Signal-Enhanced Detection of Multiplexed Cardiac Biomarkers by a Paper-Based Fluorogenic Immunodevice Integrated with Zinc Oxide Nanowires

Principles and Applications of ZnO Nanomaterials in Optical Biosensors and ZnO Nanomaterial-Enhanced Biodetection

Significant research accomplishments have been made so far for the development and application of ZnO nanomaterials in enhanced optical biodetection. The unparalleled optical properties of ZnO nanomaterials and their reduced dimensionality have been successfully exploited to push the limits of conventional optical biosensors and optical biodetection platforms for a wide range of bioanalytes. ZnO nanomaterial-enabled advancements in optical biosensors have been demonstrated to improve key sensor performance characteristics such as the limit of detection and dynamic range. In addition, all nanomaterial forms of ZnO, ranging from 0-dimensional (0D) and 1D to 2D nanostructures, have been proven to be useful, ensuring their versatile fabrication into functional biosensors. The employment of ZnO as an essential biosensing element has been assessed not only for ensembles but also for individual nanomaterials, which is advantageous for the realization of high miniaturization and minimal invasiveness in biosensors and biodevices. Moreover, the nanomaterials' incorporations into biosensors have been shown to be useful and functional for a variety of optical detection modes, such as absorption, colorimetry, fluorescence, near-band-edge emission, deep-level emission, chemiluminescence, surface evanescent wave, whispering gallery mode, lossy-mode resonance, surface plasmon resonance, and surface-enhanced Raman scattering. The detection capabilities of these ZnO nanomaterial-based optical biosensors demonstrated so far are highly encouraging and, in some cases, permit quantitative analyses of ultra-trace level bioanalytes that cannot be measured by other means. Hence, steady research endeavors are expected in this burgeoning field, whose scientific and technological impacts will grow immensely in the future. This review provides a timely and much needed review of the research efforts made in the field of ZnO nanomaterial-based optical biosensors in a comprehensive and systematic manner. The topical discussions in this review are organized by the different modes of optical detection listed above and further grouped by the dimensionality of the ZnO nanostructures used in biosensors. Following an overview of a given optical detection mode, the unique properties of ZnO nanomaterials critical to enhanced biodetection are presented in detail. Subsequently, specific biosensing applications of ZnO nanomaterials are discussed for ~40 different bioanalytes, and the important roles that the ZnO nanomaterials play in bioanalyte detection are also identified.

A surface molecularly imprinted microfluidic paper based device with smartphone assisted colorimetric detection for butachlor in mung bean

A microfluidic paper chip colorimetric detection system based on surface molecular imprinting of zinc ferrite nanoparticles was established, and the detection images were obtained by smartphone for gray value analysis and determination of butachlor. The best functional monomers and addition ratio were selected by quantum chemical simulation calculation, the properties of the prepared molecularly imprinted polymers were analyzed, and the detection conditions were optimized. The linear range, sensitivity, and selectivity of the method were evaluated. The results showed that under the optimum conditions, the concentration of 2-80 ng/g had a good linear relationship (R2 is 0.9953), the detection limit was 1.43 ng/g, the specificity was good, and the whole detection process did not exceed 20 min. The microfluidic paper chip was applied to detect butachlor in mung bean samples. The results showed that the recovery was 93.4-106.4 %, and the relative standard deviation was less than 5.6 %.

A multiplexed immunochemical microarray for the determination of cardiovascular disease biomarkers

