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Zhao, Z.; Mi, Y.; Ur Rehman, H.; Sun, E.; Cao, X.; Wang, N. Triboelectric Nanogenerators in Point-of-Care Diagnostics. Encyclopedia. Available online: https://encyclopedia.pub/entry/55149 (accessed on 14 April 2024).
Zhao Z, Mi Y, Ur Rehman H, Sun E, Cao X, Wang N. Triboelectric Nanogenerators in Point-of-Care Diagnostics. Encyclopedia. Available at: https://encyclopedia.pub/entry/55149. Accessed April 14, 2024.
Zhao, Zequan, Yajun Mi, Hafeez Ur Rehman, Enqi Sun, Xia Cao, Ning Wang. "Triboelectric Nanogenerators in Point-of-Care Diagnostics" Encyclopedia, https://encyclopedia.pub/entry/55149 (accessed April 14, 2024).
Zhao, Z., Mi, Y., Ur Rehman, H., Sun, E., Cao, X., & Wang, N. (2024, February 19). Triboelectric Nanogenerators in Point-of-Care Diagnostics. In Encyclopedia. https://encyclopedia.pub/entry/55149
Zhao, Zequan, et al. "Triboelectric Nanogenerators in Point-of-Care Diagnostics." Encyclopedia. Web. 19 February, 2024.
Triboelectric Nanogenerators in Point-of-Care Diagnostics
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In the constantly evolving field of medical diagnostics, triboelectric nanogenerators (TENGs) stand out as a groundbreaking innovation for simultaneously harnessing mechanical energy from micromovements and sensing stimuli from both the human body and the ambient environment. This advancement diminishes the dependence of biosensors on external power sources and paves the way for the application of TENGs in self-powered medical devices, especially in the realm of point-of-care diagnostics.

point-of-care diagnostics triboelectric nanogenerator self-powered sensing wearable electronics

