Point of care monitoring of hemodialysis patients with a breath ammonia measurement device based on printed polyaniline nanoparticle sensors

A Flexible Ammonia Gas Sensor Based on a Grafted Polyaniline Grown on a Polyethylene Terephthalate Film

A novel NH3 gas sensor is introduced, employing polyaniline (PANI) with a unique structure called a graft film. The preparation method was simple: polydopamine (PD) was coated on a flexible polyethylene terephthalate (PET) film and PANI graft chains were grown on its surface. This distinctive three-layer sensor showed a response value of 12 for 50 ppm NH3 in a dry atmosphere at 50 °C. This value surpasses those of previously reported sensors using structurally controlled PANI films. Additionally, it is on par with sensors that combine PANI with metal oxide semiconductors or carbon materials, the high sensitivity of which have been reported. To confirm our film's potential as a flexible sensor, the effect of bending on the its characteristics was investigated. This revealed that although bending decreased the response value, it had no effect on the response time or recovery. This indicated that the sensor film itself was not broken by bending and had sufficient mechanical strength.

Highly sensitive Cu-ethylenediamine/PANI composite sensor for NH3 detection at room temperature

Ammonia detection is needed in several sectors including environmental monitoring, automobile industry, and in medical diagnosis. Conducting polymers, such as polyaniline (PANI), have been utilized to develop NH₃ sensors operating at room temperature. However, the performance of these sensors in terms of sensitivity and selectivity need improvement. Functionalization of conducting PANI with metal nanocomposites have shown improved sensor performance. In this work, we report a highly sensitive copper-based nanocomposite for NH₃ detection. The novelty lies in utilization of copper-ethylenediamine (Cu-en) nanocomposite functionalized over PANI for gas sensing. Resistance of the 20 wt% Cu-en with PANI increased 3.8 times upon exposure to 100 ppm of NH₃. The nanocomposite sensor detected NH₃ concentrations as low as 2 ppm. Further, the sensing mechanism was studied by in-situ IV characteristics and impedance spectroscopy during NH₃ exposure. NH₃ showed ionic interaction with PANI, and Cu²⁺. The strong affinity of Cu²⁺ for the lone pair of NH₃ enhanced the sensor response from 0.78 to 3.8 for 100 ppm of NH₃ at 20 °C. The sensor response was completely recovered after heating at 75 °C, which indicates reusability of the sensor. The sensor showed selectivity for NH₃ over ethanol and H₂S. The response was reasonably stable after bending the flexible sensor for 1000 times at a radius of 5 mm.

Environmental formaldehyde sensing at room temperature by smartphone-assisted and wearable plasmonic nanohybrids

Formaldehyde is a toxic and carcinogenic indoor air pollutant. Promising for its routine detection are gas sensors based on localized surface plasmon resonance (LSPR). Such sensors trace analytes by converting tiny changes in the local dielectric environment into easily readable, optical signals. Yet, this mechanism is inherently non-selective to volatile organic compounds (like formaldehyde) and yields rarely detection limits below parts-per-million concentrations. Here, we reveal that chemical reaction-mediated LSPR with nanohybrids of Ag/AgO_x core-shell clusters on TiO₂ enables highly selective formaldehyde sensing down to 5 parts-per-billion (ppb). Therein, AgO_x is reduced by the formaldehyde to metallic Ag resulting in strong plasmonic signal changes, as measured by UV/Vis spectroscopy and confirmed by X-ray diffraction. This interaction is highly selective to formaldehyde over other aldehydes, alcohols, ketones, aromatic compounds (as confirmed by high-resolution mass spectrometry), inorganics, and quite robust to relative humidity changes. Since this sensor works at room temperature, such LSPR nanohybrids are directly deposited onto flexible wristbands to quantify formaldehyde between 40-500 ppb at 50% RH, even with a widely available smartphone camera (Pearson correlation coefficient r = 0.998). Such chemoresponsive coatings open new avenues for wearable devices in environmental, food, health and occupational safety applications, as demonstrated by an early field test in the pathology of a local hospital.

Application of nanoparticles in the diagnosis and treatment of chronic kidney disease

With the development of nanotechnology, nanoparticles have been used in various industries. In medicine, nanoparticles have been used in the diagnosis and treatment of diseases. The kidney is an important organ for waste excretion and maintaining the balance of the internal environment; it filters various metabolic wastes. Kidney dysfunction may result in the accumulation of excess water and various toxins in the body without being discharged, leading to complications and life-threatening conditions. Based on their physical and chemical properties, nanoparticles can enter cells and cross biological barriers to reach the kidneys and therefore, can be used in the diagnosis and treatment of chronic kidney disease (CKD). In the first search, we used the English terms "Renal Insufficiency, Chronic" [Mesh] as the subject word and terms such as "Chronic Renal Insufficiencies," "Chronic Renal Insufficiency," "Chronic Kidney Diseases," "Kidney Disease, Chronic," "Renal Disease, Chronic" as free words. In the second search, we used "Nanoparticles" [Mesh] as the subject word and "Nanocrystalline Materials," "Materials, Nanocrystalline," "Nanocrystals," and others as free words. The relevant literature was searched and read. Moreover, we analyzed and summarized the application and mechanism of nanoparticles in the diagnosis of CKD, application of nanoparticles in the diagnosis and treatment of renal fibrosis and vascular calcification (VC), and their clinical application in patients undergoing dialysis. Specifically, we found that nanoparticles can detect CKD in the early stages in a variety of ways, such as via breath sensors that detect gases and biosensors that detect urine and can be used as a contrast agent to avoid kidney damage. In addition, nanoparticles can be used to treat and reverse renal fibrosis, as well as detect and treat VC in patients with early CKD. Simultaneously, nanoparticles can improve safety and convenience for patients undergoing dialysis. Finally, we summarize the current advantages and limitations of nanoparticles applied to CKD as well as their future prospects.

