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Continuous imaging of cardiac functions is highly desirable for the assessment of long-term cardiovascular health, detection of acute cardiac dysfunction and clinical management of critically ill or surgical patients 1 – 4 . However, conventional non-invasive approaches to image the cardiac function cannot provide continuous measurements owing to device bulkiness 5 – 11 , and existing wearable cardiac devices can only capture signals on the skin 12 – 16 . Here we report a wearable ultrasonic device for continuous, real-time and direct cardiac function assessment. We introduce innovations in device design and material fabrication that improve the mechanical coupling between the device and human skin, allowing the left ventricle to be examined from different views during motion. We also develop a deep learning model that automatically extracts the left ventricular volume from the continuous image recording, yielding waveforms of key cardiac performance indices such as stroke volume, cardiac output and ejection fraction. This technology enables dynamic wearable monitoring of cardiac performance with substantially improved accuracy in various environments. Innovations in device design, material fabrication and deep learning are described, leading to a wearable ultrasound transducer capable of dynamic cardiac imaging in various environments and under different conditions.

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

Electronic patches, based on various mechanisms, allow continuous and noninvasive monitoring of biomolecules on the skin surface. However, to date, such devices are unable to sense biomolecules in deep tissues, which have a stronger and faster correlation with the human physiological status than those on the skin surface. Here, we demonstrate a photoacoustic patch for three-dimensional (3D) mapping of hemoglobin in deep tissues. This photoacoustic patch integrates an array of ultrasonic transducers and vertical-cavity surface-emitting laser (VCSEL) diodes on a common soft substrate. The high-power VCSEL diodes can generate laser pulses that penetrate >2 cm into biological tissues and activate hemoglobin molecules to generate acoustic waves, which can be collected by the transducers for 3D imaging of the hemoglobin with a high spatial resolution. Additionally, the photoacoustic signal amplitude and temperature have a linear relationship, which allows 3D mapping of core temperatures with high accuracy and fast response. With access to biomolecules in deep tissues, this technology adds unprecedented capabilities to wearable electronics and thus holds significant implications for various applications in both basic research and clinical practice. The authors present a wearable photoacoustic patch, which integrates laser diodes and piezoelectric transducers for three-dimensional imaging of hemoglobin and temperature in deep tissues.

Rapid fabricating and harnessing stimuli-responsive behaviors of microscale bio-compatible hydrogels are of great interest to the emerging micro-mechanics, drug delivery, artificial scaffolds, nano-robotics, and lab chips. Herein, we demonstrate a novel femtosecond laser additive manufacturing process with smart materials for soft interactive hydrogel micro-machines. Bio-compatible hyaluronic acid methacryloyl was polymerized with hydrophilic diacrylate into an absorbent hydrogel matrix under a tight topological control through a 532 nm green femtosecond laser beam. The proposed hetero-scanning strategy modifies the hierarchical polymeric degrees inside the hydrogel matrix, leading to a controllable surface tension mismatch. Strikingly, these programmable stimuli-responsive matrices mechanized hydrogels into robotic applications at the micro/nanoscale (<300 × 300 × 100 μm3). Reverse high-freedom shape mutations of diversified microstructures were created from simple initial shapes and identified without evident fatigue. We further confirmed the biocompatibility, cell adhesion, and tunable mechanics of the as-prepared hydrogels. Benefiting from the high-efficiency two-photon polymerization (TPP), nanometer feature size (<200 nm), and flexible digitalized modeling technique, many more micro/nanoscale hydrogel robots or machines have become obtainable in respect of future interdisciplinary applications.