1. Introduction

The development of the triboelectric nanogenerator (TENG) marks a significant milestone in the field of energy harvesting and sensory applications due to the coupled effects of triboelectricity and electrostatic induction [1][2][3][4]. This innovative device is capable of converting mechanical energy from various sources, such as human motion, wind, or water waves, into useful electrical energy [5][6][7]. This conversion principle, which is grounded in the triboelectric effect, involves a wide selection of triboelectric materials with different and, in some cases, even the same, electron affinity that lead to electron transfer and generate an alternating electrical current if combined with the electrostatic induction effect [8][9][10]. Consequently, the broad applicability and adaptability of TENGs make them a sustainable and efficient solution in diverse sectors, ranging from environmental monitoring to biomedical applications. This is especially true in settings where conventional power sources are impractical or unavailable [11][12][13][14]. This versatility, coupled with their environmental friendliness and cost effectiveness, positions TENGs at the forefront of next-generation technology for energy harvesting and self-powered sensing systems [15][16][17].
Point-of-Care Diagnostics (PoCD) have revolutionized medical testing by bringing diagnostic tools directly to the patient’s location [18][19][20][21]. This approach significantly reduces the time between testing and obtaining results, which is crucial in many clinical scenarios. The main benefits of PoCD include portability, ease of use, and rapid turnaround time, allowing for immediate medical decision making [22][23][24][25]. These diagnostics cover a wide spectrum, from glucose monitoring in diabetes management to infectious disease testing. Their deployment in various settings, including remote areas and in-field operations, underscores their versatility and their critical role in enhancing global health access. By simplifying and expediting the diagnostic process, PoCD serves as a vital tool in managing and controlling diseases, particularly in resource-limited environments, where traditional laboratory facilities are scarce.
Despite the significant advancements in, and benefits of PoCD, several challenges hinder their widespread adoption and effectiveness. The primary issue is their reliance on stable power sources, which is a significant barrier in remote or underdeveloped areas. Furthermore, the accuracy and sensitivity of these devices may be compromised due to their miniaturized and portable nature; potentially leading to less reliable results compared to standard laboratory equipment. Another critical aspect is the need for user-friendly interfaces, as these devices often operate outside of traditional clinical settings and are used by individuals without specialized training. Ensuring robustness and durability is also paramount, as PoCD devices must withstand varied environmental conditions without degradation of performance. 
The integration of TENG into PoCD systems presents a novel solution to many of these challenges. Firstly, TENGs offer a sustainable and reliable power source that is crucial for PoCD’s operation in remote or power-limited environments. The ability of TENG to harness energy from everyday movements and environmental factors negates the dependence of PoCD systems on external power supplies [26][27][28]. This aspect not only enhances their portability, but also significantly increases the accessibility of PoCD devices in various settings. Moreover, TENG technology can potentially improve the sensitivity and accuracy of diagnostic tools through advanced sensor integration [29][30][31][32]. This enhancement is critical in achieving laboratory-level precision in portable formats. Additionally, TENGs can contribute to the durability and robustness of PoCD devices due to their inherent mechanical strength and flexibility, considering the wide selection of materials and various working modes. This feature is particularly beneficial in rugged or harsh environments, as it ensures consistent device performance. The adaptability of TENGs also allows for customization in PoCD design, accommodating diverse medical applications and user requirements [33][34][35]. This flexibility may pave the way for more user-friendly interfaces that are tailored to the specific needs and skills of the end-user. Lastly, TENGs can play a pivotal role in advancing data management systems within PoCD, facilitating efficient and secure transmission of medical data; this is integral to telemedicine and remote healthcare services.
The advantages of TENGs in PoCD are multifaceted and go beyond their self-powering capability [36][37][38]. For instance, the flexibility of TENGs allows for the creation of conformable and wearable diagnostic devices that can comfortably adhere to various body parts, providing continuous health monitoring. This adaptability is especially beneficial in developing patient-specific diagnostic tools. Moreover, the customizability of TENGs enables the design of devices tailored to specific medical conditions, enhancing diagnostic precision and efficacy. In terms of biocompatibility, TENG materials can be engineered to be non-toxic and compatible with the human body, ensuring they are safe and suitable for long-term use [39][40][41][42]. This feature is critical in applications involving them being in direct contact with skin or used internally. The low cost of TENG components and their manufacturing process significantly reduces the overall expense of diagnostic devices, making PoCD affordable and accessible to those in low-resource settings. Furthermore, TENGs exhibit high durability and reliability, which are essential for consistent device performance over time [43][44]. Their ability to operate effectively in diverse environmental conditions further broadens the scope of their application in global health contexts. The integration of TENGs in PoCD not only addresses current limitations, but also opens new possibilities for innovative, efficient, and patient-centric diagnostic solutions.

2. Working Principle of TENG

TENGs primarily harness the triboelectric effect and electrostatic induction to convert biomechanical energy into electrical energy, which can then power medical equipment. The basic principle is that when two materials with differing electronegativity come into contact, electron transfer occurs between them [45]. Upon separation, the electrostatic induction effect causes electrons to flow through an external load. Repeating this process enables TENGs to generate alternating current. Based on this, TENGs are categorized into four working modes [10]: vertical contact-separation mode [46][47], lateral sliding mode [48][49], single electrode mode [50][51][52], and freestanding triboelectric layer mode [53][54].
Vertical contact-separation (CS) mode: In this mode, when two objects with different electronegativities are in vertical contact, electron exchange occurs at the contact surface. As they separate, the equal but opposite charges between them induce a potential difference across attached electrodes, generating an electric current when they are connected through wires. This potential difference diminishes over time. Upon re-contact, the process reverses, creating an opposite potential difference and current. This cycle of contact and separation produces alternating current.
Lateral sliding (LS) mode: This mode operates similarly to the vertical contact-separation mode, but with a key difference: the relative displacement shifts from vertical to horizontal. The alternating current is generated through repeated horizontal displacement.
Single electrode (SE) mode: The simplest in structure, this mode utilizes the ground as an electrode. A potential difference is generated between a metal electrode and the ground through electrostatic induction, thereby inducing current flow.
Freestanding triboelectric layer (FT) mode: In the FT mode, a charged object is placed between two electrodes that are attached to dielectric layers. Movement of the charged object between these electrodes alters the potential difference, resulting in current generation.

