Optical imaging techniques for point-of-care diagnostics

Metasurfaces-based imaging and applications: from miniaturized optical components to functional imaging platforms

This review focuses on the imaging applications of metasurfaces. These optical elements provide a unique platform to control light; not only do they have a reduced size and complexity compared to conventional imaging systems but they also enable novel imaging modalities, such as functional-imaging techniques. This review highlights the development of metalenses, from their basic principles, to the achievement of achromatic and tunable lenses, and metasurfaces implemented in functional optical imaging applications.

3D-printable portable open-source platform for low-cost lens-less holographic cellular imaging

Digital holographic microscopy is an emerging, potentially low-cost alternative to conventional light microscopy for micro-object imaging on earth, underwater and in space. Immediate access to micron-scale objects however requires a well-balanced system design and sophisticated reconstruction algorithms, that are commercially available, however not accessible cost-efficiently. Here, we present an open-source implementation of a lens-less digital inline holographic microscope platform, based on off-the-shelf optical, electronic and mechanical components, costing less than $190. It employs a Blu-Ray semiconductor-laser-pickup or a light-emitting-diode, a pinhole, a 3D-printed housing consisting of 3 parts and a single-board portable computer and camera with an open-source implementation of the Fresnel-Kirchhoff routine. We demonstrate 1.55 μm spatial resolution by laser-pickup and 3.91 μm by the light-emitting-diode source. The housing and mechanical components are 3D printed. Both printer and reconstruction software source codes are open. The light-weight microscope allows to image label-free micro-spheres of 6.5 μm diameter, human red-blood-cells of about 8 μm diameter as well as fast-growing plant Nicotiana-tabacum-BY-2 suspension cells with 50 μm sizes. The imaging capability is validated by imaging-contrast quantification involving a standardized test target. The presented 3D-printable portable open-source platform represents a fully-open design, low-cost modular and versatile imaging-solution for use in high- and low-resource areas of the world.

Dark-Field Microwells toward High-Throughput Direct miRNA Sensing with Gold Nanoparticles

MicroRNA (miRNA) is a class of short RNA that is emerging as an ideal biomarker, as its expression level has been found to correlate with different types of diseases including diabetes and cancer. The detection of miRNA is highly beneficial for early diagnostics and disease monitoring. However, miRNA sensing remains difficult because of its small size and low expression levels. Common techniques such as quantitative real-time polymerase chain reaction (qRT-PCR), in situ hybridization and Northern blotting have been developed to quantify miRNA in a given sample. Nevertheless, these methods face common challenges in point-of-care practice as they either require complicated sample handling and expensive equipment, or suffer from low sensitivity. Here we present a new tool based on dark-field microwells to overcome these challenges in miRNA sensing. This miniaturized device enables the readout of a gold nanoparticle assay without the need of a dark-field microscope. We demonstrate the feasibility of the dark-field microwells to detect miRNA in both buffer solution and cell lysate. The dark-field microwells allow affordable miRNA sensing at a high throughput which make them a promising tool for point-of-care diagnostics.

Towards Lateral Flow Quantitative Assays: Detection Approaches

Point-of-care (POC) or bedside analysis is a global trend in modern diagnostics. Progress in POC testing has largely been provided by advanced manufacturing technology for lateral flow (immunochromatographic) test strips. They are widely used to rapidly and easily control a variety of biomarkers of infectious diseases and metabolic and functional disorders, as well as in consumer protection and environmental monitoring. However, traditional lateral flow tests rely on visual assessment and qualitative conclusion, which limit the objectivity and information output of the assays. Therefore, there is a need for approaches that retain the advantages of lateral flow assays and provide reliable quantitative information about the content of a target compound in a sample mixture. This review describes the main options for detecting, processing, and interpreting immunochromatographic analysis results. The possibilities of modern portable detectors that register colored, fluorescent, magnetic, and conductive labels are discussed. Prospects for further development in this direction are also examined.

Microfluidic radiobioassays: a radiometric detection tool for understanding cellular physiology and pharmacokinetics

The investigation of molecular uptake and its kinetics in cells is valuable for understanding the cellular physiological status, the observation of drug interventions, and the development of imaging agents and pharmaceuticals. Microfluidic radiobioassays, or microfluidic radiometric bioassays, constitute a radiometric imaging-on-a-chip technology for the assay of biological samples using radiotracers. From 2006 to date, microfluidic radiobioassays have shown advantages in many applications, including radiotracer characterization, enzyme activity radiobioassays, fast drug evaluation, single-cell imaging, facilitation of dynamic positron emission tomography (PET) imaging, and cellular pharmacokinetics (PK)/pharmacodynamics (PD) studies. These advantages lie in the minimized and integrated detection scheme, allowing real-time tracking of dynamic uptake, high sensitivity radiotracer imaging, and quantitative interpretation of imaging results. In this review, the basics of radiotracers, various radiometric detection methods, and applications of microfluidic radiobioassays will be introduced and summarized, and the potential applications and future directions of microfluidic radiobioassays will be forecasted.

Lighting Up Biosensors: Now and the Decade To Come

Optical biosensors are defined as portable optical devices that use biorecognition molecules to interrogate a sample for the presence of a target. The capabilities of optical biosensors have expanded rapidly with advances in miniature optical components and molecular engineering. Biosensors to meet the needs in health and environmental monitoring and food safety have become commercially available, with many more in the pipeline. We review the innovative approaches to overcoming existing hurdles to practical biosensor designs and explore potential areas for future breakthroughs in optical biosensor technology.

