspiration, the lessons in microfluidics and overall system design are likely applicable across a broad range of analytes.

The rich composition of solutes and metabolites in sweat and its relative ease of collection upon excretion from skin pores make this class of biofluid an attractive candidate for point of care analysis. Wearable technologies that combine electrochemical sensors with conventional or emerging semiconductor device technologies offer valuable capabilities in sweat sensing, but they are limited to assays that support amperometric, potentiometric, and colorimetric analyses. Here, we present a complementary approach that exploits fluorometric sensing modalities integrated into a soft, skin-interfaced microfluidic system which, when paired with a simple smartphone-based imaging module, allows for in situ measurement of important biomarkers in sweat. A network array of microchannels and a collection of microreservoirs pre-filled with fluorescent probes that selectively react with target analytes in sweat (e.g. probes), enable quantitative, rapid analysis. Field studies on human subjects demonstrate the ability to measure the concentrations of chloride, sodium and zinc in sweat, with accuracy that matches that of conventional laboratory techniques. The results highlight the versatility of advanced fluorescent-based imaging modalities in body-worn sweat microfluidics platforms, and they suggest some practical potential for these ideas.

Eccrine sweat has rapidly emerged as a non-invasive, ergonomic, and rich source of chemical analytes with numerous technological demonstrations now showing the ability for continuous electrochemical sensing. However, beyond active perspirers (athletes, workers, etc.), continuous sweat access in individuals at rest has hindered the advancement of both sweat sensing science and technology. Reported here is integration of sudomotor axon reflex sweat stimulation for continuous wearable sweat analyte analysis, including the ability for side-by-side integration of chemical stimulants & sensors without cross-contamination. This integration approach is uniquely compatible with sensors which consume the analyte (enzymatic) or sensors which equilibrate with analyte concentrations. In vivo validation is performed using iontophoretic delivery of carbachol with ion-selective and impedance sensors for sweat analysis. Carbachol has shown prolonged sweat stimulation in directly stimulated regions for five hours or longer. This work represents a significant leap forward in sweat sensing technology, and may be of broader interest to those interested in on-skin sensing integrated with drug-delivery.

The demand for wearable sensors has grown rapidly in recent years, with increasing attention being given to epidermal chemical sensing. Here, we present the first example of a fully integrated eyeglasses wireless multiplexed chemical sensing platform capable of real-time monitoring of sweat electrolytes and metabolites. The new concept has been realized by integrating an amperometric lactate biosensor and a potentiometric potassium ion-selective electrode into the two nose-bridge pads of the glasses and interfacing them with a wireless electronic backbone placed on the glasses' arms. Simultaneous real-time monitoring of sweat lactate and potassium levels with no apparent cross-talk is demonstrated along with wireless signal transduction. The electrochemical sensors were screen-printed on polyethylene terephthalate (PET) stickers and placed on each side of the glasses' nose pads in order to monitor sweat metabolites and electrolytes. The electronic backbone on the arms of the glasses' frame offers control of the amperometric and potentiometric transducers and enables Bluetooth wireless data transmission to the host device. The new eyeglasses system offers an interchangeable-sensor feature in connection with a variety of different nose-bridge amperometric and potentiometric sensor stickers. For example, the lactate bridge-pad sensor was replaced with a glucose one to offer convenient monitoring of sweat glucose. Such a fully integrated wireless "Lab-on-a-Glass" multiplexed biosensor platform can be readily expanded for the simultaneous monitoring of additional sweat electrolytes and metabolites.

Herein we present a novel sensor for the detection of monosaccharides (e.g. glucose, fructose) in solution, using electrical impedance spectroscopy. The sensor is based on carbon interdigitated electrodes, printed on paper using screen printing. The surface of the electrodes was modified with a thin layer of hydrogel containing acrylamide copolymerised with 20 mol% 3-(Acrylamido)phenylboronic acid (PBA). It was observed that the hydrogel layers containing 20 mol% PBA swell considerably in the presence of glucose and fructose. This in turn changes the measured impedance across the electrodes, making it a suitable sensor for the quantitative detection of saccharides. We investigated the impedance and capacitance variations with different concentrations of glucose and fructose (0-5 mM) in aqueous phosphate buffer solutions. Variations in impedance were attributed to changes in the dielectric properties of the hydrogel under an applied electric field, due to swelling of the hydrogel layer induced by uptake and binding of sugar molecules to the boronate species within the gel. Impedance measurements at 1 kHz demonstrated that hydrogel swelling leads to an increased mobility of ions within the swollen hydrogel layer. The impedance decreased with increasing sugar concentration and the relative capacitance curves are markedly different for fructose and glucose, as the hydrogel exhibits greater swelling in the presence of fructose than glucose over the same concentration range. As the proposed sensor was shown to be suitable for the detection of glucose at concentration levels found in human sweat, future work will focus on the incorporation of these modified paper-based electrodes into wearable skin patches for non-invasive sugar monitoring in sweat.