3. TENG for Cardiovascular and Respiratory System Real-Time Diagnosis

3.1. Cardiovascular Diagnosis

3.1.1. Blood Pressure and Pulse Diagnosis

In the field of cardiovascular diagnostics, particularly at the point-of-care level, the integration of TENG technology has marked a paradigm shift, especially in blood pressure monitoring techniques. A significant leap in this domain has been the introduction of a cuff-free, self-powered continuous blood pressure monitoring system by Ran et al. [55]. This system is a testament to the innovative application of TENG technology in medical devices. The core of this system is a double sandwich-structured triboelectric sensor, where the thoughtfully engineered composition of the electrode materials not only elevates the system’s sensitivity but also reinforces its structural integrity, ensuring long-term durability. The sensor’s advanced design showcases remarkable adaptability and precision in detecting blood vessel signals. Its high sensitivity, quantified at 0.89 V/kPa, is a clear indicator of its ability to detect minute changes in blood pressure.
Pulse diagnosis stands as a critical component in the realm of cardiovascular health assessment, and the integration of TENG technology has marked a significant evolution in this area. Among the notable advancements, the work of Xu et al. in developing a self-powered sensitive ultra-pulse sensor (SUPS) represents a milestone in enhancing pulse diagnosis capabilities [56]. This innovative SUPS incorporates a nanowire array that is complemented by a melamine sponge layer, which empowers the SUPS with exceptional sensitivity and responsiveness. The device exhibits a remarkable sensitivity of 10.29 nA/kPa, making it highly capable of detecting even the most subtle changes in pulse rhythm. This level of sensitivity is crucial for identifying and monitoring various cardiovascular conditions, such as atrial fibrillation and supraventricular tachycardia, which require precise and continuous pulse monitoring. 

3.1.2. Cardiac Diagnosis

The development of TENG-based cardiac real-time diagnosis represents a significant advancement in the monitoring of heart activity. Utilizing the principles of TENGs, this approach enables the sensing and analysis of various cardiovascular functions. The strength of this technology lies in its modularity, which allows for the creation of devices that are not only compact and flexible but also biocompatible. These attributes greatly enhance the functionality and integration of devices within the cardiac monitoring and treatment landscape.
A prime example of this modularity in action is the self-powered endocardial pressure sensor (SEPS), which has been innovatively designed by Liu et al. [57]. The SEPS is a testament to the effectiveness of modular design, and comprises four distinct layers that collectively offer robust protection against blood and moisture. This design facilitates the real-time monitoring of endocardial pressure, making it a critical tool in cardiac health management and allowing for seamless integration with surgical catheters. This feature is particularly advantageous for minimally invasive implantation, which is a key consideration in modern medical procedures.

3.2. Respiratory System Diagnosis

3.2.1. Respiratory System Diseases Diagnosis

Hypoventilation diagnostics are crucial for detecting respiratory issues, particularly in conditions such as hypoventilation syndrome and asthma. The integration of TENG technology has led to significant advancements in this area, enhancing the capability for accurate and real-time respiratory monitoring.
The advancements in PoCD for respiratory conditions have been significantly enhanced by the development of a wearable medical device by Peng et al. [58], which was tailored specifically for respiratory diseases, including hypoventilation syndrome and asthma. In the work, a modular electronic skin (e-skin) was developed for real-time respiratory monitoring and diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS). This e-skin uses TENG technology and consists of multilayer polyacrylonitrile and polyamide 66 nanofibers, along with gold electrodes. The e-skin is capable of providing energy autonomy and accurate real-time respiration monitoring. Its high-pressure sensitivity, good air permeability, and excellent working stability make it a suitable foundation for a self-powered diagnostic system. This system can detect and evaluate the severity of OSAHS in real time, thereby potentially improving sleep quality. In the context of PoCD, the application of TENG technology in hypoventilation diagnostics marks a significant advancement because they can provide healthcare professionals with immediate and actionable data, enabling prompt intervention in acute respiratory conditions. Their ease of use and non-invasive nature make them ideal for various settings, including home-based care, thereby enhancing patient accessibility to critical health monitoring.