A nanoneedle-based reactional wettability variation sensor array for on-site detection of metal ions with a smartphone

An enhancement of the reactional wettability variation (RWV) sensing strategy is achieved based on the wettability switch of a nanoneedle surface. The sensor unit is formed by coating hydrophobic azoimidazole compounds, as the responder compounds onto the originally hydrophilic surface of cobalt hydroxide nanoneedles. The complexation reaction between metal ions and azoimidazole ligands etches the hydrophobic coating and switches the surface wettability, making the surface hydrophilic again. This switch is revealed by a decrease in the static contact angle (CA) and an increase in the sliding angle of the surface. The reactivity is tuned by the derivatization and conformational manipulation of the azoimidazole compounds. A sensor array composed of six as-tuned sensor units is constructed to distinguish among the species and concentrations of Fe³⁺, Ni²⁺ and La³⁺ at a low limit of 10^-6 M using the chemometric method of principal component analysis (PCA). In addition, a new on-site detection strategy is developed based on PCA of the sliding angle, which can be measured conveniently and swiftly with a smartphone app and a commercially available setup. The application of the general RWV strategy is envisioned to open new possibilities for on-site detection.

Lateral and Vertical Flow Assays for Point-of-Care Diagnostics

Lateral flow assays (LFAs) have been the pillar of rapid point-of-care (POC) diagnostics due to their simplicity, rapid process, and low cost. Recent advances in sensitivity, selectivity, and chemical stability enhancement have ensured the foothold of LFAs in commercial POC diagnostics. This paper reviews recent developments in labeling strategies and detection methods of LFAs. Moreover, vertical flow assays (VFAs) have emerged as an alternate paper-based assay due to faster detection time and unique multiplexing capabilities. Smartphones as LFA readers have been transformed into a universal integrated platform for imaging, data processing, and storage, providing quantitative results in low-resource settings. Commercial LFAs and VFAs products are evaluated with regards to their performance, market trends, and regulatory issues. The future outlook of the flow-based assays for POC diagnostics is also discussed.

Micro-optical Components for Bioimaging on Tissues, Cells and Subcellular Structures

Bioimaging generally indicates imaging techniques that acquire biological information from living forms. Among different imaging techniques, optical microscopy plays a predominant role in observing tissues, cells and biomolecules. Along with the fast development of microtechnology, developing miniaturized and integrated optical imaging systems has become essential to provide new imaging solutions for point-of-care applications. In this review, we will introduce the basic micro-optical components and their fabrication technologies first, and further emphasize the development of integrated optical systems for in vitro and in vivo bioimaging, respectively. We will conclude by giving our perspectives on micro-optical components for bioimaging applications in the near future.

Metalens-Based Miniaturized Optical Systems

Metasurfaces have been studied and widely applied to optical systems. A metasurface-based flat lens (metalens) holds promise in wave-front engineering for multiple applications. The metalens has become a breakthrough technology for miniaturized optical system development, due to its outstanding characteristics, such as ultrathinness and cost-effectiveness. Compared to conventional macro- or meso-scale optics manufacturing methods, the micro-machining process for metalenses is relatively straightforward and more suitable for mass production. Due to their remarkable abilities and superior optical performance, metalenses in refractive or diffractive mode could potentially replace traditional optics. In this review, we give a brief overview of the most recent studies on metalenses and their applications with a specific focus on miniaturized optical imaging and sensing systems. We discuss approaches for overcoming technical challenges in the bio-optics field, including a large field of view (FOV), chromatic aberration, and high-resolution imaging.

Cell phone based colorimetric analysis for point-of-care settings

Cell phones show considerable promise for point-of-care (POC) diagnostic procedures because they are accessible, connected, and computationally powerful. Cell phone image processing methods are being developed for the detection and quantification of a wide range of targets, employing methods from microscopy to fluorescence techniques. However, most of the lab-based biological and biochemical assays still lack a robust and repeatable cell phone analogue. Existing solutions require external smartphone hardware to obtain quantitative results, imposing a design tradeoff between accessibility and accuracy. Here, we develop a cell phone imaging algorithm that enables analysis of assays that would typically be evaluated via spectroscopy. The developed technique uses the saturation parameter of hue-saturation-value color space to enable POC diagnosis. Through the analysis of over 10 000 images, we show that the saturation method consistently outperforms existing algorithms under a wide range of operating field conditions. The performance improvement is also proven analytically via the mathematic relationship between the saturation method and existing techniques. The method presented here is a step forward towards the development of POC diagnostics by reducing the required equipment, improving the limit of detection (LOD), and increasing the precision of quantitative results.

Detection of breast cancer lymph node metastases in frozen sections with a point-of-care low-cost microscope scanner

Background

Detection of lymph node metastases is essential in breast cancer diagnostics and staging, affecting treatment and prognosis. Intraoperative microscopy analysis of sentinel lymph node frozen sections is standard for detection of axillary metastases but requires access to a pathologist for sample analysis. Remote analysis of digitized samples is an alternative solution but is limited by the requirement for high-end slide scanning equipment.

Objective

To determine whether the image quality achievable with a low-cost, miniature digital microscope scanner is sufficient for detection of metastases in breast cancer lymph node frozen sections.