Challenges and Opportunities for Printed Electrical Gas Sensors

Printed electrical gas sensors are a low-cost, lightweight, low-power, and potentially disposable alternative to gas sensors manufactured using conventional methods such as photolithography, etching, and chemical vapor deposition. The growing interest in Internet-of-Things, smart homes, wearable devices, and point-of-need sensors has been the main driver fueling the development of new classes of printed electrical gas sensors. In this Perspective, we provide an insight into the current research related to printed electrical gas sensors including materials, methods of fabrication, and applications in monitoring food quality, air quality, diagnosis of diseases, and detection of hazardous gases. We further describe the challenges and future opportunities for this emerging technology.

MoSe2/multiwalled carbon nanotube composite for ammonia sensing in natural humid environment

Herein, we report ammonia sensing in a natural highly humid environment using MoSe₂/multi-walled carbon nanotube (MWCNT) composite as sensing platform. The composite synthesis involved two steps, in the first step, MWCNTs were treated in an acidic medium to obtain -COOH group functionalized MWCNTs. In the second step, functionalized MWCNTs were probe sonicated with MoSe₂ to obtain MoSe₂/MWCNT composite. Proposed device exhibited superior sensing properties at a temperature down to 16^∘ C and relative humidity of 80%. Under these extreme natural environmental conditions, the device exhibited a relative response of 21% for 0.5 ppm of ammonia and superior noise free signal further suggests their use even below this concentration. Composite based device has also displayed better adsorption selectivity towards NH₃ as compared with other reducing and oxidizing gas molecules. Density functional theory simulations were further employed to understand the underlying adsorption process and selectivity behavior of the composite. Simulations predicted lowest negative adsorption energy for ammonia, implying physisorption (-0.387 eV) type exothermic adsorption process. Present results indicate that a composite with the rightly engineered MoSe₂ and MWCNTs weight ratio may serve as a potential candidate for ammonia sensing in a highly humid environment.

Study on Ammonia Content and Distribution in the Microenvironment Based on Covalent Organic Framework Nanochannels

A crack-free micrometer-sized compact structure of 1,3,5-tris(4-aminophenyl)benzene-terephthaldehyde-covalent organic frameworks (TAPB-PDA-COFs) was constructed in situ at the tip of a theta micropipette (TMP). The COF-covered theta micropipette (CTP) then created a stable liquid-gas interface inside COF nanochannels, which was utilized to electrochemically analyze the content and distribution of ammonia gas in the microenvironments. The TMP-based electrochemical ammonia sensor (TEAS) shows a high sensing response, with current increasing linearly from 0 to 50,000 ppm ammonia, owing to the absorption of ammonia gas in the solvent meniscus that connects both barrels of the TEAS. The TEAS also exhibits a short response and recovery time of 5 ± 2 s and 6 ± 2 s, respectively. This response of the ammonia sensor is remarkably stable and repeatable, with a relative standard deviation of 6% for 500 ppm ammonia gas dispensing with humidity control. Due to its fast, reproducible, and stable response to ammonia gas, the TEAS was also utilized as a scanning electrochemical microscopy (SECM) probe for imaging the distribution of ammonia gas in a microspace. This study unlocks new possibilities for using a TMP in designing microscale probes for gas sensing and imaging.

Fluorescent Polymers Conspectus

The development of luminescent materials is critical to humankind. The Nobel Prizes awarded in 2008 and 2010 for research on the development of green fluorescent proteins and super-resolved fluorescence imaging are proof of this (2014). Fluorescent probes, smart polymer machines, fluorescent chemosensors, fluorescence molecular thermometers, fluorescent imaging, drug delivery carriers, and other applications make fluorescent polymers (FPs) exciting materials. Two major branches can be distinguished in the field: (1) macromolecules with fluorophores in their structure and (2) aggregation-induced emission (AIE) FPs. In the first, the polymer (which may be conjugated) contains a fluorophore, conferring photoluminescent properties to the final material, offering tunable structures, robust mechanical properties, and low detection limits in sensing applications when compared to small-molecule or inorganic luminescent materials. In the latter, AIE FPs use a novel mode of fluorescence dependent on the aggregation state. AIE FP intra- and intermolecular interactions confer synergistic effects, improving their properties and performance over small molecules aggregation-induced, emission-based fluorescent materials (AIEgens). Despite their outstanding advantages (over classic polymers) of high emission efficiency, signal amplification, good processability, and multiple functionalization, AIE polymers have received less attention. This review examines some of the most significant advances in the broad field of FPs over the last six years, concluding with a general outlook and discussion of future challenges to promote advancements in these promising materials that can serve as a springboard for future innovation in the field.

