Fabrication, characterization and applications of graphene electronic tattoos.

Numerous fields of science and technology, including healthcare, robotics and bioelectronics, have begun to switch their research direction from developing 'high-end, high-cost' tools towards 'high-end, low-cost' solutions. Graphene electronic tattoos (GETs), whose fabrication protocol is discussed in this work, are ideal building blocks of future wearable technology due to their outstanding electromechanical properties. The GETs are composed of high-quality, large-scale graphene that is transferred onto tattoo paper, resulting in an electronic device that is applied onto skin like a temporary tattoo. Here, we provide a comprehensive GET fabrication protocol, starting from graphene growth and ending with integration onto human skin. The methodology presented is unique since it utilizes high-quality electronic-grade graphene, while the processing is done by using low-cost and off-the-shelf methods, such as a mechanical cutter plotter. The GETs can be either used in combination with advanced scientific equipment to perform precision experiments, or with low-cost electrophysiology boards, to conduct similar operations from home. In this protocol, we showcase how GETs can be applied onto the human body and how they can be used to obtain a variety of biopotentials, including electroencephalogram (brain waves), electrocardiogram (heart activity), electromyogram (muscle activity), as well as monitoring of body temperature and hydration. With graphene available from commercial sources, the whole protocol consumes ~3 h of labor and does not require highly trained personnel. The protocol described in this work can be readily replicated in simple laboratories, including high school facilities.

Small-Dose Endoscopic Tattooing Using a Novel Needle for Localization Prior to Laparoscopic Surgery of Colorectal Cancer.

BACKGROUNDS: Endoscopic tattooing failure by deep mural injection or tattoo leakage-induced massive staining causes localization errors or decreased laparoscopic visualization. To overcome these, we developed a novel tattoo needle with comparatively shorter needle (length, 2.5 mm) and minimal-caliber catheter (volume, 0.3 mL). AIMS: The single-center, prospective observational study aimed to determine the efficacy and safety of a small-doze endoscopic tattooing prior to laparoscopic surgery for colorectal cancer, using the needle. METHODS: Patients with colorectal cancer indicated for laparoscopic surgery were recruited. With the novel needle, a single tattoo was created at the anterior wall close to the lesion. During laparoscopic surgery, surgeons assessed the tattoo visibility, tattoo leakage, and the disturbance of laparoscopic view by tattoo leakage. The primary endpoint was an accurate localization by visible tattoo. Secondary endpoints were adverse events related to tattooing, the need for intraoperative endoscopy, and tattoo leakage. RESULTS: A total of 383 tattoos in 358 patients were analyzed. Accurate tumor localization rate was 96.6% (95% confidence interval [CI]: 94.3-98.0%). No adverse events occurred. Intraoperative colonoscopy was performed in 7 (1.8%) patients with invisible tattoo. Tattoo leakage was found in 4.2% (95%CI: 2.6-6.7%), and leakage disturbed the laparoscopic view of the surgical plane in 0.7% (95%CI: 0.3-2.3%). CONCLUSIONS: Prior to laparoscopic surgery for colorectal cancer, our endoscopic tattooing with a standardized protocol using a novel needle is considered a simple, highly reliable localization technique with an extremely safe profile, which would be valuable to reduce physician's efforts and redundant medical resources. Trial registration number UMIN000021012. Date of registration: June 2016.

Micropigmentation for vitiligo on light to moderately colored skin: Updated evidence from a clinical and animal study.

Micropigmentation, also termed medical tattooing, can be a useful alternative treatment for patients with vitiligo who are resistant to conventional treatments. To assess the benefits and risks of micropigmentation in the treatment of refractory vitiligo, 25 lesions of 14 patients with vitiligo (Fitzpatrick skin types III and IV) were subjected to micropigmentation using an electric tattooing machine between December 2018 and March 2019. The procedure was repeated until satisfactory results were obtained. Treatment response was assessed by color matching of the treated lesion and surrounding skin using a 4-point scale (poor, fair, good and excellent). Excellent color matching was achieved in 80% (20/25) of cases after a median of three (range, 1-5) treatment sessions. Procedure-associated pain was considerable, but no anesthetic injection was needed. Immediate erythema and swelling were noticed after each procedure, but resolved within a few days. Overall, the treatment was tolerable. This study was limited by a small sample, no control group and a short follow-up period. This study revealed that micropigmentation was beneficial for patients with refractory vitiligo who had light to moderately colored skin. Pigment selection, implantation depth and selection of body parts amenable to treatment were critical.