A fluorescence antibody microarray has been developed for the determination of relevant cardiovascular disease biomarkers for the analysis of human plasma samples. Recording characteristic protein molecular fingerprints to assess individual's states of health could allow diagnosis to go beyond the simple identification of the disease, providing information on its stage or prognosis. Precisely, cardiovascular diseases (CVDs) are complex disorders which involve different degenerative processes encompassing a collection of biomarkers related to disease progression or stage. The novel approach that we propose is a fluorescent microarray chip has been developed accomplishing simultaneous determination of the most significant cardiac biomarkers in plasma aiming to determine the CVD status stage of the patient. As proof of concept, we have chosen five relevant biomarkers, C-reactive protein (CRP) as biomarker of inflammation, cystatin C (CysC) as biomarker of renal failure that is directly related with heart failure, cardiac troponin I (cTnI) as already established biomarker for cardiac damage, heart fatty acid binding protein as biomarker of ischemia (H-FABP), and finally, NT-proBNP (N-terminal pro-brain natriuretic peptide), a well-established heart failure biomarker. After the optimization of the multiplexed microarray, the assay allowed the simultaneous determination of 5 biomarkers in a buffer solution reaching LODs of 15 ± 5, 3 ± 1, 24 ± 3, 25 ± 3, and 3 ± 1 ng mL-1, for CRP, CysC, H-FABP, cTnI, and NT-proBNP, respectively. After solving the matrix effect, and demonstrating the accuracy for each biomarker, the chip was able to determine 24 samples per microarray chip. Then, the microarray has been used on a small pilot clinical study with 29 plasma samples from clinical patients which suffered different CVD and other related disorders. Results show the superior capability of the chip to provide clinical information related to the disease in terms of turnaround time (1 h 30 min total assay and measurement) and amount of information delivered in respect to reference technologies used in hospital laboratories (clinical analyzers). Despite the failure to detect c-TnI at the reported threshold, the microarray technology could be a powerful approach to diagnose the cardiovascular disease at early stage, monitor its progress, and eventually providing information about an eminent potential risk of suffering a myocardial infarction. The microarray chip here reported could be the starting point for achieving powerful multiplexed diagnostic technologies for the diagnosis of CVDs or any other pathology for which biomarkers have been identified at different stages of the disease.

Deep Learning-Enabled Multiplexed Point-of-Care Sensor using a Paper-Based Fluorescence Vertical Flow Assay

Multiplexed computational sensing with a point-of-care serodiagnosis assay to simultaneously quantify three biomarkers of acute cardiac injury is demonstrated. This point-of-care sensor includes a paper-based fluorescence vertical flow assay (fxVFA) processed by a low-cost mobile reader, which quantifies the target biomarkers through trained neural networks, all within <15 min of test time using 50 µL of serum sample per patient. This fxVFA platform is validated using human serum samples to quantify three cardiac biomarkers, i.e., myoglobin, creatine kinase-MB, and heart-type fatty acid binding protein, achieving less than 0.52 ng mL-1 limit-of-detection for all three biomarkers with minimal cross-reactivity. Biomarker concentration quantification using the fxVFA that is coupled to neural network-based inference is blindly tested using 46 individually activated cartridges, which shows a high correlation with the ground truth concentrations for all three biomarkers achieving >0.9 linearity and <15% coefficient of variation. The competitive performance of this multiplexed computational fxVFA along with its inexpensive paper-based design and handheld footprint makes it a promising point-of-care sensor platform that can expand access to diagnostics in resource-limited settings.

Advances in paper based isothermal nucleic acid amplification tests for water-related infectious diseases

Water-associated or water-related infectious disease outbreaks are caused by pathogens such as bacteria, viruses, and protozoa, which can be transmitted through contaminated water sources, poor sanitation practices, or insect vectors. Low- and middle-income countries bear the major burden of these infections due to inadequate hygiene and subpar laboratory facilities, making it challenging to monitor and detect infections in a timely manner. However, even developed countries are not immune to these diseases, as inadequate wastewater management and contaminated drinking water supplies can also contribute to disease outbreaks. Nucleic acid amplification tests have proven to be effective for early disease intervention and surveillance of both new and existing diseases. In recent years, paper-based diagnostic devices have made significant progress and become an essential tool in detecting and managing water-associated diseases. In this review, we highlight the importance of paper and its variants as a diagnostic tool and discuss the properties, design modifications, and various paper-based device formats developed and used for detecting water-associated pathogens.