Selective and self-validating breath-level detection of hydrogen sulfide in humid air by gold nanoparticle-functionalized nanotube arrays

We demonstrate the selective detection of hydrogen sulfide at breath concentration levels under humid airflow, using a self-validating 64-channel sensor array based on semiconducting single-walled carbon nanotubes (sc-SWCNTs). The reproducible sensor fabrication process is based on a multiplexed and controlled dielectrophoretic deposition of sc-SWCNTs. The sensing area is functionalized with gold nanoparticles to address the detection at room temperature by exploiting the affinity between gold and sulfur atoms of the gas. Sensing devices functionalized with an optimized distribution of nanoparticles show a sensitivity of 0.122%/part per billion (ppb) and a calculated limit of detection (LOD) of 3 ppb. Beyond the self-validation, our sensors show increased stability and higher response levels compared to some commercially available electrochemical sensors. The cross-sensitivity to breath gases NH₃ and NO is addressed demonstrating the high selectivity to H₂S. Finally, mathematical models of sensors' electrical characteristics and sensing responses are developed to enhance the differentiation capabilities of the platform to be used in breath analysis applications.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material (details on the dielectrophoretic deposition, AuNP functionalization optimization, full range of experimental and model H₂S sensing response up to 820 ppb, and sensing response to NO gas) is available in the online version of this article at 10.1007/s12274-021-3771-7.

Photoacoustic detection of ammonia exhaled by individuals with chronic kidney disease

Ammonia (NH₃) has been reported as a breath biomarker for chronic kidney disease (CKD) usually detected at concentrations greater than 0.25 parts per million by volume (ppmV). NH₃ was detected in breath of individuals with CKD through gaseous photoacoustic spectroscopy (PAS). The efficiency of hemodialysis (HD) was demonstrated. Eight volunteers aged between 20 and 60 years and without previous respiratory disease were eligible, among which six were control volunteers (CV) and two volunteers with advanced CKD, named CKDV1 and CKDV2. The presence of CKD was confirmed by the calculation of creatinine clearance (CC) according to the Cockcroft-Gault equation. Before HD, the mean NH₃ concentration exhaled by CKDV1 was 0.9 ± 0.1 ppmV and after HD was 0.20 ± 0.03 ppmV, which demonstrated an efficiency of 76% NH₃ reduction in breath. The CKDV2 exhaled 1.27 ± 0.03 ppmV of NH₃ pre-HD and 0.42 ± 0.08 ppmV post-HD, which resulted in efficiency of about 67%. It was not possible to quantify NH₃ from CV, what led us to infer that all of them exhaled amounts below the detection limit, i.e., 0.20 ppmV. This assumption is underpinned by CC, whose values hovered at 90 ≤ CC ≤ 120 mL/ min, confirming normal renal function.

Noninvasive Detection of Ammonia in the Breath of Hemodialysis Patients Using a Highly Sensitive Ammonia Sensor Based on a Polypyrrole/Sulfonated Graphene Nanocomposite

In this work, we fabricated fast-responsive and highly sensitive chemiresistive sensors based on nanocomposites of polypyrrole and graphitic materials such as graphene oxide (GO), reduced graphene oxide (RGO), and sulfonated graphene (SRGO) by an in situ chemical oxidative polymerization method. The synthesized nanocomposites were characterized using field emission scanning electron microscopy (FESEM), energy-dispersive spectroscopy (EDS), Fourier transform infrared (FT-IR) spectroscopy, and X-ray diffraction (XRD). The effects of the operating temperature of different nanocomposites were investigated at four temperatures (28, 40, 50, and 60 °C), and the results were compared with that of the polypyrrole-based sensor. The experimental results for sensors indicate that the proposed PPy/SRGO sensor could be an appropriate choice for NH₃ detection at 28 °C in the range of 0.50 parts per billion (ppb) to 12 parts per million (ppm). The PPy/SRGO nanocomposite gas sensor exhibited fast responsivity, good repeatability, and high chemical selectivity to low-concentration ammonia against humidity, methanol, ethanol, acetone, formaldehyde, dibutylamine, dimethylamine, methylamine, carbon monoxide, and nitrogen oxide at 28 °C. We utilized the PPy/SRGO sensor for studying the variation of the ammonia concentration in hemodialysis (HD) patients' breath before and after dialysis and correlated it with the blood urea nitrogen (BUN) levels. The results of the PPy/SRGO sensor indicated that the breath ammonia concentration significantly decreased after dialysis in agreement with BUN. The results demonstrate the potential application of the PPy/SRGO sensor for noninvasive detection of ammonia in breath and make this type of sensor a promising tool for the diagnosis of renal and liver diseases.