3.2.2. Respiratory Product Detection

In the realm of respiratory product detection, several innovative studies have been conducted, focusing on the sensing of various gases such as carbon dioxide, ammonia, and ethanol, which are crucial indicators of respiratory health and environmental quality.
Zhao et al. have developed a groundbreaking self-powered CO2 gas sensor leveraging the triboelectric nanogenerator (TENG), revolutionizing CO2 detection in the context of the Internet of Things (IoT) [59]. This innovative sensor operates at room temperature and is characterized by its high sensitivity and independence from external power sources. Its working principle is based on the distinctive behavior of gas discharge induced by TENG. Specifically, when CO2 is mixed with N2, the produced negative CO2 ions interfere with plasma formation, thereby increasing the threshold voltage for gas discharge and altering its characteristics. This phenomenon underpins the sensor’s diverse detection modes, including a threshold concentration detection mode in which the discharge ceases at a specific CO2 concentration. The sensor’s capability is further exemplified by its ability to adjust detectable threshold concentrations between 1000 and 200,000 ppm and to utilize step and continuous detection modes for CO2 concentrations below the threshold. Additionally, the sensor showcases unique discharge electrode distances (dmax) for different gases, with CO2, O2, air, and N2 measuring 0.11, 0.28, 0.45, and 0.55 mm, respectively. These features enable the sensor to detect CO2 concentrations with exceptional precision, as demonstrated by the linear increase in discharge current with rising CO2 levels until the threshold concentration is reached, at which point the discharge current drops to zero.

4. TENG for Neuromuscular System Real-Time Diagnosis

4.1. Neurological System Diagnosis

The application of TENGs in neurological system diagnosis marks a significant evolution in medical technology, particularly in PoCD for neurological conditions such as Parkinson’s disease.
Kim et al. focused on creating a highly adaptable and biocompatible TENG using natural biomaterials [60]. Their hydrogel TENG incorporates a unique blend of catechol, chitosan, and diatom to form the hydrogel electrode. The electrode is complemented by an M-shaped Kapton film. This design ensures the device is not only stretchable and self-healing but also sensitive to low-frequency motions, which are crucial indicators in the diagnosis and monitoring of Parkinson’s disease. The ability to capture such subtle movements allows for a detailed understanding of the disease’s progression and the effectiveness of ongoing treatments. The natural composition of the hydrogel also ensures biocompatibility, reducing the risk of adverse reactions when the device is used for extended periods.
On the other hand, Yuce et al. developed a custom-made TENG that is tailored for the specific needs of Parkinson’s disease patients [61]. Their device leverages a combination of a dielectric and aluminum electrodes to create a flexible and sensitive tool for monitoring minute muscular activities and hand movements. This sensitivity is vital for accurately assessing the progression of Parkinson’s disease. The flexible nature of the device ensures that it can be comfortably worn by patients, facilitating long-term monitoring without causing discomfort or hindering daily activities. By tracking these subtle movements, the device provides valuable data that can be used to tailor individual treatment plans and monitor the effectiveness of various therapeutic interventions.
The significance of these TENG-based systems in PoCD lies in their ability to facilitate early detection and continuous monitoring of Parkinson’s disease. By providing real-time data on tremors and muscular movements, these devices aid in the timely adjustment of treatment plans and can potentially slow the progression of the disease.

4.2. Musculoskeletal System Diagnosis

4.2.1. Motion Diagnosis

In the dynamic field of musculoskeletal system diagnostics, the work of Shi et al. stands out as a notable contribution [62]. They developed a biosensor that ingeniously integrates conductive polymers within a TENG framework. This biosensor distinguishes itself through its enhanced performance capabilities, particularly in the high-precision detection of subtle finger movements. Such a feature is invaluable in assessing conditions that impair fine motor skills, making it a critical tool in the realm of point-of-care diagnostics (PoCD). Furthermore, the sensor’s compatibility with wireless technology marks a significant advancement. It enables remote monitoring of patients’ finger movements, providing crucial real-time data for diagnostic and treatment procedures from a distance. This innovative approach aligns perfectly with the objectives of PoCD, offering immediate and accurate patient assessment in various settings.
Building on the innovative advancements in the field of motion diagnosis, the work of yang et al. [63] represents a significant leap forward; their transparent self-powered triboelectric sensor is based on PVA/PA hydrogel. This system, ingeniously crafted for medical nursing human–machine interfaces (HMI), is a testament to the intricate integration of TENG technology in healthcare. The core of this system lies in its tripartite modular design, which encompasses a TENG device that is adept at converting mechanical stimuli into electrical signals; a sophisticated multichannel signal processing unit; and an intuitive user interface module. The TENG device, a marvel of engineering, is strategically designed to be attached to various body joints, making it highly versatile. Its capability to translate even the subtlest of mechanical movements into discernible electrical signals is groundbreaking. The signal processing unit, with its multichannel architecture, meticulously collects, processes, and encodes these signals, ensuring their accuracy and reliability. The user interface module then emerges as the crucial link, providing real-time feedback and assistance, thereby bridging the gap between patients and medical staff in a seamless manner.