MnO4--Triggered Immediate-Stable Real-Time Fluorescence Immunosensor with High Response Speed and Low Steady-State Error

Real-time chemical and biological sensing in vitro is important for application in health and environmental monitoring. Thus, a more rapid and stable detection method is urgently needed. Herein, an immediate-stable real-time fluorescent immunosensor with a high response speed (∼100%, <1 s) and approximately zero steady-state error is constructed. The developed sensor is based on the MnO₄^--triggered in situ immediate-stable fluorogenic reaction between dopamine and orcinol monohydrate to produce azamonardine (DMTM). The obtained DMTM is identified and characterized by high-resolution mass spectrometry, ¹H NMR spectroscopy, ¹³C NMR spectroscopy, and theoretical calculations. The present sensor achieves a highly sensitive detection of dopamine (DA) with a limit of detection (LOD) of 10 nM as well as alkaline phosphates (ALP) with an LOD of 0.1 mU/mL by using orcinol monohydrate phosphate sodium salt as a substrate. As a proof of concept, ALP-triggered fluorescence ELISA using cardiac troponin I (cTnI) as a model antigen target is further constructed. The developed real-time sensor achieves the detection of cTnI with an LOD of 0.05 ng/mL. Moreover, the sensor proposed by us is successfully applied to assess the cTnI level in clinical serum specimens and yields results consistent with those obtained by the commercial ELISA method. The immediate-stable real-time fluorescence immunosensor provides a promising and powerful platform for the trace detection of biomolecules in clinical diagnosis.

Microwave-assisted synthesis of blue fluorescent molybdenum nanoclusters with maltose-cysteine Schiff base for detection of myoglobin and γ-aminobutyric acid in biofluids

The fabrication of stable fluorescent MoNCs (molybdenum nanoclusters) in aqueous media is quite challenging as it is not much explored yet. Herein, we report a facile and efficient strategy for fabricating MoNCs using 2,3 dialdehyde maltose-cysteine Schiff base (DAM-cysteine) as a ligand for detecting myoglobin and γ-aminobutyric acid (GABA) in biofluids with high selectivity and sensitivity. The DAM-cysteine-MoNCs displayed fluorescence of bright blue color under a UV light at 365 nm with an emission peak at 444 nm after excitation at 370 nm. The synthesized DAM-cysteine-MoNCs were homogeneously distributed with a mean size of 2.01 ± 0.98 nm as confirmed by the high-resolution transmission electron microscopy (HR-TEM). Further, X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared (FT-IR) techniques were utilized to confirm the elemental oxidation states and surface functional groups of the DAM-cysteine-MoNCs. After the addition of myoglobin and GABA, the emission peak of DAM-cysteine-MoNCs at 444 nm was significantly quenched. This resulted in the development of a quantitative assay for the detection of myoglobin (0.1-0.5 μM) and GABA (0.125-2.5 μM) with the lower limit of detection as 56.48 and 112.75 nM for myoglobin and GABA, respectively.

DNA Tetrahedron-Based Valency Controlled Signal Probes for Tunable Protein Detection

Combined detection of multiple markers related to the same disease could improve the accuracy of disease diagnosis. However, the abundance levels of multiple markers of the same disease varied widely in real samples, making it difficult for the traditional detection method to meet the requirements of a wide detection range. Herein, three kinds of cardiac biomarkers, cardiac troponin I (cTnI), myoglobin (Myo), and C-reaction protein (CRP), which were from the pM level to the μM level in real samples, were selected as model targets. Valency-controlled signal probes based on DNA tetrahedron nanostructures (DTNs) and platinum nanoparticles (PtNPs) were constructed for tunable cardiac biomarker detection. PtNPs with high horseradish peroxidase-like activity and stability served as signal molecules, and DTNs with unique spatial structure and sequence specificity were used for precisely controlling the number of connected PtNPs. By controlling the number of PtNPs connected to DTNs, monovalent, bivalent, and trivalent signal probes were obtained and were used for the detection of cardiac markers in different concentration ranges. The limit of detection of cTnI, Myo, and CRP was 3.0 pM, 0.4 nM, and 6.7 nM, respectively. Furthermore, it performed satisfactorily for the detection of cardiac markers in 10% human serum. It was anticipated that the design of valency-controlled signal probes based on DTNs and nanozymes could be extended to the construction of other multi-target detection platforms, thus providing a basis for the development of a new precision medical detection platform.