ZENose (ZIF-Based Electrochemical Nose) Platform for Noninvasive Ammonia Detection

Breathomics is a widely emerging tool for noninvasive disease diagnosis and focuses on the detection of various levels of volatile organic compounds and inorganic gases present in human breath. One of the rapid, easy-to-use, and noninvasive detection methods being investigated is a system that can measure exhaled breath ammonia levels and can be correlated to the functional state of protein metabolic pathways and the renal functioning system. In this work, we have demonstrated the development of an electrochemical nose system using ferrocene encapsulated into zeolitic imidazole framework, Fc@ZIF-8, which can be successfully used for the detection of ammonia levels in breath. This is the first report of an electrochemical gas sensor platform that uses a faradaic probe (that is ferrocene) encapsulated into a metal-organic framework cavity used for disease diagnosis by monitoring the levels of the target gas and can be used for breathomics applications. This work demonstrates that low levels of ammonia gas (up to 400 ppb) can be detected with high sensitivity and specificity. The morphological and structural characterization of the novel, synthesized Fc@ZIF-8 nanocomposite has been performed using powder X-ray diffraction, field emission scanning electron microscopy, Fourier transform infrared, ultraviolet-visible spectroscopy, and dynamic light scattering. Electrochemical characterization of the material has been performed using a standard glassy carbon electrode, and further application of the material has been shown using the in-house designed and reported spiral electrochemical notification coupled electrode, used for ammonia gas sensing. Cross-reactivity studies have also been performed to demonstrate sensor specificity toward the target gas. We demonstrate the first of its kind electrochemical bifunctional probe platform that can be used for sensing ammonia levels in breath, with high sensitivity and specificity, due to the hybrid material system-zinc-imidazole framework 8 (having excellent physisorption properties) and ferrocene (acting as a redox mediator). We envision that such a sensing system will allow noninvasive and early diagnosis of chronic kidney disease, thus leading to early treatment and a decrease in the mortality rate.

Exhaled breath analysis in disease detection

Investigating the use of exhaled breath analysis to diagnose and monitor different diseases has attracted much interest in recent years. This review introduces conventionally used methods and some emerging technologies aimed at breath analysis and their relevance to lung disease, airway inflammation, gastrointestinal disorders, metabolic disorders and kidney diseases. One section correlates breath components and specific diseases, whereas the other discusses some unique ideas, strategies, and devices to analyze exhaled breath for the diagnosis of some common diseases. This review aims to briefly introduce the potential application of exhaled breath analysis for the diagnosis and screening of various diseases, thereby providing a new avenue for the detection of non-invasive diseases.

Breath Ammonia Is a Useful Biomarker Predicting Kidney Function in Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is a public health problem and its prevalence has increased worldwide; patients are commonly unaware of the condition. The present study aimed to investigate whether exhaled breath ammonia via vertical-channel organic semiconductor (V-OSC) sensor measurement could be used for rapid CKD screening. We enrolled 121 CKD stage 1–5 patients, including 19 stage 1 patients, 26 stage 2 patients, 38 stage 3 patients, 21 stage 4 patients, and 17 stage 5 patients, from July 2019 to January 2020. Demographic and laboratory data were recorded. The exhaled ammonia was collected and rapidly measured by the V-OSC sensor to correlate with kidney function. Results showed no significant difference in age, sex, body weight, hemoglobin, albumin level, and comorbidities in different CKD stage patients. Correlation analysis demonstrated a good correlation between breath ammonia and blood urea nitrogen levels, serum creatinine levels, and estimated glomerular filtration rate (eGFR). Breath ammonia concentration was significantly elevated with increased CKD stage compared with the previous stage (CKD stage 1/2/3/4/5: 636 ± 94; 1020 ± 120; 1943 ± 326; 4421 ± 1042; 12781 ± 1807 ppb, p < 0.05). The receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.835 (p < 0.0001) for distinguishing CKD stage 1 from other CKD stages at 974 ppb (sensitivity, 69%; specificity, 95%). The AUC was 0.831 (p < 0.0001) for distinguishing between patients with/without eGFR < 60 mL/min/1.73 m² (cutoff 1187 ppb: sensitivity, 71%; specificity, 78%). At 886 ppb, the sensitivity increased to 80% but the specificity decreased to 69%. This value is suitable for kidney function screening. Breath ammonia detection with V-OSC is a real time, inexpensive, and easy to administer measurement device for screening CKD with reliable diagnostic accuracy.

Rapid and Selective NH3 Sensing by Porous CuBr

Fast and selective detection of NH3 at parts-per-billion (ppb) concentrations with inexpensive and low-power sensors represents a long-standing challenge. Here, a room temperature, solid-state sensor is presented consisting of nanostructured porous (78%) CuBr films. These are prepared by flame-aerosol deposition of CuO onto sensor substrates followed by dry reduction and bromination. Each step is monitored in situ through the film resistance affording excellent process control. Such porous CuBr films feature an order of magnitude higher NH3 sensitivity and five times faster response times than conventional denser CuBr films. That way, rapid (within 2.2 min) sensing of even the lowest (e.g., 5 ppb) NH3 concentrations at 90% relative humidity is attained with outstanding selectivity (30-260) over typical confounders including ethanol, acetone, H2, CH4, isoprene, acetic acid, formaldehyde, methanol, and CO, superior to state-of-the-art sensors. This sensor is ideal for hand-held and battery-driven devices or integration into wearable electronics as it does not require heating. From a broader perspective, the process opens exciting new avenues to also explore other bromides and classes of semiconductors (e.g., sulfides, nitrides, carbides) currently not accessible by flame-aerosol technology.

Real-time PCR for direct aptamer quantification on functionalized graphene surfaces

In this study, we develop a real-time PCR strategy to directly detect and quantify DNA aptamers on functionalized graphene surfaces using a Staphylococcus aureus aptamer (SA20) as demonstration case. We show that real-time PCR allowed aptamer quantification in the range of 0.05 fg to 2.5 ng. Using this quantitative technique, it was possible to determine that graphene functionalization with amino modified SA20 (preceded by a graphene surface modification with thionine) was much more efficient than the process using SA20 with a pyrene modification. We also demonstrated that the functionalization methods investigated were selective to graphene as compared to bare silicon dioxide surfaces. The precise quantification of aptamers immobilized on graphene surface was performed for the first time by molecular biology techniques, introducing a novel methodology of wide application.