Methods

Lymph node frozen sections from 79 breast cancer patients were digitized using a prototype miniature microscope scanner and a high-end slide scanner. Images were independently reviewed by two pathologists and results compared between devices with conventional light microscopy analysis as ground truth.

Results

Detection of metastases in the images acquired with the miniature scanner yielded an overall sensitivity of 91% and specificity of 99% and showed strong agreement when compared to light microscopy (k = 0.91). Strong agreement was also observed when results were compared to results from the high-end slide scanner (k = 0.94). A majority of discrepant cases were micrometastases and sections of which no anticytokeratin staining was available.

Conclusion

Accuracy of detection of metastatic cells in breast cancer sentinel lymph node frozen sections by visual analysis of samples digitized using low-cost, point-of-care microscopy is comparable to analysis of digital samples scanned using a high-end, whole slide scanner. This technique could potentially provide a workflow for digital diagnostics in resource-limited settings, facilitate sample analysis at the point-of-care and reduce the need for trained experts on-site during surgical procedures.

Paper-based multiplexed vertical flow assay for point-of-care testing

We developed a multiplexed point-of-care immunodiagnostic assay for antibody detection in human sera made through the vertical stacking of functional paper layers. In this multiplexed vertical flow immunodiagnostic assay (xVFA), a colorimetric signal is generated by gold nanoparticles captured on a spatially-multiplexed sensing membrane containing specific antigens. The assay is completed in 20 minutes, following which the sensing membrane is imaged by a cost-effective mobile-phone reader. The images are sent to a server, where the results are rapidly analyzed and relayed back to the user. The performance of the assay was evaluated by measuring Lyme-specific antibodies in human sera as model target antibodies. The presented platform is rapid, simple, inexpensive, and allows for simultaneous and quantitative measurement of multiple antibodies and/or antigens making it a suitable point-of-care platform for disease diagnostics.

Rapid imaging, detection, and quantification of Nosema ceranae spores in honey bees using mobile phone-based fluorescence microscopy

Recent declines in honey bee colonies in the United States have put increased strain on agricultural pollination. Nosema ceranae and Nosema apis, are microsporidian parasites that are highly pathogenic to honey bees and have been implicated as a factor in honey bee losses. While traditional methods for quantifying Nosema infection have high sensitivity and specificity, there is no field-portable device for field measurements by beekeepers. Here we present a field-portable and cost-effective smartphone-based platform for detection and quantification of chitin-positive Nosema spores in honey bees. The handheld platform, weighing only 374 g, consists of a smartphone-based fluorescence microscope, a custom-developed smartphone application, and an easy to perform sample preparation protocol. We tested the performance of the platform using samples at different parasite concentrations and compared the method with manual microscopic counts and qPCR quantification. We demonstrated that this device provides results that are comparable with other methods, having a limit of detection of 0.5 × 106 spores per bee. Thus, the assay can easily identify infected colonies and provide accurate quantification of infection levels requiring treatment of infection, suggesting that this method is potentially adaptable for diagnosis of Nosema infection in the field by beekeepers. Coupled with treatment recommendations, this protocol and smartphone-based optical platform could improve the diagnosis and treatment of nosemosis in bees and provide a powerful proof-of-principle for the use of such mobile diagnostics as useful analytical tools for beekeepers in resource-limited settings.

Symmetry Breaking-Induced Plasmonic Mode Splitting in Coupled Gold-Silver Alloy Nanodisk Array for Ultrasensitive RGB Colorimetric Biosensing

We report the first observation of symmetry breaking-induced mode splitting in coupled gold-silver alloy nanodisk array (ANA). According to the plasmonic hybridization picture, the original localized surface plasmon resonance (LSPR) of individual nanodisk is split into a pair of high and low energy modes when placed in between a superstrate and a substrate. Although well studied in single silver nanoparticles, the high energy mode has been largely suppressed in gold nanoparticles, which nevertheless are more chemically robust and have superior environmental stability. Herein, we show that the high energy mode can be partially restored and precisely engineered to ∼540 nm for silver-rich alloy nanodisk which has excellent environmental stability. However, peak broadening and red-shifting occur due to plasmonic dephasing when the nanodisk diameter increases. We next demonstrate that a far-field coupled ANA fabricated by low-cost nanosphere lithography can fully restore the high energy mode with electric field concentration extended into the superstrate, thereby imparting greater sensitivity to local refractive index changes. The high energy mode at 540 nm is of key importance for color change detection using low-cost RGB cameras/human vision and broadband light sources (e.g., the sun). The index sensitivity of ANA is the highest among existing plasmonic arrays (particles or holes) within a similar resonance wavelength region. We demonstrate colorimetric detection of sub-nanomolar and sub-monolayer biotin-streptavidin surface binding with a smartphone camera and a white light lamp. The high performance yet low-cost fabrication and detection technology could potentially result in affordable point-of-care biosensing technologies.

Polymeric biomaterials for biophotonic applications

With the growing importance of optical techniques in medical diagnosis and treatment, there exists a pressing need to develop and optimize materials platform for biophotonic applications. Particularly, the design of biocompatible and biodegradable materials with desired optical, mechanical, chemical, and biological properties is required to enable clinically relevant biophotonic devices for translating in vitro optical techniques into in situ and in vivo use. This technological trend propels the development of natural and synthetic polymeric biomaterials to replace traditional brittle, nondegradable silica glass based optical materials. In this review, we present an overview of the advances in polymeric optical material development, optical device design and fabrication techniques, and the accompanying applications to imaging, sensing and phototherapy.