Microfluidic Paper-Based Device for Medicinal Diagnosis

BACKGROUND

The demand for point-of-care testing (POCT) devices has rapidly grown since they offer immediate test results with ease of use, makingthem suitable for home self-testing patients and caretakers. However, the POCT development has faced the challenges of increased cost and limited resources. Therefore, the paper substrate as a low-cost material has been employed to develop a cost-effective POCT device, known as "Microfluidic paper-based analytical devices (μPADs)". This device is gaining attention as a promising tool for medicinal diagnostic applications owing to its unique features of simple fabrication, low cost, enabling manipulation flow (capillarydriven flow), the ability to store reagents, and accommodating multistep assay requirements.

OBJECTIVE

This review comprehensively examines the fabrication methods and device designs (2D/3D configuration) and their advantages and disadvantages, focusing on updated μPADs applications for motif identification.

METHODS

The evolution of paper-based devices, starting from the traditional devices of dipstick and lateral flow assay (LFA) with μPADs, has been described. Patterned structure fabrication of each technique has been compared among the equipment used, benefits, and drawbacks. Microfluidic device designs, including 2D and 3D configurations, have been introduced as well as their modifications. Various designs of μPADs have been integrated with many powerful detection methods such as colorimetry, electrochemistry, fluorescence, chemiluminescence, electrochemiluminescence, and SER-based sensors for medicinal diagnosis applications.

CONCLUSION

The μPADs potential to deal with commercialization in terms of the state-of-the-art of μPADs in medicinal diagnosis has been discussed. A great prototype, which is currently in a reallife application breakthrough, has been updated.

Machine Learning-Based Quantification of (-)-trans-Δ-Tetrahydrocannabinol from Human Saliva Samples on a Smartphone-Based Paper Microfluidic Platform

(-)-trans-Δ-Tetrahydrocannabinol (THC) is a major psychoactive component in cannabis. Despite the recent trends of THC legalization for medical or recreational use in some areas, many THC-driven impairments have been verified. Therefore, convenient, sensitive, quantitative detection of THC is highly needed to improve its regulation and legalization. We demonstrated a biosensor platform to detect and quantify THC with a paper microfluidic chip and a handheld smartphone-based fluorescence microscope. Microfluidic competitive immunoassay was applied with anti-THC-conjugated fluorescent nanoparticles. The smartphone-based fluorescence microscope counted the fluorescent nanoparticles in the test zone, achieving a 1 pg/mL limit of detection from human saliva samples. Specificity experiments were conducted with cannabidiol (CBD) and various mixtures of THC and CBD. No cross-reactivity to CBD was found. Machine learning techniques were also used to quantify the THC concentrations from multiple saliva samples. Multidimensional data were collected by diluting the saliva samples with saline at four different dilutions. A training database was established to estimate the THC concentration from multiple saliva samples, eliminating the sample-to-sample variations. The classification algorithms included k-nearest neighbor (k-NN), decision tree, and support vector machine (SVM), and the SVM showed the best accuracy of 88% in estimating six different THC concentrations. Additional validation experiments were conducted using independent validation sample sets, successfully identifying positive samples at 100% accuracy and quantifying the THC concentration at 80% accuracy. The platform provided a quick, low-cost, sensitive, and quantitative point-of-care saliva test for cannabis.