Silver nanowire inks for direct-write electronic tattoo applications.

Room-temperature printing of conductive traces has the potential to facilitate the direct writing of electronic tattoos and other medical devices onto biological tissue, such as human skin. However, in order to achieve sufficient electrical performance, the vast majority of conductive inks require biologically harmful post-processing techniques. In addition, most printed conductive traces will degrade with bending stresses that occur from everyday movement. In this work, water-based inks consisting of high aspect ratio silver nanowires are shown to enable the printing of conductive traces at low temperatures and without harmful post-processing. Moreover, the traces produced from these inks retain high electrical performance, even while undergoing up to 50% bending strain and cyclic bending strain over a thousand bending cycles. This ink has a rapid dry time of less than 2 minutes, which is imperative for applications requiring the direct writing of electronics on sensitive surfaces. Demonstrations of conductive traces printed onto soft, nonplanar materials, including an apple and a human finger, highlight the utility of these new silver nanowire inks. These mechanically robust films are ideally suited for printing directly on biological substrates and may find potential applications in the direct-write printing of electronic tattoos and other biomedical devices.

How much medication is delivered in a novel drug delivery technique that uses a tattoo machine?

BACKGROUND: Even though dermatologists often perform drug delivery procedures, it is necessary to assess their safety. OBJECTIVE: Quantify the amount of medication delivered using the MMP drug delivery technique and outline other safety parameters. METHODS: Using a simple and novel technique, we attempted to quantify the amount of medication delivered by weighing human skin samples before and after delivery. RESULTS: In drug delivery done on human skin using a liquid with a density of 1,271,460 µg/ml (the values expressed in this manuscript are in µg), a needling density of 570 perforations/cm2 , and a needling depth of 300 microns, we estimate that 1,175 µg/cm2 were delivered (standard deviation 601 µg/cm2 , standard error 190 µg/cm2 ). LIMITATIONS: This result is only applicable to the protocol proposed in this study for the MMP drug delivery technique. CONCLUSION: The MMP drug delivery technique injects small amounts of medication (1,175 µg/cm2 ) homogeneously into the dermis.

Home monitoring of sleep with a temporary-tattoo EEG, EOG and EMG electrode array: a feasibility study.

OBJECTIVE: Circadian and sleep dysfunction have long been symptomatic hallmarks of a variety of devastating neurodegenerative conditions. The gold standard for sleep monitoring is overnight sleep in a polysomnography (PSG) laboratory. However, this method has several limitations such as availability, cost and being labour-intensive. In recent years there has been a heightened interest in home-based sleep monitoring via wearable sensors. Our objective was to demonstrate the use of printed electrode technology as a novel platform for sleep monitoring. APPROACH: Printed electrode arrays offer exciting opportunities in the realm of wearable electrophysiology. In particular, soft electrodes can conform neatly to the wearer's skin, allowing user convenience and stable recordings. As such, soft skin-adhesive non-gel-based electrodes offer a unique opportunity to combine electroencephalography (EEG), electromyography (EMG), electrooculography (EOG) and facial EMG capabilities to capture neural and motor functions in comfortable non-laboratory settings. In this investigation temporary-tattoo dry electrode system for sleep staging analysis was designed, implemented and tested. MAIN RESULTS: EMG, EOG and EEG were successfully recorded using a wireless system. Stable recordings were achieved both at a hospital environment and a home setting. Sleep monitoring during a 6 h session shows clear differentiation of sleep stages. SIGNIFICANCE: The new system has great potential in monitoring sleep disorders in the home environment. Specifically, it may allow the identification of disorders associated with neurological disorders such as rapid eye movement (REM) sleep behavior disorder.

