Tactile sensing is required for the dexterous manipulation of objects in robotic applications. In particular, the ability to measure and distinguish in real time normal and shear forces is crucial for slip detection and interaction with fragile objects. Here, we report a biomimetic soft electronic skin (e-skin) that is composed of an array of capacitors and capable of measuring and discriminating in real time both normal and tangential forces. It is enabled by a three-dimensional structure that mimics the interlocked dermis-epidermis interface in human skin. Moreover, pyramid microstructures arranged along nature-inspired phyllotaxis spirals resulted in an e-skin with increased sensitivity, minimal hysteresis, excellent cycling stability, and response time in the millisecond range. The e-skin provided sensing feedback for controlling a robot arm in various tasks, illustrating its potential application in robotics with tactile feedback.

https://robotics.sciencemag.org/content/robotics/3/24/eaau6914.full-text.pdf

A hierarchically patterned, bioinspired e-skin able to detect the direction of applied pressure for robotics.

With the development of information technology, the concept of smart healthcare has gradually come to the fore. Smart healthcare uses a new generation of information technologies, such as the internet of things (loT), big data, cloud computing, and artificial intelligence, to transform the traditional medical system in an all-round way, making healthcare more efficient, more convenient, and more personalized. With the aim of introducing the concept of smart healthcare, in this review, we first list the key technologies that support smart healthcare and introduce the current status of smart healthcare in several important fields. Then we expound the existing problems with smart healthcare and try to propose solutions to them. Finally, we look ahead and evaluate the future prospects of smart healthcare.

Smart healthcare: making medical care more intelligent

Background: Artificial intelligence (AI) is a rapidly developing computer technology that has begun to be widely used in the medical field to improve the professional level and efficiency of clinical work, in addition to avoiding medical errors. In developing countries, the inequality between urban and rural health services is a serious problem, of which the shortage of qualified healthcare providers is the major cause of the unavailability and low quality of healthcare in rural areas. Some studies have shown that the application of computer-assisted or AI medical techniques could improve healthcare outcomes in rural areas of developing countries. Therefore, the development of suitable medical AI technology for rural areas is worth discussing and probing. Methods: This article reviews and discusses the literature concerning the prospects of medical AI technology, the inequity of healthcare, and the application of computer-assisted or AI medical techniques in rural areas of developing countries. Results: Medical AI technology not only could improve physicians' efficiency and quality of medical services, but other health workers could also be trained to use this technique to compensate for the lack of physicians, thereby improving the availability of healthcare access and medical service quality. This article proposes a multilevel medical AI service network, including a frontline medical AI system (basic level), regional medical AI support centers (middle levels), and a national medical AI development center (top level). Conclusion: The promotion of medical AI technology in rural areas of developing countries might be one means of alleviating the inequality between urban and rural health services. The establishment of a multilevel medical AI service network system may be a solution.

The Application of Medical Artificial Intelligence Technology in Rural Areas of Developing Countries.

Challenges of continuum robots in clinical context: a review

The emerging capability to 3D print a diverse palette of functional inks will enable the mass democratization of patient-specific wearable devices and smart biomedical implants for applications such as health monitoring and regenerative biomedicines. These personalized wearables could be fabricated via ex situ printing, which involves first printing a design on a planar substrate and then deploying it to the target surface. However, this can result in a geometrically and dynamically mismatched interface between printed materials and target surfaces. In situ printing provides a potential remedy by directly printing 3D constructs on the target surfaces. This new manufacturing procedure requires the assistance of artificial intelligence (AI) to sense, adapt and predict the state of the printing environment, such as a dynamically morphing organ. In this Review, we discuss electronic and biological inks for in situ 3D printing, AI-empowered 3D-printing approaches with open-loop, closed-loop and predictive control, and recent developments in surgical robotics and AI that could be integrated in future 3D-printing approaches. We anticipate that this convergence of AI, 3D printing, functional materials and personalized biomedical devices will lead to a compelling future for smart manufacturing. Artificial intelligence can be used to facilitate the 3D printing of functional materials and devices directly on target surfaces, such as human bodies. This Review surveys ex situ and in situ artificial-intelligence-assisted 3D printing of multifunctional materials and its combination with surgical robots to enable autonomous medical care and smart biomanufacturing.

3D-printed multifunctional materials enabled by artificial-intelligence-assisted fabrication technologies

The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development. This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described. A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot. The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.

Review of emerging surgical robotic technology

Purpose
Studies comparing laparoscopic (LIHR) vs. open inguinal hernia repair (OIHR) have shown similar recurrence rates but have disagreed on perioperative outcomes and costs. The aim of this study is to compare laparoscopic vs. open outcomes and costs.

Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair

Background Commercially available microbubbles such as Definity contain octafluoropropane encapsulated in a lipid shell. This perfluorocarbon can be compressed into liquid nanodroplets at room temperatures and activated with transthoracic diagnostic ultrasound. The aim of this study was to determine the size range and acoustic characteristics of Definity nanodroplets (DNDs) compared with Definity microbubbles (DMBs). Methods An in vitro flow system was used with a diagnostic ultrasound transducer (S5-1, iE33). DMBs were prepared using package insert instructions. DNDs were prepared by cooling DMBs in a −10°C to −15°C isopropyl alcohol bath before hand-pressurizing the solution. The formed DNDs were sized, diluted to 1% solutions, and infused continuously into a phosphate-buffered saline solution running within Silastic tubing. Acoustic intensity (AI) was compared with equivalent dilutions of DMBs at different mechanical indices (MIs) ranging from 0.2 to 1.4 ( n  = 6 comparisons at each MI) using real-time 56-Hz and triggered 2-Hz frame rates (FRs). A 3-cm-thick tissue-mimicking phantom was used to simulate transthoracic attenuation. In vivo transthoracic studies were performed in four normal pigs infused with 10% intravenous infusions of DMBs or DNDs at real-time and triggered end-systolic FRs to compare differences in myocardial and left ventricular cavity AI. Results DNDs were smaller than DMBs and ranged in size from 50 to 1,000 nm. In vitro studies revealed that at an MI of 0.2 and an FR of 56 Hz, DMBs had high AI (37 ± 2 dB), but AI dropped to 25 ± 2 dB at an MI of 1.0 ( P P Conclusion These data indicate significant differences in acoustic responses of the commercially available DMBs when administered as an equivalent number of DNDs. The DND formulation may render them more useful for high-MI real-time imaging and other targeted transthoracic diagnostic applications.

Acoustic Behavior of a Reactivated, Commercially Available Ultrasound Contrast Agent

We investigate the feasibility of estimating the total energy expenditure (TEE) of a human for walking/running activities with micro-Doppler signatures. Doppler radar can capture micro-Doppler signatures produced from limb motions when a human moves. As the micro-Doppler signatures contain information regarding limb movement, TEE can be estimated by analyzing the Doppler spectrogram. To understand the relationship between the TEE and micro-Doppler signatures, basic arm and leg motions are measured by the Doppler radar, whereas a respiratory gas analyzer measures the volume of exchanged respiratory gas (O2 and CO2) to obtain a reference TEE. The area of micro-Doppler signatures in a spectrogram has been suggested to serve as key information to estimate TEE. For the verification of the suggested approach, TEE was measured for seven human subjects, who performed walking and running activities on a treadmill at five different speeds using both the Doppler radar and the respiratory gas analyzer. We confirm that strong correlations exist between the micro-Doppler area and the TEE. Finally, a regression model for walking and running activities is developed for a person. Then, the model calculates the TEE under two scenarios, and we find that the estimation errors are 13.2% and 12.3%.

Application of Micro-Doppler Signatures for Estimation of Total Energy Expenditure in Humans for Walking/Running Activities

Background Microbubbles (MB) can be compressed to nanometer-sized droplets and reactivated with diagnostic ultrasound; these reactivated MB possess unique imaging characteristics. Objective We hypothesized that droplets formed from compressing Definity MB may be used for infarct-enhancement imaging. Methods Fourteen rats underwent ligation of their left anterior descending (LAD) artery, and five pigs underwent 90 minute balloon occlusions of their mid LAD. At 48 hours in rats, transthoracic ultrasound was performed at two and four minutes following 200 μL intravenous injections (IVI) of Definity droplets (DD), at which point the MI was increased from 0.5 to 1.5 to assess for a transient contrast enhancement zone (TEZ) within akinetic segments. In pigs, 1.0 mL injections of DD were administered and low frame rate (triggered end systolic or 10 Hz) imaging 2–4 minutes post iVI to selectively activate and image the infarct zone (IZ). Infarct size was defined by delayed enhancement magnetic resonance imaging (DE-MRI) and post-mortem staining (TTC). Results Increasing MI to 1.5 (at two or four minutes after IVI) resulted in a TEZ in rats, which correlated with infarct size (r = 0.94, p<0.001). A TEZ was not seen at 2–4 minutes in any rat (n = 8) following Definity MB injections. Fluorescent staining confirmed DD presence within the infarct zone 10 minutes after intravenous injection. In pigs, selective enhancement within the IZ was achieved by using a low frame rate single pulse harmonic mode; IZ size matched the location seen with DE-MRI and correlated with TTC defect size (r = 0.90, p<0.05). Conclusion DD formulated from commercially available MB can be acoustically activated for selective infarct enhancement imaging.

/pdf/selective-infarct-zone-imaging-with-intravenous-acoustically-4m9n89xt0d.pdf

Songita A. Choudhury

Papers

Review of emerging surgical robotic technology

Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair

Acoustic Behavior of a Reactivated, Commercially Available Ultrasound Contrast Agent

Application of Micro-Doppler Signatures for Estimation of Total Energy Expenditure in Humans for Walking/Running Activities

Selective infarct zone imaging with intravenous acoustically activated droplets