Deep transfer learning-based hologram classification for molecular diagnostics

Lens-free digital in-line holography (LDIH) is a promising microscopic tool that overcomes several drawbacks (e.g., limited field of view) of traditional lens-based microcopy. However, extensive computation is required to reconstruct object images from the complex diffraction patterns produced by LDIH. This limits LDIH utility for point-of-care applications, particularly in resource limited settings. We describe a deep transfer learning (DTL) based approach to process LDIH images in the context of cellular analyses. Specifically, we captured holograms of cells labeled with molecular-specific microbeads and trained neural networks to classify these holograms without reconstruction. Using raw holograms as input, the trained networks were able to classify individual cells according to the number of cell-bound microbeads. The DTL-based approach including a VGG19 pretrained network showed robust performance with experimental data. Combined with the developed DTL approach, LDIH could be realized as a low-cost, portable tool for point-of-care diagnostics.

Noninvasive Glucose Monitoring with a Contact Lens and Smartphone

Diabetes has become a chronic metabolic disorder, and the growing diabetes population makes medical care more important. We investigated using a portable and noninvasive contact lens as an ideal sensor for diabetes patients whose tear fluid contains glucose. The key feature is the reversible covalent interaction between boronic acid and glucose, which can provide a noninvasive glucose sensor for diabetes patients. We present a phenylboronic acid (PBA)-based HEMA contact lens that exhibits a reversible swelling/shrinking effect to change its thickness. The difference in thickness can be detected in a picture taken with a smartphone and analyzed using software. Our novel technique offers the following capabilities: (i) non-enzymatic and continuous glucose detection with the contact lens; (ii) no need for an embedded circuit and power source for the glucose sensor; and (iii) the use of a smartphone to detect the change in thickness of the contact lens with no need for additional photo-sensors. This technique is promising for a noninvasive measurement of the glucose level and simple implementation of glucose sensing with a smartphone.

3D-Printed Biosensor Arrays for Medical Diagnostics

While the technology is relatively new, low-cost 3D printing has impacted many aspects of human life. 3D printers are being used as manufacturing tools for a wide variety of devices in a spectrum of applications ranging from diagnosis to implants to external prostheses. The ease of use, availability of 3D-design software and low cost has made 3D printing an accessible manufacturing and fabrication tool in many bioanalytical research laboratories. 3D printers can print materials with varying density, optical character, strength and chemical properties that provide the user with a vast array of strategic options. In this review, we focus on applications in biomedical diagnostics and how this revolutionary technique is facilitating the development of low-cost, sensitive, and often geometrically complex tools. 3D printing in the fabrication of microfluidics, supporting equipment, and optical and electronic components of diagnostic devices is presented. Emerging diagnostics systems using 3D bioprinting as a tool to incorporate living cells or biomaterials into 3D printing is also reviewed.

Redox-Magnetohydrodynamically Controlled Fluid Flow with Poly(3,4-ethylenedioxythiophene) Coupled to an Epitaxial Light Sheet Confocal Microscope for Image Cytometry Applications

We present the merging of two technologies to perform continuous high-resolution fluorescence imaging of cellular suspensions in a deep microfluidics chamber with no moving parts. An epitaxial light sheet confocal microscope (e-LSCM) was used to image suspensions enabled by fluid transport via redox-magnetohydrodynamics (R-MHD). The e-LSCM features a linear solid state sensor, oriented perpendicular to the direction of flow, that can bin the emission across different numbers of pixels, yielding electronically adjustable optical sectioning. This, in addition to intensity thresholding, defines the axial resolution, which was validated with an optical phantom of polystyrene microspheres suspended in agarose. The linear fluid speed within the microfluidics chamber was uniform (0.16-2.9%) across the 0.5-1.0 mm lateral field of view (dependent upon the chosen magnification) with continuous acquisition. Also, the camera's linear exposure periods were controlled to ensure an accurate image aspect ratio across this span. Poly(3,4-ethylenedioxythiophene) (PEDOT) was electrodeposited as an immobilized redox film on electrodes of a chip for R-MHD, and the fluid flow was calibrated to specific linear speeds as a function of applied current. Images of leukocytes stained with acridine orange, a fluorescent, amphipathic vital dye that intercalates DNA, were acquired in the R-MHD microfluidics chamber with the e-LSCM to demonstrate imaging of biological samples. The combination of these technologies provides a miniaturizable platform for large sample volumes and high-throughput, image-based analysis without the requirement of moving parts, enabling development of robust, point-of-care image cytometry.

Operational assessment of point-of-care diagnostics in rural primary healthcare clinics of KwaZulu-Natal, South Africa: a cross-sectional survey

BACKGROUND

The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Access to diagnostic testing may not be uniform in rural settings, which may result in poor access to essential healthcare services. The aim of this study is to determine the availability, current usage, and need for point-of-care (POC) diagnostic tests among rural primary healthcare (PHC) clinics in South Africa's KwaZulu-Natal (KZN) province.

METHODS

We used the KZN's Department of Health (DoH) clinic classification to identify the 232 rural PHC clinics in KZN, South Africa. We then randomly sampled 100 of 232 rural PHC clinics. Selected health clinics were surveyed between April to August 2015 to obtain clinic-level data for health-worker volume and to determine the accessibility, availability, usage and need for POC tests. Professional healthcare workers responsible for POC testing at each clinic were interviewed to assess the awareness of POC testing. Data were survey weighted and analysed using Stata 13.