An Investigation of PS-b-PEO Polymersomes for the Oral Treatment and Diagnosis of Hyperammonemia

Ammonia-scavenging transmembrane pH-gradient poly(styrene)-b-poly(ethylene oxide) polymersomes are investigated for the oral treatment and diagnosis of hyperammonemia, a condition associated with serious neurologic complications in patients with liver disease as well as in infants with urea cycle disorders. While these polymersomes are highly stable in simulated intestinal fluids at extreme bile salt and osmolality conditions, they unexpectedly do not reduce plasmatic ammonia levels in cirrhotic rats after oral dosing. Incubation in dietary fiber hydrogels mimicking the colonic environment suggests that the vesicles are probably destabilized during the dehydration of the intestinal chyme. The findings question the relevance of commonly used simulated intestinal fluids for studying vesicular stability. With the encapsulation of a pH-sensitive dye in the polymersome core, the local pH increase upon ammonia influx could be exploited to assess the ammonia concentration in the plasma of healthy and cirrhotic rats as well as in other fluids. Due to its high sensitivity and selectivity, this polymersome-based assay could prove useful in the monitoring of hyperammonemic patients and in other applications such as drug screening tests.

On-Line Analysis of Exhaled Breath Focus Review

On-line analysis of exhaled breath offers insight into a person's metabolism without the need for sample preparation or sample collection. Due to its noninvasive nature and the possibility to sample continuously, the analysis of breath has great clinical potential. The unique features of this technology make it an attractive candidate for applications in medicine, beyond the task of diagnosis. We review the current methodologies for on-line breath analysis, discuss current and future applications, and critically evaluate challenges and pitfalls such as the need for standardization. Special emphasis is given to the use of the technology in diagnosing respiratory diseases, potential niche applications, and the promise of breath analysis for personalized medicine. The analytical methodologies used range from very small and low-cost chemical sensors, which are ideal for continuous monitoring of disease status, to optical spectroscopy and state-of-the-art, high-resolution mass spectrometry. The latter can be utilized for untargeted analysis of exhaled breath, with the capability to identify hitherto unknown molecules. The interpretation of the resulting big data sets is complex and often constrained due to a limited number of participants. Even larger data sets will be needed for assessing reproducibility and for validation of biomarker candidates. In addition, molecular structures and quantification of compounds are generally not easily available from on-line measurements and require complementary measurements, for example, a separation method coupled to mass spectrometry. Furthermore, a lack of standardization still hampers the application of the technique to screen larger cohorts of patients. This review summarizes the present status and continuous improvements of the principal on-line breath analysis methods and evaluates obstacles for their wider application.

Development of low-cost hybrid multi-walled carbon nanotube-based ammonia gas-sensing strips with an integrated sensor read-out system for clinical breath analyzer applications

This work demonstrates the development of Ag@polyaniline/multi-walled carbon nanotube nanocomposite-based sensor strips and a suitable integrated electronic read-out system for the measurement of trace-level concentrations of ammonia (NH₃). The sensor is optimized under various operating conditions and the resulting sensor exhibited an enhanced response (32% for 2 ppm) with excellent selectivity. Stable performance was observed towards NH₃ in the presence of high concentrations of CO₂ (>40 000 ppm), simulated and real breath samples. A suitable electronic sensor read-out system has also been designed and developed based on multi-scale resistance-to-voltage conversion architecture, processed by a 32-bit microcontroller which is operatable over a wide range of sensor resistance (1 kΩ to 200 MΩ). As a proof of concept, integration of gas-sensing strips with the electronic read-out system was tested with various levels of NH₃ (<2 ppm as normal, >2 ppm as critical and 2 ppm as threshold), which is important for clinical breath analyzer applications. The developed prototype device can be readily incorporated into a portable, low-cost and non-invasive point-of-care breath NH₃ detection unit for portable pre-diagnostic breath analyzer applications.

A Versatile Method to Enhance the Operational Current of Air-Stable Organic Gas Sensor for Monitoring of Breath Ammonia in Hemodialysis Patients

Point-of-care (POC) application for monitoring of breath ammonia (BA) in hemodialysis (HD) patients has emerged as a promising noninvasive health monitoring approach. In this context, many organic gas sensors have been reported for BA detection. However, one of the major challenges for its integration with affordable household POC application is to achieve stable performance for accuracy and high operational current at low voltage for low-cost read-out circuitry. Herein, we exploited the stability of the Donor-Acceptor polymer on the cylindrical nanopore structure to realize the sensors with a high sensitivity and stability. Then, we proposed a double active layer (DL) strategy that exploits an ultrathin layer of Poly(3-hexylthiophene-2,5-diyl) (P3HT) to serve as a work function buffer to enhance the operational current. The DL sensor exhibits a sustainable enhanced operational current of microampere level and a stable sensing response even with the presence of P3HT layer. This effect is carefully examined with different aspects, including vertical composition profile of DL configuration, lifetime testing on different sensing layer, morphological analysis, and the versatility of the DL strategy. Finally, we utilize the DL sensor to conduct a tracing of BA concentration in two HD patients before and after HD, and correlate it with the blood urea nitrogen (BUN) levels. A good correlation coefficient of 0.96 is achieved. Moreover, the feasibility of DL sensor integrated into a low-cost circuitry was also verified. The results demonstrate the potential of this DL strategy to be used to integrate organic sensor for affordable household POC devices.