Simple, Skin-Attachable, and Multifunctional Colorimetric Sweat Sensor

In situ analysis of sweat provides a simple, convenient, cost-effective, and noninvasive approach for the early diagnosis of physical illness in humans and is particularly useful in family care. In this study, a flexible and skin-attachable colorimetric sweat sensor for multiplexed analysis is developed using a simple, cost-effective, and convenient method. The obtained sweat sensor can be used to simultaneously detect glucose, lactate, urea, and pH value in sweat, as well as sweat loss and skin temperature. Only 2.5 μL of sweat is enough for the whole test, and the sweat loss and chemical-sensing results can be read out conveniently by naked eyes or a smartphone. In addition, body temperature can also be detected with an additional electrical circuit. Our sweat sensor provides a new, cost-effective, and convenient approach for in vitro diagnosis of multiple components in sweat, and the easy fabrication and cost-effectiveness make our sensor commercializable in the near future.

Microfluidic Paper-Based Analytical Devices for the Determination of Food Contaminants: Developments and Applications

Food safety is an issue that cannot be ignored at any time because of the great impact of food contaminants on people's daily life, social production, and the economy. Because of the extensive demand for high-quality food, it is necessary to develop rapid, reliable, and efficient devices for food contaminant detection. Microfluidic paper-based analytical devices (μPADs) have been applied in a variety of detection fields owing to the advantages of low-cost, ease of handling, and portability. This review systematically discusses the latest progress of μPADs, including the fundamentals of fabrication as well as applications in the detection of chemical and biological hazards in foods, hoping to provide suitable screening strategies for contaminants in foods and accelerating the technology transformation of μPADs from the lab into the field.

Modification of Microfluidic Paper-Based Devices with an Oxidant Layer for Distance Readout of Reducing Substances

We developed a novel strategy for modification of paper cellulose with water-insoluble oxidants for distance readout of reducing substances on microfluidic paper-based analytical devices (μPADs). Water-insoluble oxidants were formed and modified onto paper cellulose through the redox reaction that occurred between paper cellulose and potassium permanganate deposited on the paper channel, developing a yellowish-brown color on the channel. As aqueous solutions containing reducing substances flowed along the channel, reducing substances were consumed owing to the redox reaction that occurred between oxidants and reducing substances until the reducing substances were depleted, forming a discolored zone on the yellowish-brown channel. The redox reaction between insoluble oxidants and reducing substances on the paper cellulose could be used for distance-based detection of a wide variety of reducing substances, which is similar to the classical potassium permanganate titration that employs the redox reaction that occurred between potassium permanganate and reducing substances. We believe that this method will broaden the analytical applications of distance-based detection on μPADs. This method was applied to ascorbic acid assay and captopril assay in real samples with analytical results comparing well with the labeled values, demonstrating its great potential in real sample analysis.

Current Advancements and Future Road Map to Develop ASSURED Microfluidic Biosensors for Infectious and Non-Infectious Diseases

Better diagnostics are always essential for the treatment and prevention of a disease. Existing technologies for detecting infectious and non-infectious diseases are mostly tedious, expensive, and do not meet the World Health Organization's (WHO) ASSURED (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverable to end user) criteria. Hence, more accurate, sensitive, and faster diagnostic technologies that meet the ASSURED criteria are highly required for timely and evidenced-based treatment. Presently, the diagnostics industry is finding interest in microfluidics-based biosensors, as this integration comprises all qualities, such as reduction in the size of the equipment, rapid turnaround time, possibility of parallel multiple analysis or multiplexing, etc. Microfluidics deal with the manipulation/analysis of fluid within micrometer-sized channels. Biosensors comprise biomolecules immobilized on a physicochemical transducer for the detection of a specific analyte. In this review article, we provide an outline of the history of microfluidics, current practices in the selection of materials in microfluidics, and how and where microfluidics-based biosensors have been used for the diagnosis of infectious and non-infectious diseases. Our inclination in this review article is toward the employment of microfluidics-based biosensors for the improvement of already existing/traditional methods in order to reduce efforts without compromising the accuracy of the diagnostic test. This article also suggests the possible improvements required in microfluidic chip-based biosensors in order to meet the ASSURED criteria.