Las reacciones alérgicas frente a las tintas de los tatuajes, un nuevo reto diagnóstico / Allergic Reactions to Tattoo Inks: A New Diagnostic Challenge

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Tatuagem associada ao retalho em C-V para reconstrução do complexo areolopapilar em tempo único / Tattooing associated with C-V flap placement in one-stage reconstruction of the nipple-areola complex

Introdução: A reconstrução do complexo areolopapilar (CAP) é etapa fundamental no tratamento do câncer de mama. Tipicamente, é realizada em dois tempos distintos, sendo primeiro a papila reconstruída e somente após sua completa cicatrização que a tatuagem é realizada. Métodos: Estudo retrospectivo realizado no período de 2015 a 2016 no Hospital São Lucas da PUCRS. Foram incluídas 21 pacientes com ausência do CAP unilateral. É descrita a técnica de reconstrução da papila com retalho local em C-V associado à tatuagem para pigmentação do CAP em tempo único. Foram apresentados os dados referentes ao tipo de reconstrução mamária realizada, às complicações e à presença de radioterapia prévia. Resultados: A maioria das pacientes foi reconstruída com implante (48%). Houve três complicações relacionadas à papila (14%), uma necrose parcial e duas deiscências pequenas. Não houve complicação relacionada à tatuagem. Onze pacientes (52%) haviam realizado radioterapia prévia na mama. Conclusão: A tatuagem associada ao retalho em C-V em tempo único é uma técnica simples e com baixo índice de complicações.

Introduction: Reconstruction of the nipple-areola complex (NAC) is a fundamental step in the treatment of breast cancer. It is usually performed in two distinct stages. Tattooing is performed only after reconstruction and complete scarring of the nipple. Methods: This retrospective study was conducted from 2015 to 2016 at the Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul. Twenty-one patients with a single NAC were included. One-stage reconstruction of the nipple using a local C-V flap associated with tattooing for pigmentation of the NAC is described. Data on the type of breast reconstruction performed, associated complications, and presence of previous breast radiotherapy were presented. Results: Most patients (48%) underwent reconstruction with an implant. Three complications (14%) were observed in the nipple, including one case of partial necrosis and two cases of small dehiscence. None of the patients had complications due to tattooing. Eleven patients (52%) underwent breast radiotherapy previously. Conclusion: Tattooing combined with one-stage reconstruction using a C-V flap is a simple technique with a low rate of complication.

From Technique of Tattooing to Biokinetics and Toxicology of Injected Tattoo Ink Particles and Chemicals.

Tattoo colourants are colourful nano- and microparticles, which are practically insoluble and thus permanent once installed in the dermis by the tattooist. Tattoo ink also has soluble ingredients and contaminants. Pigments can distribute via the lymph and possibly also directly to the blood, and a minute fraction may over time undergo metabolic breakdown and as hapten(s) induce allergic reactions of red tattoos. Carbon black of black tattoos has a tendency to agglomerate and form larger bodies that can elicit foreign body reactions in black tattoos and even granuloma formation with overlap to sarcoidosis in the clinic. Very little is known about the biokinetics and safety profile of the many tattoo pigments in use, and no specific pigment-related chemical of tattoo ink causing identified adverse reactions in humans has been depicted. Inks have many ingredients and contaminants. Insoluble and soluble ingredients of inks supposedly have very different characteristics of absorption, distribution, metabolism, and excretion, with pigments being extremely slowly excreted, contrasting soluble ingredients with fast elimination. Tattoos are a single-dose exposure. Controlling the safety of tattoo inks by banning potentially critical chemicals hitherto has been unsuccessful due to lacking documentation of clinical and epidemiological relevance and because the tattoo industry is already internationally established, free, and in the ownership of the people. Doctors treating patients with tattoo complications consequently have a key role in identifying risk situations and local outbreaks, which needs clarification, therapy, and the intervention of authorities. In the treatment of complications, as seen in general practice and in other specialties, basic insight into the fate of tattoo pigments in the body is necessary. Tattoo complications are complicated and facetted with many entities and disease mechanisms; they are a new subspecialty in medicine and dermatology.

Adenopatía pigmentada por tinta de tatuaje como hallazgo accidental en cirugía de mama. Caso clínico / Pigmented adenopathy by tattoo ink as an accidental finding in breast surgery. Case report

Damos a conocer el hallazgo de una adenopatía axilar pigmentada durante la realización de una mastectomía bilateral profiláctica en una paciente de 35 años. El estudio anatomopatológico reveló pigmento compatible con tinta en el interior del ganglio. Esto, junto con la presencia de un tatuaje próximo a la axila de la paciente, permitió identificar el tatuaje como causa de la coloración de la adenopatía. Discutimos el diagnóstico diferencial a realizar en casos similares. Hasta un tercio de la población joven en España se ha realizado algún tatuaje, y las series de autopsias muestran la alta incidencia de presencia de pigmento en ganglios próximos a esos tatuajes. Creemos necesario realizar un correcto diagnóstico diferencial con melanoma y otras etiologías en pacientes tatuados para llevar a cabo una adecuada indicación quirúrgica (AU)