Breath Sensors for Health Monitoring

Breath sensors can revolutionize medical diagnostics by on-demand detection and monitoring of health parameters in a noninvasive and personalized fashion. Despite extensive research for more than two decades, however, only a few breath sensors have been translated into clinical practice. Actually, most never even left the scientific laboratories. Here, we describe key challenges that currently impede realization of breath sensors and highlight strategies to overcome them. Specifically, we start with breath marker selection (with emphasis on metabolic and inflammatory markers) and breath sampling. Next, the sensitivity, stability, and selectivity requirements for breath sensors are described. Concepts are elaborated to systematically address these requirements by material design (focusing on chemoresistive metal oxides), orthogonal arrays, and filters. Finally, aspects of portable device integration, user communication, and clinical applicability are discussed.

Highly sensitive ammonia sensor for diagnostic purpose using reduced graphene oxide and conductive polymer

In this study, we fabricate ammonia sensors based on hybrid thin films of reduced graphene oxide (RGO) and conducting polymers using the Langmuir-Schaefer (LS) technique. The RGO is first prepared using hydrazine (Hy) and/or pyrrole (Py) as the reducing agents, and the resulting pyrrole-reduced RGO (Py-RGO) is then hybridized with polyaniline (PANI) and/or polypyrrole (PPy) by in-situ polymerization. The four different thin films of Hy-RGO, Py-RGO, Py-RGO/PANI, and Py-RGO/PPy are deposited on interdigitated microelectrodes by the LS techniques, and their structures are characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). The results of ammonia sensing experiments indicate that the Py-RGO/PANI film exhibits the highest sensor response of these four films, and that it exhibits high reproducibility, high linearity of concentration dependency, and a very low detection limit (0.2 ppm) both in N₂ and exhaled air environments. The current gas sensor, therefore, has potential for diagnostic purposes because it has the additional advantages of facile fabrication, ease of use at room temperature, and portability compared to conventional high-sensitivity ammonia sensors.

Indium Nitrite (InN)-Based Ultrasensitive and Selective Ammonia Sensor Using an External Silicone Oil Filter for Medical Application

Ammonia is an essential biomarker for noninvasive diagnosis of liver malfunction. Therefore, selective detection of ammonia is essential for medical application. Here, we demonstrate a portable device to selectively detect sub-ppm ammonia gas. The presented gas sensor is composed of a Pt coating on top of an ultrathin Indium nitrite (InN) epilayer with a lower detection limit of 0.2 ppm, at operating temperature of 200 °C, and detection time of 1 min. The sensor connected with the external filter of nonpolar 500 CS silicone oil to diagnose liver malfunction. The absorption of 0.7 ppm acetone and 0.4 ppm ammonia gas in 10 cc silicone oil is 80% (0.56 ppm) and 21.11% (0.084 ppm), respectively, with a flow rate of 10 cc/min at 25 °C. The absorption of acetone gas is 6.66-fold higher as compared to ammonia gas. The percentage variation in response for 0.7 ppm ammonia and 0.7 ppm acetone with and without silicone oil on InN sensor is 17.5% and 4%, and 22.5%, and 14% respectively. Furthermore, the percentage variation in response for 0.7 ppm ammonia gas with silicone oil on InN sensor is 4.3-fold higher than that of 0.7 ppm acetone. The results show that the InN sensor is suitable for diagnosis of liver malfunction.

Developments to monitor the exhalome in organ failure in critically ill patients-a look into the future

Critically ill patients typically need some kind of functional organ support or replacement. Cardiopulmonary and renal replacement therapies are well established measures in intensive care units. However, there are also inherent risks associated with these treatments. The appropriate and timely commencement, maintenance and termination of organ replacement procedures currently use weak surrogates as decision support in clinical practice. A more reasonable application of extracorporeal organ support can be expected to potentially lower adverse events and save costs in healthcare systems, if a precise online monitoring was available. The analysis of the exhalome offers great opportunities to detect circulatory, pulmonary, and renal failure in critically ill patients. Volatile organic compounds and exhalation patterns are associated with a series of metabolic disorders and may be key to indicate the appropriate time point for initiation, maintenance and termination of organ support technologies. It may thus be expected that mortality, infection risk, replacement therapy days, and medical costs of intensive care treatment may possibly be reduced using exhalome analysis for control of organ replacement therapies in the distant future.

A Reduced GO-Graphene Hybrid Gas Sensor for Ultra-Low Concentration Ammonia Detection

A hybrid structure gas sensor of reduced graphene oxide (RGO) decorated graphene (RGO-Gr) is designed for ultra-low concentration ammonia detection. The resistance value of the RGO-Gr hybrid is the indicator of the ammonia concentration and controlled by effective charge transport from RGO to graphene after ammonia molecule adsorption. In this hybrid material, RGO is the adsorbing layer to catch ammonia molecules and graphene is the conductive layer to effectively enhance charge/electron transport. Compared to a RGO gas sensor, the signal-to-noise ratio (SNR) of the RGO-Gr is increased from 22 to 1008. Meanwhile, the response of the RGO-Gr gas sensor is better than that of either a pristine graphene or RGO gas sensor. It is found that the RGO reduction time is related to the content of functional groups that directly reflect on the gas sensing properties of the sensor. The RGO-Gr gas sensor with 10 min reduction time has the best gas sensing properties in this type of sensor. The highest sensitivity is 2.88% towards 0.5 ppm, and the ammonia gas detection limit is calculated to be 36 ppb.