RESULTS

Among 100 rural clinics, the average number of patients seen per week was 2865 ± 2231 (range 374-11,731). The average number of POC tests available and in use was 6.3 (CI: 6.2-6.5) out of a potential of 51 tests. The following POC tests were universally available in all rural clinics: urine total protein, urine leukocytes, urine nitrate, urine pregnancy, HIV antibody and blood glucose test. The average number of desired POC diagnostic tests reported by the clinical staff was estimated at 15 (CI: 13-17) per clinic. The most requested POC tests reported were serum creatinine (37%), CD4 count (37%), cholesterol (32%), tuberculosis (31%), and HIV viral load (23%).

CONCLUSION

Several POC tests are widely available and in use at rural PHC clinics in South Africa's KZN province. However, healthcare workers have requested additional POC tests to improve detection and management of priority disease conditions.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT02692274.

Fast and robust Fourier domain-based classification for on-chip lens-free flow cytometry

The development of portable haematology analysers receives increased attention due to their deployability in resource-limited or emergency settings. Lens-free in-line holographic microscopy is one of the technologies that is being pushed forward in this regard as it eliminates complex and expensive optics, making miniaturisation and integration with microfluidics possible. On-chip flow cytometry enables high-speed capturing of individual cells in suspension, giving rise to high-throughput cell counting and classification. To perform a real-time analysis on this high-throughput content, we propose a fast and robust framework for the classification of leukocytes. The raw data consists of holographic acquisitions of leukocytes, captured with a high-speed camera as they are flowing through a microfluidic chip. Three different types of leukocytes are considered: granulocytes, monocytes and T-lymphocytes. The proposed method bypasses the reconstruction of the holographic data altogether by extracting Zernike moments directly from the frequency domain. By doing so, we introduce robustness to translations and rotations of cells, as well as to changes in distance of a cell with respect to the image sensor, achieving classification accuracies up to 96.8%. Furthermore, the reduced computational complexity of this approach, compared to traditional frameworks that involve the reconstruction of the holographic data, allows for very fast processing and classification, making it applicable in high-throughput flow cytometry setups.

Convolutional neural network-based malaria diagnosis from focus stack of blood smear images acquired using custom-built slide scanner

The present paper introduces a focus stacking-based approach for automated quantitative detection of Plasmodium falciparum malaria from blood smear. For the detection, a custom designed convolutional neural network (CNN) operating on focus stack of images is used. The cell counting problem is addressed as the segmentation problem and we propose a 2-level segmentation strategy. Use of CNN operating on focus stack for the detection of malaria is first of its kind, and it not only improved the detection accuracy (both in terms of sensitivity [97.06%] and specificity [98.50%]) but also favored the processing on cell patches and avoided the need for hand-engineered features. The slide images are acquired with a custom-built portable slide scanner made from low-cost, off-the-shelf components and is suitable for point-of-care diagnostics. The proposed approach of employing sophisticated algorithmic processing together with inexpensive instrumentation can potentially benefit clinicians to enable malaria diagnosis.

Mechano-Based Transductive Sensing for Wearable Healthcare

Wearable healthcare presents exciting opportunities for continuous, real-time, and noninvasive monitoring of health status. Even though electrochemical and optical sensing have already made great advances, there is still an urgent demand for alternative signal transformation in terms of miniaturization, wearability, conformability, and stretchability. Mechano-based transductive sensing, referred to the efficient transformation of biosignals into measureable mechanical signals, is claimed to exhibit the aforementioned desirable properties, and ultrasensitivity. In this Concept, a focus on pressure, strain, deflection, and swelling transductive principles based on micro-/nanostructures for wearable healthcare is presented. Special attention is paid to biophysical sensors based on pressure/strain, and biochemical sensors based on microfluidic pressure, microcantilever, and photonic crystals. There are still many challenges to be confronted in terms of sample collection, miniaturization, and wireless data readout. With continuing efforts toward solving those problems, it is anticipated that mechano-based transduction will provide an accessible route for multimode wearable healthcare systems integrated with physical, electrophysiological, and biochemical sensors.

Rapid enumeration of CD4 + T lymphocytes using an integrated microfluidic system based on Chemiluminescence image detection at point-of-care testing

An integrated microfluidic system has been developed for rapid enumeration of CD4 + T lymphocytes at point-of-care (POC) settings. A concise microfluidic chip, which consists of three separate chambers, respectively, for reaction, detection and waste storage, is developed to automate CD4 detection. To simplify CD4 + T lymphocyte enumeration, a single polycarbonate bead immobilized with CD4 antibody is adopted by the microfluidic chip to capture the CD4 antigen in the lysed testing sample. Desired performance is achieved by actuating the single bead for efficient mixing, as well as transferring it between different reaction chambers to reduce non-specific reaction. A controllable external magnetic field is applied to drive the single bead with a built-in ferrous core for different purposes. Chemiluminescence reaction is implemented in an independent chamber to reduce non-specific binding of enzyme. A simple flow control strategy is adopted to conveniently release the waste reagent into the waste storage chamber by just opening the vent hole without actively pumping. A sensitive CCD camera is used to collect the reaction signal by taking picture from the single bead, and then the signal intensity is further analyzed for CD4 + T lymphocyte enumeration. Experimental results show that rapid, convenient, accurate and low-cost CD4 + T lymphocyte enumeration can be obtained with the developed microfluidic system at POC test.