This paper describes a technique that utilizes the osmotic properties of hydrogels to passively draw fluid through a membrane and pass it along to a microfluidic network for sensing purposes. This technique may enable non-invasive collection and manipulation of sweat for biosensing. To demonstrate the concept, thin hydrogel discs equilibrated in saline or glycerol were integrated with a microfluidic device. The hydrogel interfaces with a water-permeable membrane. The high concentration of solute in the hydrogel creates an osmotic pressure difference across the membrane, driving fluid flow through the membrane and into the device. The release of solute from the hydrogel autonomously pumps the fluid into an adjacent microfluidic channel. The flowrate of liquid drawn through the membrane is controlled by the osmotic pressure of the hydrogel and its interfacial contact area with the membrane. The flowrate gradually decreases over time as the continuous influx of withdrawn fluid dilutes the concentrated solute in the hydrogel. Initial testing has shown the device can pump accurate levels of glucose across the membrane and through a microchannel to a reservoir with a glucose sensor. Sensors and electrodes can be implemented in future microfluidic devices operating on these principles to test for other bioanalytes in sweat.

Wearable sweat biosensensing technology has dominantly relied on techniques which place planar-sensors or fluid-capture materials directly onto the skin surface. This 'on-skin' approach can result in sample volumes in the μL regime, due to the roughness of skin and/or due to the presence of hair. Not only does this increase the required sampling time to 10's of minutes or more, but it also increases the time that sweat spends on skin and therefore increases the amount of analyte contamination coming from the skin surface. Reported here is a first demonstration of a new paradigm in sweat sampling and sensing, where sample volumes are reduced from the μL's to nL's regime, and where analyte contamination from skin is reduced or even eliminated. A micro-porous membrane is constructed such that it is porous to sweat only. To complete a working device, first placed onto skin is a cosmetic-grade oil, secondly this membrane, and thirdly the sensors. As a result, spreading of sweat is isolated to only regions above the sweat glands before it reaches the sensors. Best case sampling intervals are on the order of several minutes, and the majority of hydrophilic (low oil solubility) contaminants from the skin surface are blocked. In vitro validation of this new approach is performed with an improved artificial skin including human hair. In vivo tests show strikingly consistent results, and reveal that the oil/membrane is robust enough to even allow horizontal sliding of a sensor.

Cortisol has long been recognized as the "stress biomarker" in evaluating stress related disorders. Plasma, urine or saliva are the current source for cortisol analysis. The sampling of these biofluids is either invasive or has reliability problems that could lead to inaccurate results. Sweat has drawn increasing attention as a promising source for non-invasive stress analysis. A sensitive HPLC-MS/MS method was developed for the quantitation of cortisol ((11β)-11,17,21-trihydroxypregn-4-ene-3,20-dione) in human eccrine sweat. At least one unknown isomer that has previously not been reported and could potentially interfere with quantification was separated from cortisol with mixed mode RP HPLC. Detection of cortisol was carried out using atmospheric pressure chemical ionization (APCI) and selected reaction monitoring (SRM) in positive ion mode, using cortisol-9,11,12,12-D4 as internal standard. LOD and LOQ were estimated to be 0.04 ng ml(-1) and 0.1 ng ml(-1), respectively. Linear range of 0.10-25.00 ng ml(-1) was obtained. Intraday precision (2.5%-9.7%) and accuracy (0.5%-2.1%), interday precision (12.3%-18.7%) and accuracy (7.1%-15.1%) were achieved. This method has been successfully applied to the cortisol analysis of human eccrine sweat samples. This is the first demonstration that HPLC-MS/MS can be used for the sensitive and highly specific determination of cortisol in human eccrine sweat in the presence of at least one isomer that has similar hydrophobicity as cortisol. This study demonstrated that human eccrine sweat could be used as a promising source for non-invasive assessment of stress biomarkers such as cortisol and other steroid hormones.