Multilayered Mesoporous Composite Nanostructures for Highly Sensitive Label-Free Quantification of Cardiac Troponin-I

Cardiac troponin-I (cTnI) is a well-known biomarker for the diagnosis and control of acute myocardial infarction in clinical practice. To improve the accuracy and reliability of cTnI electrochemical immunosensors, we propose a multilayer nanostructure consisting of Fe₃O₄-COOH labeled anti-cTnI monoclonal antibody (Fe₃O₄-COOH-Ab₁) and anti-cTnI polyclonal antibody (Ab₂) conjugated on Au-Ag nanoparticles (NPs) decorated on a metal–organic framework (Au-Ag@ZIF-67-Ab₂). In this design, Fe₃O₄-COOH was used for separation of cTnI in specimens and signal amplification, hierarchical porous ZIF-67 extremely enhanced the specific surface area, and Au-Ag NPs synergically promoted the conductivity and sensitivity. They were additionally employed as an immobilization platform to enhance antibody loading. Electron microscopy images indicated that Ag-Au NPs with an average diameter of 1.9 ± 0.5 nm were uniformly decorated on plate-like ZIF-67 particles (with average size of 690 nm) without any agglomeration. Several electrochemical assays were implemented to precisely evaluate the immunosensor performance. The square wave voltammetry technique exhibited the best performance with a sensitivity of 0.98 mA mL cm⁻² ng⁻¹ and a detection limit of 0.047 pg mL⁻¹ in the linear range of 0.04 to 8 ng mL⁻¹.

Nanotechnology for cardiovascular diseases

Cardiovascular diseases have become the major killers in today's world, among which coronary artery diseases (CADs) make the greatest contributions to morbidity and mortality. Although state-of-the-art technologies have increased our knowledge of the cardiovascular system, the current diagnosis and treatment modalities for CADs still have limitations. As an emerging cross-disciplinary approach, nanotechnology has shown great potential for clinical use. In this review, recent advances in nanotechnology in the diagnosis of CADs will first be elucidated. Both the sensitivity and specificity of biosensors for biomarker detection and molecular imaging strategies, such as magnetic resonance imaging, optical imaging, nuclear scintigraphy, and multimodal imaging strategies, have been greatly increased with the assistance of nanomaterials. Second, various nanomaterials, such as liposomes, polymers (PLGA), inorganic nanoparticles (AuNPs, MnO2, etc.), natural nanoparticles (HDL, HA), and biomimetic nanoparticles (cell-membrane coating) will be discussed as engineered as drug (chemicals, proteins, peptides, and nucleic acids) carriers targeting pathological sites based on their optimal physicochemical properties and surface modification potential. Finally, some of these nanomaterials themselves are regarded as pharmaceuticals for the treatment of atherosclerosis because of their intrinsic antioxidative/anti-inflammatory and photoelectric/photothermal characteristics in a complex plaque microenvironment. In summary, novel nanotechnology-based research in the process of clinical transformation could continue to expand the horizon of nanoscale technologies in the diagnosis and therapy of CADs in the foreseeable future.

Nanomaterial-assisted microfluidics for multiplex assays

Simultaneous detection of different biomarkers from a single specimen in a single test, allowing more rapid, efficient, and low-cost analysis, is of great significance for accurate diagnosis of disease and efficient monitoring of therapy. Recently, developments in microfabrication and nanotechnology have advanced the integration of nanomaterials in microfluidic devices toward multiplex assays of biomarkers, combining both the advantages of microfluidics and the unique properties of nanomaterials. In this review, we focus on the state of the art in multiplexed detection of biomarkers based on nanomaterial-assisted microfluidics. Following an overview of the typical microfluidic analytical techniques and the most commonly used nanomaterials for biochemistry analysis, we highlight in detail the nanomaterial-assisted microfluidic strategies for different biomarkers. These highly integrated platforms with minimum sample consumption, high sensitivity and specificity, low detection limit, enhanced signals, and reduced detection time have been extensively applied in various domains and show great potential in future point-of-care testing and clinical diagnostics.