4.2.2. Bone Morphology Diagnosis

Bone morphology diagnosis represents an important aspect of musculoskeletal healthcare. The application of TENGs in this field has opened new avenues for the non-invasive and accurate assessment of bone health. TENG technology, as applied in bone morphology diagnostics, utilizes the principle of converting mechanical energy into electrical energy. This conversion enables the detailed analysis of bone structure and composition without the need for invasive procedures. Sensitivity and accuracy are vital for detecting subtle changes in bone morphology, which are often indicators of conditions such as osteoporosis or other bone degenerative diseases.

5. TENG for Sweat and Bacteria Real-Time Diagnosis

5.1. Sweat Sensing

5.1.1. Lactic Acid and Creatinine Detection

The innovative self-powered molecular imprinted polymers-based triboelectric sensor (MIP-TES), designed by Kanokpaka et al., represents a significant advancement in wearable sweat sensors, particularly for lactate detection [64]. This sensor uniquely addresses the challenges previously faced in this field, such as the use of noble materials, dependence on immobile power supplies, and complexities in circuit connections. The MIP-TES offers a multifunctional, non-invasive approach for specific and simultaneous detection of lactate in human sweat. Its functioning is based on a free-standing PVDF/graphene flexible electrode modified with poly(3-aminophenyl boronic acid), which undergoes surface property changes upon lactate adsorption, enabling selective lactate sensing. The integration of this sensor with a triboelectric nanogenerator system allows it to harvest mechanical energy from human movement, converting it into electrical output. This feature is particularly noteworthy as it enables the sensor to power LED lights directly, without external energy sources, indicating lactate concentration levels.
A trailblazing advancement in this arena has been achieved by Gao et al. [65], who have harnessed the innovative capabilities of TENGs to devise a wearable device adept at concurrently monitoring biochemical and electrophysiological signals from human sweat. This device represents a significant leap forward in non-invasive health monitoring, ingeniously amalgamating multiple sensing modalities into a singular, wearable platform. It features a flexible lactate sensor, utilizing an enzyme-based reaction to translate the concentration of lactate in sweat into a proportional electrical signal. This development is pivotal, as fluctuations in lactic acid levels can be indicative of a range of physical states and athletic performance metrics. Enhancing the functionality of the lactate sensor is a wireless potentiostat, which adeptly amplifies and digitizes the signal, thus ensuring accurate, real-time data transmission.