Biosensors are being developed to provide rapid, quantitative, diagnostic information to clinicians in order to help guide patient treatment, without the need for centralised laboratory assays. The success of glucose monitoring is a key example of where technology innovation has met a clinical need at multiple levels – from the pathology laboratory all the way to the patient's home. However, few other biosensor devices are currently in routine use. Here we review the challenges and opportunities regarding the integration of biosensor techniques into body fluid sampling approaches, with emphasis on the point-of-care setting.

Desorption ionisation on porous silicon mass spectrometry imaging (DIOS-MSI) was used on fingerprints to map the distribution of exogenous and endogenous molecules present in sweat. Our attention was focused on the proof-of-principle to detect illicit drugs and their metabolites to exemplify the technique's potential in the area of forensic and workplace testing.

A simple but efficient sweat pore mapping method based on a fluorescein-PVP composite film was developed for fingerprint analysis. The composite film displays a fluorometric turn-on response upon contact with a small quantity of water secreted from human sweat pores, allowing precise mapping of sweat pores on a fingertip.

Increasingly, smartphones are used as portable personal computers, revolutionizing communication styles and entire lifestyles. Using 3D-printing technology we have made a disposable minicartridge that can be easily prototyped to turn any kind of smartphone or tablet into a portable luminometer to detect chemiluminescence derived from enzyme-coupled reactions. As proof-of-principle, lactate oxidase was coupled with horseradish peroxidase for lactate determination in oral fluid and sweat. Lactate can be quantified in less than five minutes with detection limits of 0.5 mmol L(-1) (corresponding to 4.5 mg dL(-1)) and 0.1 mmol L(-1) (corresponding to 0.9 mg dL(-1)) in oral fluid and sweat, respectively. A smartphone-based device shows adequate analytical performance to offer a cost-effective alternative for non-invasive lactate measurement. It could be used to evaluate lactate variation in relation to the anaerobic threshold in endurance sport and for monitoring lactic acidosis in critical-care patients.

Dermal exposure to sensitizing metals is a serious occupational and public health problem. The usual approach to dermal exposure assessment is to process samples by chemical methods that use reactants to digest the metal particles and quantify the mass. In the case of dermal exposure assessment, these reactants are not representative of the skin surface film liquids and hence, may overestimate bioaccessibility. We hypothesize that the amount and form of sensitizer on a sample that leaches in a biological fluid, as can be estimated using artificial sweat, may be a more relevant metric for assessing health risks. Beryllium metal (Be), nickel metal (Ni), and chromium carbide (Cr3C2) particles were characterized and masses of sensitizing ions were measured using established reactant-assisted digestion procedures and extraction in artificial sweat under physiologically relevant conditions. Chromium ions released into artificial sweat were speciated to understand valence states. The ratios of the fraction of metal dissolved in artificial sweat relative to that dissolved by chemical-specific reactants were 1/2 (Be), 1/108 (Ni), and 1/2500 (Cr). The divalent Be and Ni cations were stable in artificial sweat over time (did not precipitate) whereas hexavalent chromium [Cr(VI)] ions decayed over time. Further analysis using speciated isotope dilution mass spectrometry revealed that the decay of Cr(VI) was accompanied by the formation of Cr(III) in the sweat model. Use of reactant-assisted analytical chemistry to quantify amounts of metal sensitizers on samples could overestimate biologically relevant exposure. In addition to mass, the valence state also influences penetration through the outer stratum corneum of the skin and is an important consideration when assessing exposure to complex sensitizers such as Cr which have multiple valence states with differing penetration efficiencies.

The development and analytical characterization of a novel ion-selective potentiometric cell in a temporary-transfer tattoo platform for monitoring ammonium levels in sweat is presented. The fabrication of this skin-worn sensor, which is based on a screen-printed design, incorporates all-solid-state potentiometric sensor technology for both the working and reference electrodes, in connection to ammonium-selective polymeric membrane based on the nonactin ionophore. The resulting tattooed potentiometric sensor exhibits a working range between 10(-4) M to 0.1 M, well within the physiological levels of ammonium in sweat. Testing under stringent mechanical stress expected on the epidermis shows that the analytical performance is not affected by factors such as stretching or bending. Since the levels of ammonium are related to the breakdown of proteins, the new wearable potentiometric tattoo sensor offers considerable promise for monitoring sport performance or detecting metabolic disorders in healthcare. Such combination of the epidermal integration, screen-printed technology and potentiometric sensing represents an attractive path towards non-invasive monitoring of a variety of electrolytes in human perspiration.