Horseradish peroxidase-triggered direct in situ fluorescent immunoassay platform for sensing cardiac troponin I and SARS-CoV-2 nucleocapsid protein in serum

Direct in situ fluorescent enzyme-linked immunosorbent assay (ELISA) is rarely investigated and reported. Herein, a direct in situ high-performance HRP-labeled fluorescent immunoassay platform was constructed. The platform was developed based on a rapid in situ fluorogenic reaction between Polyethyleneimine (PEI) and p-Phenylenediamine (PPD) analogues to generate fluorescent copolymer nanoparticles (FCNPs). The formation mechanism of FCNPs was found to be the oxidation of •OH radicals, which was further proved by nitrogen protection and scavenger of •OH radicals. Meantime, the fluorescence wavelength of FCNPs could be adjusted from 471 to 512 nm by introducing various substitution groups into the PPD structure. Using cardiac troponin I (cTnI) and SARS-CoV-2 nucleocapsid protein (N-protein) as the model antigens, the proposed fluorescent ELISA exhibited a wide dynamic range of 5-180 ng/mL and a low limit of detection (LOD) of 0.19 ng/mL for cTnI, and dynamic range of 0-120 ng/mL and a LOD of 0.33 ng/mL for SARS-CoV-2 N protein, respectively. Noteworthy, the proposed method was successful applied to evaluate the cTnI and SARS-CoV-2 N protein levels in serum with satisfied results. Therefore, the proposed platform paved ways for developing novel fluorescence-based HRP-labeled ELISA technologies and broadening biomarker related clinical diagnostics.

Recent Advances and Applications in Paper-Based Devices for Point-of-Care Testing

Point-of-care testing (POCT), as a portable and user-friendly technology, can obtain accurate test results immediately at the sampling point. Nowadays, microfluidic paper-based analysis devices (μPads) have attracted the eye of the public and accelerated the development of POCT. A variety of detection methods are combined with μPads to realize precise, rapid and sensitive POCT. This article mainly introduced the development of electrochemistry and optical detection methods on μPads for POCT and their applications on disease analysis, environmental monitoring and food control in the past 5 years. Finally, the challenges and future development prospects of μPads for POCT were discussed.

Advances in multiplex electrical and optical detection of biomarkers using microfluidic devices

Microfluidic devices can provide a versatile, cost-effective platform for disease diagnostics and risk assessment by quantifying biomarkers. In particular, simultaneous testing of several biomarkers can be powerful. Here, we critically review work from the previous 4 years up to February 2021 on developing microfluidic devices for multiplexed detection of biomarkers from samples. We focus on two principal approaches: electrical and optical detection methods that can distinguish and quantify biomarkers. Both electrical and spectroscopic multiplexed detection strategies are being employed to reach limits of detection below clinical sample levels. Some of the most promising strategies for point-of-care assays involve inexpensive materials such as paper-based microfluidic devices, or portable and accessible detectors such as smartphones. This review does not comprehensively cover all multiplexed microfluidic biomarker studies, but rather provides a critical evaluation of key work and suggests promising prospects for future advancement in this field. Electrical and optical multiplexing are powerful approaches for microfluidic biomarker analysis.

Rapid synthesis of microwave-assisted zinc oxide nanorods on a paper-based analytical device for fluorometric detection of l-dopa

l-dopa is a catecholamine neurotransmitter used to treat Parkinson's disease. This paper presents a low-cost paper-based biosensor aimed at enhancing the convenience of monitoring l-dopa concentrations. ZnO nanorods (ZnO-NRs) were synthesized on papers in less than 90 min using a microwave-assisted hydrothermal method. The ZnO-NRs amplify green fluorescence signals to enhance the detection sensitivity of l-dopa, best measured at excitation/emission wavelengths of 475/537 nm. We systematically characterized the effect of reaction conditions on the corresponding fluorescence enhancements. The proposed ZnO NRs-paper biosensor presented a ∼3-fold increase in green fluorescence compared to unmodified papers. The linear range of detection for l-dopa was 25-2000 nM, with a limit of detection of 24 nM, which meets the clinical requirements for the monitoring of l-dopa in Parkinson's patients.