We report the finding of an axillary pigmented adenopathy during a bilateral profilactic mastectomy in a 35- year-old patient. The anatomopathologycal analysis revealed pigmentation compatible with ink inside the lymphatic node. The presence of a tattoo close to the axillary region of the patient made us identify the tattoo as the cause of the adenopathy coloration. We discuss the differential diagnosis to be considered in this cases. Around one third of the spanish population wears a tattoo, and series of autopsies show an elevated incidence of the presence of pigment in nodes adjacent to tattoos. The correct differential diagnosis with melanoma and other etiologies in tattooed patients is necessary to establish an adequate surgical indication (AU)

Tattoo machines, needles and utilities.

Starting out as a professional tattooist back in 1977 in Copenhagen, Denmark, Frank Rosenkilde has personally experienced the remarkable development of tattoo machines, needles and utilities: all the way from home-made equipment to industrial products of substantially improved quality. Machines can be constructed like the traditional dual-coil and single-coil machines or can be e-coil, rotary and hybrid machines, with the more convenient and precise rotary machines being the recent trend. This development has resulted in disposable needles and utilities. Newer machines are more easily kept clean and protected with foil to prevent crosscontaminations and infections. The machines and the tattooists' knowledge and awareness about prevention of infection have developed hand-in-hand. For decades, Frank Rosenkilde has been collecting tattoo machines. Part of his collection is presented here, supplemented by his personal notes.

The technique and craftsmanship of tattooing in the professional tattoo parlour.

This chapter will briefly explain the tools and techniques behind a good tattoo. Beside the fact that the professional tattoo artist needs to have talent for composing and drawing motives - the artistic part of his or her profession - the technical side of the process must also be mastered to make great tattoos. The craftsmanship behind the art.

Survey of studies on microbial contamination of marketed tattoo inks.

Tattooing became a popular phenomenon during the late twentieth century. Because the act of tattooing involves repeated injection of ink through the skin, a risk of contracting infections from contaminated tattooing equipment and ink and the surrounding environment exists. Progress has been made in infection control strategies; however, contraction of bacterial and viral infections from tattooing continues to occur. The risk of acquiring a tattoo-related infection largely depends on the hygiene conditions under which the tattoo is applied. Nevertheless, even when adequate hygiene and sanitation measures are taken, the inks themselves may contain infectious microorganisms that are able to survive under hostile conditions, such as in inks. The results of the few studies on the microbiological quality of unopened and opened tattoo inks are reported. Some authors' conclusions demonstrated that the current ink sterilisation systems show a low capability to inactivate microbial contamination in tattoo inks. At the moment, European Resolution ResAP2008-1 recommends that the ink be sterile and supplied in containers that maintain the sterility of the product until application. In light of the outcomes of published studies, at the moment, preservation of the microbial quality and safety of ink seems challenging and still difficult to reach.

The Amsterdam model for control of tattoo parlours and businesses.

In the early 1980s, an outbreak of hepatitis B in Amsterdam stood at the start of the development of the first hygiene guidelines for tattooists in The Netherlands. Ever since, infection control in tattoo practice has continued to prove its importance as tattoo-related outbreaks of infectious diseases have continued to be reported in Europe. Furthermore, the act of tattooing includes breaking the skin barrier but is performed by professionals who are not medically trained. The Ministry of Health has now implemented uniform regulations that apply to professionals who perform tattooing and apply permanent make-up. These regulations include hygiene guidelines that were developed by the National Institute for Public Health and the Environment in cooperation with representatives of the tattooing associations. The guidelines contain a list of requirements, including for the studio interior, the cleanness of the studio, the safe use of permitted equipment and products, sterilization methods, and the information provided to the customer. A permit may be granted after an inspection by the local health service, during which the act of tattooing has to be performed. It is now estimated that over 95% of all tattoos in The Netherlands were obtained at one of the almost 900 licensed studios. Reports of complications are generally low in number. We suggest that uniform European hygiene guidelines would further contribute to the safety of tattooing.