Continuous stacking computational approach based automated microscope slide scanner

Cost-effective and automated acquisition of whole slide images is a bottleneck for wide-scale deployment of digital pathology. In this article, a computation augmented approach for the development of an automated microscope slide scanner is presented. The realization of a prototype device built using inexpensive off-the-shelf optical components and motors is detailed. The applicability of the developed prototype to clinical diagnostic testing is demonstrated by generating good quality digital images of malaria-infected blood smears. Further, the acquired slide images have been processed to identify and count the number of malaria-infected red blood cells and thereby perform quantitative parasitemia level estimation. The presented prototype would enable cost-effective deployment of slide-based cyto-diagnostic testing in endemic areas.

Acoustofluidic devices controlled by cell phones

Acoustofluidic devices have continuously demonstrated their potential to impact medical diagnostics and lab-on-a-chip applications. To bring these technologies to real-world applications, they must be made more accessible to end users. Herein, we report on the effort to provide an easy-to-use and portable system for controlling sharp-edge-based acoustofluidic devices. With the use of a cell phone and a modified Bluetooth® speaker, on-demand and hands-free pumping and mixing are achieved. Additionally, a novel design for a sharp-edge-based acoustofluidic device is proposed that combines both pumping and mixing functions into a single device, thus removing the need for external equipment typically needed to accomplish these two tasks. These applications serve to demonstrate the potential function that acoustofluidic devices can provide in point-of-care platforms. To further this point-of-care goal, we also design a portable microscope that combines with the cell phone and Bluetooth® power supply, providing a completely transportable acoustofluidic testing station. This work serves to bolster the promising position that acoustofluidic devices have within the rapidly changing research and diagnostics fields.

Photoluminescence properties of a ScBO3:Cr3+ phosphor and its applications for broadband near-infrared LEDs

A new NIR-emitting phosphor ScBO₃:Cr³⁺ was investigated and its great potential for applications in broadband NIR pc-LEDs was demonstrated.

A Field-Portable Cell Analyzer without a Microscope and Reagents

This paper demonstrates a commercial-level field-portable lens-free cell analyzer called the NaviCell (No-stain and Automated Versatile Innovative cell analyzer) capable of automatically analyzing cell count and viability without employing an optical microscope and reagents. Based on the lens-free shadow imaging technique, the NaviCell (162 × 135 × 138 mm³ and 1.02 kg) has the advantage of providing analysis results with improved standard deviation between measurement results, owing to its large field of view. Importantly, the cell counting and viability testing can be analyzed without the use of any reagent, thereby simplifying the measurement procedure and reducing potential errors during sample preparation. In this study, the performance of the NaviCell for cell counting and viability testing was demonstrated using 13 and six cell lines, respectively. Based on the results of the hemocytometer (de facto standard), the error rate (ER) and coefficient of variation (CV) of the NaviCell are approximately 3.27 and 2.16 times better than the commercial cell counter, respectively. The cell viability testing of the NaviCell also showed an ER and CV performance improvement of 5.09 and 1.8 times, respectively, demonstrating sufficient potential in the field of cell analysis.

Recent Advances in Fluorescence Lifetime Analytical Microsystems: Contact Optics and CMOS Time-Resolved Electronics

Fluorescence spectroscopy has become a prominent research tool with wide applications in medical diagnostics and bio-imaging. However, the realization of combined high-performance, portable, and low-cost spectroscopic sensors still remains a challenge, which has limited the technique to the laboratories. A fluorescence lifetime measurement seeks to obtain the characteristic lifetime from the fluorescence decay profile. Time-correlated single photon counting (TCSPC) and time-gated techniques are two key variations of time-resolved measurements. However, commercial time-resolved analysis systems typically contain complex optics and discrete electronic components, which lead to bulkiness and a high cost. These two limitations can be significantly mitigated using contact sensing and complementary metal-oxide-semiconductor (CMOS) implementation. Contact sensing simplifies the optics, whereas CMOS technology enables on-chip, arrayed detection and signal processing, significantly reducing size and power consumption. This paper examines recent advances in contact sensing and CMOS time-resolved circuits for the realization of fully integrated fluorescence lifetime measurement microsystems. The high level of performance from recently reported prototypes suggests that the CMOS-based contact sensing microsystems are emerging as sound technologies for application-specific, low-cost, and portable time-resolved diagnostic devices.

The Role of Affordable, Point-of-Care Technologies for Cancer Care in Low- and Middle-Income Countries: A Review and Commentary

As the burden of non-communicable diseases such as cancer continues to rise in low- and middle-income countries (LMICs), it is essential to identify and invest in promising solutions for cancer control and treatment. Point-of-care technologies (POCTs) have played critical roles in curbing infectious disease epidemics in both high- and low-income settings, and their successes can serve as a model for transforming cancer care in LMICs, where access to traditional clinical resources is often limited. The versatility, cost-effectiveness, and simplicity of POCTs warrant attention for their potential to revolutionize cancer detection, diagnosis, and treatment. This paper reviews the landscape of affordable POCTs for cancer care in LMICs with a focus on imaging tools, in vitro diagnostics, and treatment technologies and aspires to encourage innovation and further investment in this space.