Compared with their three-dimensional (3D) counterparts, low-dimensional metal halide perovskites (2D and quasi-2D; B 2 A n −1 M n X 3 n +1 , such as B = R-NH 3 + , A = HC(NH 2 ) 2 + , Cs + ; M = Pb 2+ , Sn 2+ ; X = Cl − , Br − , I − ) with periodic inorganic–organic structures have shown promising stability and hysteresis-free electrical performance 1 – 6 . However, their unique multiple-quantum-well structure limits the device efficiencies because of the grain boundaries and randomly oriented quantum wells in polycrystals 7 . In single crystals, the carrier transport through the thickness direction is hindered by the layered insulating organic spacers 8 . Furthermore, the strong quantum confinement from the organic spacers limits the generation and transport of free carriers 9 , 10 . Also, lead-free metal halide perovskites have been developed but their device performance is limited by their low crystallinity and structural instability 11 . Here we report a low-dimensional metal halide perovskite BA 2 MA n −1 Sn n I 3 n +1 (BA, butylammonium; MA, methylammonium; n  = 1, 3, 5) superlattice by chemical epitaxy. The inorganic slabs are aligned vertical to the substrate and interconnected in a criss-cross 2D network parallel to the substrate, leading to efficient carrier transport in three dimensions. A lattice-mismatched substrate compresses the organic spacers, which weakens the quantum confinement. The performance of a superlattice solar cell has been certified under the quasi-steady state, showing a stable 12.36% photoelectric conversion efficiency. Moreover, an intraband exciton relaxation process may have yielded an unusually high open-circuit voltage ( V OC ). Fabrication of a low-dimensional metal halide perovskite superlattice by chemical epitaxy is reported, with a criss-cross two-dimensional network parallel to the substrate, leading to efficient carrier transport in three dimensions.

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

Serial assessment of the biomechanical properties of tissues can be used to aid the early detection and management of pathophysiological conditions, to track the evolution of lesions and to evaluate the progress of rehabilitation. However, current methods are invasive, can be used only for short-term measurements, or have insufficient penetration depth or spatial resolution. Here we describe a stretchable ultrasonic array for performing serial non-invasive elastographic measurements of tissues up to 4 cm beneath the skin at a spatial resolution of 0.5 mm. The array conforms to human skin and acoustically couples with it, allowing for accurate elastographic imaging, which we validated via magnetic resonance elastography. We used the device to map three-dimensional distributions of the Young’s modulus of tissues ex vivo, to detect microstructural damage in the muscles of volunteers before the onset of soreness and to monitor the dynamic recovery process of muscle injuries during physiotherapies. The technology may facilitate the diagnosis and treatment of diseases affecting tissue biomechanics. A stretchable ultrasonic array conforming to the skin allows for the three-dimensional imaging of tissue modulus at depths of up to 4 cm.

Wearable electromyography devices can detect muscular activity for health monitoring and body motion tracking, but this approach is limited by weak and stochastic signals with a low spatial resolution. Alternatively, echomyography can detect muscle movement using ultrasound waves, but typically relies on complex transducer arrays, which are bulky, have high power consumption and can limit user mobility. Here we report a fully integrated wearable echomyography system that consists of a customized single transducer, a wireless circuit for data processing and an on-board battery for power. The system can be attached to the skin and provides accurate long-term wireless monitoring of muscles. To illustrate its capabilities, we use this system to detect the activity of the diaphragm, which allows the recognition of different breathing modes. We also develop a deep learning algorithm to correlate the single-transducer radio-frequency data from forearm muscles with hand gestures to accurately and continuously track 13 hand joints with a mean error of only 7.9°. An echomyography system based on a single transducer can be integrated into a wearable patch and used to monitor breathing patterns and hand gestures.

Mimicking natural botanical/zoological systems has revolutionarily inspired fourdimensional (4D) hydrogel robotics, interactive actuators/machines, automatic biomedical devices, and self-adaptive photonics. The controllable high-freedom shape reconfiguration holds the key to satisfying the ever-increasing demands. However, miniaturized biocompatible 4D hydrogels remain rigorously stifled due to current approach/material limits. In this research, we spatiotemporally program micro/ nano (μ/n) hydrogels through a heterojunction geometric strategy in femtosecond laser direct writing (fsLDW). Polyethylene incorporated N-isopropylacrylamide as programmable interactive materials here. Dynamic chiral torsion, site-specific mutation, anisotropic deformation, selective structural coloration of hydrogel nanowire, and spontaneous self-repairing as reusable μ/n robotics were identified. Hydrogel-materialized monolayer nanowires operate as the most fundamental block at nanometric accuracy to promise high freedom reconfiguration and high force-to-weight ratio/bending curvature under tight topological control. Taking use of this biomimetic fsLDW, we spatiotemporally constructed several in/out-plane selfdriven hydrogel grippers, diverse 2D-to-3D transforming from the same monolayer shape, responsive photonic crystal, and self-clenched fists at μ/n scale. Predictably, the geometry-modulable hydrogels would open new access to massively-reproducible robotics, actuators/sensors for microenvironments, or lab-on-chip devices.