5.1.2. Sweat Electrolyte Analysis

In the realm of wearable health monitoring, Shen et al. have designed an innovative device, known as the Wearable Sweat Monitoring Platform (WSMP), which harnesses the combined capabilities of an Electrowetting on Dielectrics (EWOD) device and a triboelectric nanogenerator (TENG) [66]. This platform is a groundbreaking advancement in sweat analysis, which efficiently analyzes the complex composition of solutes and metabolites in human sweat, thereby providing real-time insights into the wearer’s health status. The WSMP is adept at actively controlling the motion of sweat droplets, enabling precise collection and transport of these droplets across various analysis chambers. This movement is facilitated by the dielectric wetting effect, which allows the droplets to merge and interact with pH indicators, providing valuable health data.
Baro et al. developed a cutting-edge, textile-based, wearable sweat sensor utilizing the principles of triboelectrification, embodied in a single electrode triboelectric nanogenerator (STENG) [67]. This innovation is marked by the integration of chemically synthesized zinc oxide (ZnO) nanorods on a textile substrate, enabling dual functionality as both a motion sensor activated by biomechanical movements, and a sweat sensor that is sensitive to variations in saline water concentration. The STENG’s efficacy is heightened by the attachment of hydrated chloride ions from saline water to physisorbed water molecules on ZnO, enhancing the electron count in ZnO’s conduction band, thus boosting charge transfer and output voltage. A miniaturized prototype of this STENG, approximately 1 cm in diameter, demonstrates remarkable efficiency in detecting sweat when attached to the human body; it has a sensitivity of about 0.02 V/μL and a detection limit near 4.8 μL. Notably, when this prototype is integrated into a shoe insole it can detect sweat during foot movement. The study also explores the STENG’s optimization, particularly its active triboelectric layer, with ZnO nanorods strategically placed on a cotton base and various materials such as aluminum, nitrile, PET, and PTFE being tested for the counter triboelectric layer. The choice of PTFE-ZnO stands out for generating superior output voltage. This refined STENG exhibits an amplified output in contact with saline water, which is linked to an increase in n-type conductivity in ZnO.

5.2. Bacteria Diagnosis and Sterilization

5.2.1. Bacteria Diagnosis

In the field of PoCD, especially in the detection of bacterial infections caused by Gram-positive bacteria, the introduction of TENG technology has brought about significant advancements. A particularly noteworthy development is the research by Wang et al., who engineered a TENG-based biosensing system that is adept at detecting Gram-positive bacteria in liquid mediums [68]. This system is ingeniously designed, featuring a blend of polyamine and vancomycin, skillfully immobilized on the surface of indium tin oxide (ITO) glass. It employs guanidine-functionalized multi-wall carbon nanotubes (CNT Arg) as potent signal amplification materials. The distinctive aspect of this system lies in its ability to specifically target and identify Gram-positive bacteria in a solution through measuring voltage changes in the biosensor. This innovation not only signifies a leap forward in clinical diagnostics of bacterial infections but also showcases its potential for environmental monitoring, underscoring its versatility and practical applicability.

5.2.2. Sterilization

The concept of a self-powered sterilization system is a response to the limitations of traditional sterilization methods, which often require external power sources or chemicals. These newer technologies leverage the principles of TENGs, which convert mechanical energy into electricity, thus providing a sustainable and portable solution for sterilization. This is particularly relevant in the context of wearable electronics, where prolonged contact with the skin can lead to bacterial growth and skin infections.
In the realm of wearable electronics, Lei et al. have pioneered a groundbreaking, self-powered sterilization system designed to address the growing concern of skin infections caused by prolonged wearing of electronic devices [69]. This innovative solution hinges on a nano/microporous fiber triboelectric nanogenerator (NMF-TENG) that serves as a sustainable energy source, coupled with an interdigital electrode enhanced by silver nanowires (AgNWs) and carbon nanotubes (CNT) for superior bactericidal efficacy. The unique design of the indium tin oxide (ITO)-based electrode significantly amplifies the local electric field to an impressive 1 MV/m, which is potent enough to eradicate bacteria. This system boasts an impressive sterilization rate of up to 90%, underscoring its potential to revolutionize the sterilization aspect of wearable technology. The creation process involves a meticulous two-component electrospinning technique, yielding a robust and flexible PA66/EC nanofiber composite film that enhances the frictional contact area of the NMF-TENG, thereby generating a higher surface charge density. This results in an impressive output of 302 V and 0.4 μA at a low-frequency motion of 1 Hz, ensuring a reliable power supply for the device. 

6. Conclusions

Firstly, the choice and durability of materials are major limiting factors in the application of TENGs. The materials currently used may encounter issues such as high costs, sourcing difficulties, or environmental impacts. Additionally, the variability in environmental conditions such as temperature, humidity, and atmospheric pressure could lead to inconsistent energy outputs from TENGs. The wear and tear of materials due to continuous friction also affects the efficiency and lifespan of TENGs. Despite the challenges, the prospects for TENGs in the field of medical diagnostics remain promising. Future research should focus on addressing these challenges, to harness the significant potential of TENGs to provide sustainable and efficient energy solutions, especially in resource-limited settings.

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