Recent Progress in Optical Biosensors Based on Smartphone Platforms

With a rapid improvement of smartphone hardware and software, especially complementary metal oxide semiconductor (CMOS) cameras, many optical biosensors based on smartphone platforms have been presented, which have pushed the development of the point-of-care testing (POCT). Imaging-based and spectrometry-based detection techniques have been widely explored via different approaches. Combined with the smartphone, imaging-based and spectrometry-based methods are currently used to investigate a wide range of molecular properties in chemical and biological science for biosensing and diagnostics. Imaging techniques based on smartphone-based microscopes are utilized to capture microscale analysts, while spectrometry-based techniques are used to probe reactions or changes of molecules. Here, we critically review the most recent progress in imaging-based and spectrometry-based smartphone-integrated platforms that have been developed for chemical experiments and biological diagnosis. We focus on the analytical performance and the complexity for implementation of the platforms.

Genome-wide host RNA signatures of infectious diseases: discovery and clinical translation

The use of whole blood gene expression to derive diagnostic biomarkers capable of distinguishing between phenotypically similar diseases holds great promise but remains a challenge. Differential gene expression analysis is used to identify the key genes that undergo changes in expression relative to healthy individuals, as well as to patients with other diseases. These key genes can act as diagnostic, prognostic and predictive markers of disease. Gene expression ‘signatures’ in the blood hold the potential to be used for the diagnosis of infectious diseases, where current diagnostics are unreliable, ineffective or of limited potential. For diagnostic tests based on RNA signatures to be useful clinically, the first step is to identify the minimum set of gene transcripts that accurately identify the disease in question. The second requirement is rapid and cost‐effective detection of the gene expression levels. Signatures have been described for a number of infectious diseases, but ‘clinic‐ready’ technologies for RNA detection from clinical samples are limited, though existing methods such as RT‐PCR are likely to be superseded by a number of emerging technologies, which may form the basis of the translation of gene expression signatures into routine diagnostic tests for a range of disease states.

Single-cell screening of multiple biophysical properties in leukemia diagnosis from peripheral blood by pure light scattering

Histology and histopathology are based on the morphometric observations of quiescent cells. Their diagnostic potential could largely benefit from a simultaneous screening of intrinsic biophysical properties at single-cell level. For such a purpose, we analyzed light scattering signatures of individual mononuclear blood cells in microfluidic flow. In particular, we extracted a set of biophysical properties including morphometric (dimension, shape and nucleus-to-cytosol ratio) and optical (optical density) ones to clearly discriminate different cell types and stages. By considering distinctive ranges of biophysical properties along with the obtained relative cell frequencies, we can identify unique cell classes corresponding to specific clinical conditions (p < 0.01). Based on such a straightforward approach, we are able to discriminate T-, B-lymphocytes, monocytes and beyond that first results on different stages of lymphoid and myeloid leukemia cells are presented. This work shows that the simultaneous screening of only three biophysical properties enables a clear distinction between pathological and physiological mononuclear blood stream cells. We believe our approach could represent a useful tool for a label-free analysis of biophysical single-cell signatures.

Advances in paper-analytical methods for pharmaceutical analysis

Paper devices have many advantages over other microfluidic devices. The paper substrate, from cellulose to glass fiber, is an inexpensive substrate that can be readily modified to suit a variety of applications. Milli- to micro-scale patterns can be designed to create a fast, cost-effective device that uses small amounts of reagents and samples. Finally, well-established chemical and biological methods can be adapted to paper to yield a portable device that can be used in resource-limited areas (e.g., field work). Altogether, the paper devices have grown into reliable analytical devices for screening low quality pharmaceuticals. This review article presents fabrication processes, detection techniques, and applications of paper microfluidic devices toward pharmaceutical screening.

Multiplexed Optical Imaging of Tumor-Directed Nanoparticles: A Review of Imaging Systems and Approaches

In recent decades, various classes of nanoparticles have been developed for optical imaging of cancers. Many of these nanoparticles are designed to specifically target tumor sites, and specific cancer biomarkers, to facilitate the visualization of tumors. However, one challenge for accurate detection of tumors is that the molecular profiles of most cancers vary greatly between patients as well as spatially and temporally within a single tumor mass. To overcome this challenge, certain nanoparticles and imaging systems have been developed to enable multiplexed imaging of large panels of cancer biomarkers. Multiplexed molecular imaging can potentially enable sensitive tumor detection, precise delineation of tumors during interventional procedures, and the prediction/monitoring of therapy response. In this review, we summarize recent advances in systems that have been developed for the imaging of optical nanoparticles that can be heavily multiplexed, which include surface-enhanced Raman-scattering nanoparticles (SERS NPs) and quantum dots (QDs). In addition to surveying the optical properties of these various types of nanoparticles, and the most-popular multiplexed imaging approaches that have been employed, representative preclinical and clinical imaging studies are also highlighted.

Point-of-care testing: applications of 3D printing

Point-of-care testing (POCT) devices fulfil a critical need in the modern healthcare ecosystem, enabling the decentralized delivery of imperative clinical strategies in both developed and developing worlds. To achieve diagnostic utility and clinical impact, POCT technologies are immensely dependent on effective translation from academic laboratories out to real-world deployment. However, the current research and development pipeline is highly bottlenecked owing to multiple restraints in material, cost, and complexity of conventionally available fabrication techniques. Recently, 3D printing technology has emerged as a revolutionary, industry-compatible method enabling cost-effective, facile, and rapid manufacturing of objects. This has allowed iterative design-build-test cycles of various things, from microfluidic chips to smartphone interfaces, that are geared towards point-of-care applications. In this review, we focus on highlighting recent works that exploit 3D printing in developing POCT devices, underscoring its utility in all analytical steps. Moreover, we also discuss key advantages of adopting 3D printing in the device development pipeline and identify promising opportunities in 3D printing technology that can benefit global health applications.