Miniaturized Bio-and Chemical-Sensors for Point-of-Care Monitoring of Chronic Kidney Diseases

This review reports the latest achievements in point-of-care (POC) sensor technologies for the monitoring of ammonia, creatinine and urea in patients suffering of chronic kidney diseases (CKDs). Abnormal levels of these nitrogen biomarkers are found in the physiological fluids, such as blood, urine and sweat, of CKD patients. Delocalized at-home monitoring of CKD biomarkers via integration of miniaturized, portable, and low cost chemical- and bio-sensors in POC devices, is an emerging approach to improve patients’ health monitoring and life quality. The successful monitoring of CKD biomarkers, performed on the different body fluids by means of sensors having strict requirements in term of size, cost, large-scale production capacity, response time and simple operation procedures for use in POC devices, is reported and discussed.

What is the real utility of breath ammonia concentration measurements in medicine and physiology?

Much effort continues to be devoted to the development of devices to analyse breath ammonia with the anticipation that breath ammonia analyses will be useful in clinical practice. In this perspective we refer to the analytical techniques that have been used to measure breath ammonia, focusing on selected ion flow tube mass spectrometry, SIFT-MS, of which we have special knowledge and understanding. From the collected data obtained using the different techniques, we exam the origins of mouth- and nose-exhaled ammonia and conclude that mouth-exhaled ammonia is always elevated above a concentration that would be equilibrated with blood ammonia and is largely produced by the action of enzymes on salivary urea. Support to this conclusion is given by the reasonable correlation between blood urea concentration and mouth-exhaled ammonia concentration. Further, it is discussed that nose-exhaled ammonia largely originates at the alveolar interface and so its concentration more closely relates to the expected alveolar blood ammonia concentration. Ingestion of proteins results in increased blood/saliva urea and ultimately mouth-exhaled ammonia as does the generation of urease by H. pylori infection. It is also concluded that when mouth-exhaled ammonia is elevated then it may be due to either abnormally high blood urea, a high pH of the saliva/mouth/airways mucosa, poor oral hygiene or a combinations of these.

Organic Gas Sensor with an Improved Lifetime for Detecting Breath Ammonia in Hemodialysis Patients

In this work, a TFB (poly[(9,9-dioctylfluorenyl-2,7-diyl)-co-(4,4'-(N-(4-s-butylphenyl)diphenylamine)]) sensor with a cylindrical nanopore structure exhibits a high sensitivity to ammonia in ppb-regime. The lifetime and sensitivity of the TFB sensor were studied and compared to those of P3HT (poly(3-hexylthiophene)), NPB (N,N'-di(1-naphthyl)-N,N'-diphenyl-(1,1'-biphenyl)-4,4'-diamine), and TAPC (4,4'-cyclohexylidenebis[N,N-bis(4-methylphenyl) benzenamine]) sensors with the same cylindrical nanopore structures. The TFB sensor outstands the others in sensitivity and lifetime and it shows a sensing response (current variation ratio) of 13% to 100 ppb ammonia after 64 days of storage in air. A repeated sensing periods testing and a long-term measurement have also been demonstrated for the test of robustness. The performance of the TFB sensor is stable in both tests, which reveals that the TFB sensor can be utilized in our targeting clinical trials. In the last part of this work, we study the change of ammonia concentration in the breath of hemodialysis (HD) patients before and after dialysis. An obvious drop of breath ammonia concentration can be observed after dialysis. The reduction of breath ammonia is also correlated with the reduction of blood urea nitrogen (BUN). A correlation coefficient of 0.82 is achieved. The result implies that TFB sensor may be used as a real-time and low cost breath ammonia sensor for the daily tracking of hemodialysis patients.

Noninvasive Body Fat Burn Monitoring from Exhaled Acetone with Si-doped WO3-sensing Nanoparticles

Obesity is a global health threat on the rise, and its prevalence continues to grow. Yet suitable biomedical sensors to monitor body fat burn rates in situ, to guide physical activity or dietary interventions toward efficient weight loss, are missing. Here, we introduce a compact and inexpensive breath acetone sensor based on Si-doped WO₃ nanoparticles that can accurately follow body fat burn rates in real time. We tested this sensor on 20 volunteers during exercise and rest and measured their individual breath acetone concentrations in good agreement with benchtop proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS). During exercise, this sensor reveals clearly the onset and progression of increasing breath acetone levels that indicate intensified body fat metabolism, as validated by parallel venous blood β-hydroxybutyrate (BOHB) measurements. Most importantly, we found that the body fat metabolism was especially pronounced for most volunteers during fasting for 3 h after exercise, with strong variation between subjects, and this was displayed correctly by the sensor in real-time. As a result, this simple breath acetone sensor enables easily applicable and hand-held body fat burn monitoring for personalized and immediate feedback on workout effectiveness that can guide dieting as well.