The mobile health market is rapidly expanding and portable diagnostics tools offer an opportunity to decrease costs and increase the availability of healthcare. Here we present a smartphone based accessory and method for the rapid colorimetric detection of pH in sweat and saliva. Sweat pH can be correlated to sodium concentration and sweat rate in order to indicate to users the proper time to hydrate during physical exercise and avoid the risk of muscle cramps. Salivary pH below a critical threshold is correlated with enamel decalcification, an acidic breakdown of calcium in the teeth. We conduct a number of human trials with the device on a treadmill to demonstrate the ability to monitor changes in sweat pH due to exercise and electrolyte intake and predict optimal hydration. Additionally, we perform trials to measure salivary pH over time to monitor the effects of diet on oral health risks.

Cystic fibrosis is a common disease which has an associated characteristic symptom of high sweat chloride content. Thus, chloride ion quantification in sweat is important towards the screening of cystic fibrosis. Electrochemical methods, being cost effective and convenient, can be exploited for this. The electrochemical oxidation of silver nanoparticles in the absence of chloride ions gives one voltammetric signal related to the oxidation of silver to silver ions. The presence of chloride ions in the solution causes the appearance of an additional signal at a lower potential which is related to the oxidation of silver to silver chloride. This signal has a peak height which correlates linearly with the concentration of chloride ions from 2 mM to 40 mM when the electrochemical experiments are performed on silver nanoparticle modified screen printed electrodes. Thus, reliable quantification was found to be achievable. Furthermore, chloride ion levels of diluted synthetic sweat samples are measured accurately with the modified electrodes. Thus, the detection of the chloride ion concentration with a silver nanoparticle modified electrode provides a proof-of-concept for a point-of-care system for preliminary screening of cystic fibrosis.

Methods were developed to quantify the amount of perfluorooctanoic acid (PFOA) extracted from textile and carpet samples through contact with water, methanol, and sweat and saliva simulants using LC/MS/MS. The limit of quantitation (LOQ) for samples extracted in water and sweat simulant is 1 ppb (ng PFOA (g sample)(-1)) while the limits of quantitation for samples extracted in saliva simulant and methanol were 3 ppb and 2.5 ppb, respectively. Method validation results are provided for a polyester control textile sample that was extracted in water on two different days by different analysts, which gave an overall recovery of 103% and standard deviation of 5.3% for 30 analyses. However, for routine application of these methods to a large number of sample sets differing in chemical and physical compositions, a complete validation for each sample type is not practical or possible since control samples for fortifications are often not available. Instead, suitable analytical methods and acceptance criteria are described which ensure accurate PFOA quantitation in each of the solvent extract types. During routine use of these methods, post-extraction spike recoveries for the different sample types and solvents are 100 +/- 15% using a dual isotopically labeled (13)C-PFOA internal standard to correct for matrix effects. A comparison of extraction solvent versus time using a wrist action shaker for textile and carpet samples demonstrates that the total extractable amount of PFOA is similar for each of the solvent types. However, as expected the rate of extraction in water and simulants is significantly less than that of methanol. Finally, a comparison of 2 h and 24 h wrist action shaker extractions with a 1.5 h pressurized fluid extraction (PFE) in methanol reveals that the 24 h wrist action shaker yields the highest results. The 2 h wrist action shaker results are similar to those of the 1.5 h PFE extraction.

The novel approach of using a micro-sensor array of miniaturised solid-state ion-selective electrodes to analyse sweat samples for sodium, potassium and chloride simultaneously is described. The array, incorporated into a miniature flow cell which is linked to a portable PC for data acquisition, constitutes a small, portable, and simple to use analytical instrument. Samples are passed through the flow cell and over the array and an immediate potentiometric response is obtained, which can be equated to the concentrations of sodium, chloride, potassium and other parameters in the sweat sample. Used here in conjunction with a Wescor Macroduct sweat sampling unit, it promises a much simplified, much less expensive procedure for sweat analysis than the procedures currently in common use.