3D-printed smartphone-based device for label-free cell separation

Aim: To assess several fabrication metrics of a 3D-printed smartphone-attachable continuous-flow magnetic focusing device for real-time separation and detection of different cell types based on their volumetric mass density in high-volume samples. Method: The smartphone apparatus has been designed and fabricated using three different 3D printing method. Several 3D printing metrics including cost, printing time, and resolution have been evaluated to propose a cost-efficient and high-performance platform for low-resource settings. Results: To apply the magnetic focusing technique on large sample volumes, a heterogeneous mixture of sample (e.g., containing blood cells and cancer cells) suspended in paramagnetic medium is pumped through a magnetic field at an optimum flow rate. The performance of the 3D-printed device has been investigated by demonstrating separation of microspheres, breast, lung, ovarian and prostate cancer cells mixed with blood cells. The separation distance of cancer and blood cells is around 100 μm, allowing the two cell types to be easily distinguished. Conclusion: This device could be useful for clinical centers in low-income countries where expensive infrastructure, equipment (e.g., FACS) and technical expertise are lacking. This device could ultimately be applied to rare cell separation and purification.

Snapshot hyperspectral retinal imaging using compact spectral resolving detector array

Hyperspectral retinal imaging captures the light spectrum from each imaging pixel. It provides spectrally encoded retinal physiological and morphological information, which could potentially benefit diagnosis and therapeutic monitoring of retinal diseases. The key challenges in hyperspectral retinal imaging are how to achieve snapshot imaging to avoid motions between the images from multiple spectral bands, and how to design a compact snapshot imager suitable for clinical use. Here, we developed a compact, snapshot hyperspectral fundus camera for rodents using a novel spectral resolving detector array (SRDA), on which a thin-film Fabry-Perot cavity filter was monolithically fabricated on each imaging pixel. We achieved hyperspectral retinal imaging with 16 wavelength bands (460 to 630 nm) at 20 fps. We also demonstrated false-color vessel contrast enhancement and retinal oxygen saturation (sO₂ ) measurement through spectral analysis. This work could potentially bring hyperspectral retinal imaging from bench to bedside.

Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus-Infected Women: Systematic Review and Meta-analysis

INTRODUCTION

The World Health Organization advocates for increased accessibility of HIV-related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure. The aim of this study is to assess the impact of POC diagnostics on maternal health outcomes in HIV-infected women.

METHODS

A systematic literature review used multiple data sources as follows: Cochrane Infectious Disease Group Specialized Register; Cochrane Central Register of Control Trials, published in The Cochrane Library; PubMed; EBSCOhost and LILACS from January 2000 to October 2015. References of included studies were hand searched. Randomized controlled trials (RCTs) and observational studies examining health outcomes of HIV-infected women were eligible for inclusion in this review. The Cochrane Risk of Bias tool was used for bias assessment of the included studies. PRISMA guidelines were used for reporting.

RESULTS

Of the 695 studies identified, six retrievable studies (five cross-sectional studies and one case control study) met the inclusion criteria and were included in this study. These studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load and TB, and the syphilis POC test impact on HIV-infected women was not found by this study. Included studies reported the impact of various HIV rapid tests across the following five maternal outcomes: timely receipt of results with pooled effect size (ES) = 1.00 (95% confidence interval [CI]: (0.98; 1.02); enabling partner testing, ES = 0.95 (0.85; 1.04); prevention of mother-to-child transmission of HIV, ES = 0.86 (0.79; 0.93); linkage to antiretroviral treatment (ART), ES = 0.76 (0.69; 0.84); and linkage to HIV care, ES = 0.50 (0.18; 0.82). No studies reported evidence of the impact of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women.

CONCLUSIONS

The review provides an international overview of the impact of HIV POC diagnostics on maternal outcomes in HIV-infected women, showing the evidence that the HIV POC test is significantly associated with decreased mother-to-child transmission of HIV and increased linkage to ART and HIV care for HIV-infected women. It also revealed a gap in the literature aimed at assessing the impact of POC diagnostics on maternal morbidity and mortality in HIV-infected women.

Label-free analysis of mononuclear human blood cells in microfluidic flow by coherent imaging tools

The investigation of the physical properties of peripheral blood mononuclear cells (PBMC) is of great relevance, as they play a key role in regulating human body health. Here we report the possibility to characterize human PBMC in their physiological conditions in a microfluidic-based measurement system. A viscoelastic polymer solution is adopted for 3D alignment of individual cells inflow. An optical signature (OS) acquisition of each flowing cell is performed using a wide angle light scattering apparatus. Besides, a quantitative phase imaging (QPI) holographic system is employed with the aim (i) to check the position in flow of individual cells using a holographic 3D cell tracking method; and (ii) to estimate their 3D morphometric features, such as their refractive index (RI). Results obtained by combining OS and QPI have been compared with literature values, showing good agreement. The results confirm the possibility to obtain sub-micrometric details of physical cell properties in microfluidic flow, avoiding chemical staining or fluorescent labelling.