Exhaled volatile substances mirror clinical conditions in pediatric chronic kidney disease

Monitoring metabolic adaptation to chronic kidney disease (CKD) early in the time course of the disease is challenging. As a non-invasive technique, analysis of exhaled breath profiles is especially attractive in children. Up to now, no reports on breath profiles in this patient cohort are available. 116 pediatric subjects suffering from mild-to-moderate CKD (n = 48) or having a functional renal transplant KTx (n = 8) and healthy controls (n = 60) matched for age and sex were investigated. Non-invasive quantitative analysis of exhaled breath profiles by means of a highly sensitive online mass spectrometric technique (PTR-ToF) was used. CKD stage, the underlying renal disease (HUS; glomerular diseases; abnormalities of kidney and urinary tract or polycystic kidney disease) and the presence of a functional renal transplant were considered as classifiers. Exhaled volatile organic compound (VOC) patterns differed between CKD/ KTx patients and healthy children. Amounts of ammonia, ethanol, isoprene, pentanal and heptanal were higher in patients compared to healthy controls (556, 146, 70.5, 9.3, and 5.4 ppbV vs. 284, 82.4, 49.6, 5.30, and 2.78 ppbV). Methylamine concentrations were lower in the patient group (6.5 vs 10.1 ppbV). These concentration differences were most pronounced in HUS and kidney transplanted patients. When patients were grouped with respect to degree of renal failure these differences could still be detected. Ammonia accumulated already in CKD stage 1, whereas alterations of isoprene (linked to cholesterol metabolism), pentanal and heptanal (linked to oxidative stress) concentrations were detectable in the breath of patients with CKD stage 2 to 4. Only weak associations between serum creatinine and exhaled VOCs were noted. Non-invasive breath testing may help to understand basic mechanisms and metabolic adaptation accompanying progression of CKD. Our results support the current notion that metabolic adaptation occurs early during the time course of CKD.

Recent analytical approaches to detect exhaled breath ammonia with special reference to renal patients

The ammonia odor from the exhaled breath of renal patients is associated with high levels of blood urea nitrogen. Typically, in the liver, ammonia and ammonium ions are converted into urea through the urea cycle. In the case of renal dysfunction, urea is unable to be removed and that causes a buildup of excessive ammonia. As small molecules, ammonia and ammonium ions can be forced into the blood-lung barrier and occur in exhaled breath. Therefore, people with renal failure have an ammonia (fishy) odor in their exhaled breath. Thus, exhaled breath ammonia can be a potential biomarker for monitoring renal diseases during hemodialyis. In this review, we have summarized the source of ammonia in the breath of end-stage renal disease patient, cause of renal disorders, exhaled breath condensate, and breath sampling. Further, various biosensor approaches to detect exhaled ammonia from renal patients and other ammonia systems are also discussed. We conclude with future perspectives, namely colorimetric-based real-time breathing diagnosis of renal failure, which might be useful for prospective studies.

The Measurement of Ammonia in Human Breath and its Potential in Clinical Diagnostics

Ammonia is an important component of metabolism and is involved in many physiological processes. During normal physiology, levels of blood ammonia are between 11 and 50 µM. Elevated blood ammonia levels are associated with a variety of pathological conditions such as liver and kidney dysfunction, Reye's syndrome and a variety of inborn errors of metabolism including urea cycle disorders (UCD), organic acidaemias and hyperinsulinism/hyperammonaemia syndrome in which ammonia may reach levels in excess of 1 mM. It is highly neurotoxic and so effective measurement is critical for assessing and monitoring disease severity and treatment. Ammonia is also a potential biomarker in exercise physiology and studies of drug metabolism. Current ammonia testing is based on blood sampling, which is inconvenient and can be subject to significant analytical errors due to the quality of the sample draw, its handling and preparation for analysis. Blood ammonia is in gaseous equilibrium with the lungs. Recent research has demonstrated the potential use of breath ammonia as a non-invasive means of measuring systemic ammonia. This requires measurement of ammonia in real breath samples with associated temperature, humidity and gas characteristics at concentrations between 50 and several thousand parts per billion. This review explores the diagnostic applications of ammonia measurement and the impact that the move from blood to breath analysis could have on how these processes and diseases are studied and managed.

Simple and inexpensive quantification of ammonia in whole blood

Quantification of ammonia in whole blood has applications in the diagnosis and management of many hepatic diseases, including cirrhosis and rare urea cycle disorders, amounting to more than 5 million patients in the United States. Current techniques for ammonia measurement suffer from limited range, poor resolution, false positives or large, complex sensor set-ups. Here we demonstrate a technique utilizing inexpensive reagents and simple methods for quantifying ammonia in 100 μL of whole blood. The sensor comprises a modified form of the indophenol reaction, which resists sources of destructive interference in blood, in conjunction with a cation-exchange membrane. The presented sensing scheme is selective against other amine containing molecules such as amino acids and has a shelf life of at least 50 days. Additionally, the resulting system has high sensitivity and allows for the accurate reliable quantification of ammonia in whole human blood samples at a minimum range of 25 to 500 μM, which is clinically for rare hyperammonemic disorders and liver disease. Furthermore, concentrations of 50 and 100 μM ammonia could be reliably discerned with p = 0.0001.