Substrate-Induced Growth of Micro/Nanostructured Zn(OH)F Arrays for Highly Sensitive Microfluidic Fluorescence Assays

To date, ZnO array-based microfluidic fluorescence assays have been widely investigated and have exhibited excellent performance in the detection of cancer biomarkers. However, the requirements of highly sensitive detection necessitate further improvement of current Zn-based fluorescence detection devices. Here, a rhombus-like Zn(OH)F array-based microfluidic fluorescence detection device is proposed. Construction of Zn(OH)F arrays on the inner wall of a microchannel is carried out via a microfluidic chemical method. A substrate-induced growth strategy for Zn(OH)F arrays is proposed, and various micro/nanostructured Zn(OH)F arrays are successfully obtained. Zn(OH)F nanorod arrays with a high aspect ratio can be constructed on the columnar ZnO nanorod arrays, and the results indicate that the fluorescence enhancement factor (EF) of the Zn(OH)F arrays toward Cy3 is approximately 4-fold that of the ZnO nanorod arrays, which can be attributed to the higher excitation light absorption and evanescent electric field. In human epididymis-specific protein 4 (HE4) detection, the limit of detection (LOD) reaches 9.3 fM, and the dynamic linear range is 10 fM to 100 pM. It has been demonstrated that Zn(OH)F nanorod array-based microfluidic devices are excellent fluorescence assay platforms that also provide a new design and construction strategy for fluorescence enhancement substrates for the detection of biomarkers.

Simultaneous and sensitive detection of multiple small biological molecules by microfluidic paper-based analytical device integrated with zinc oxide nanorods

In this work, ZnO nanorods (ZnO NRs) with different sizes were hydrothermally grown on the surface of Whatman filter paper for the fabrication of a microfluidic paper-based device (μPAD) for the simultaneous detection of glucose and uric acid. As dual enzymatic reaction was employed for the colorimetric detection in this μPAD, the presence of ZnO NRs promoted the enzyme immobilization thus significantly enhancing the colorimetric signal. The coffee ring effect was effectively conquered by the uniform distribution of ZnO NR as well as a specialized double-layered μPAD design. Meanwhile, two color indicators with distinct colors were used to provide complementary results to better quantify the concentration of the analytes by naked eye. As a result, two linear calibration curves were obtained for the detection of glucose (0.01-10 mmol L^-1) and uric acid (0.01-5 mmol L^-1), along with a LOD of 3 μmol L^-1 for glucose and 4 μmol L^-1 for uric acid, respectively. The practical usefulness of the proposed μPAD was further validated by the simultaneous analysis of glucose and uric acid in serum samples and urine samples.

Recent advances in lab-on-paper diagnostic devices using blood samples

Lab-on-paper, or microfluidic paper-based analytical devices (μPADs), use paper as a substrate material, and are patterned with a system of microchannels, reaction zones and sensing elements to perform analysis and detection. The sample transfer in such devices is performed by capillary action. As a result, external driving forces are not required, and hence the size and cost of the device are significantly reduced. Lab-on-paper devices have thus attracted significant attention for point-of-care medical diagnostic purposes in recent years, particularly in less-developed regions of the world lacking medical resources and infrastructures. This review discusses the major advances in lab-on-paper technology for blood analysis and diagnosis in the past five years. The review focuses particularly on the many clinical applications of lab-on-paper devices, including diabetes diagnosis, acute myocardial infarction (AMI) detection, kidney function diagnosis, liver function diagnosis, cholesterol and triglyceride (TG) analysis, sickle-cell disease (SCD) and phenylketonuria (PKU) analysis, virus analysis, C-reactive protein (CRP) analysis, blood ion analysis, cancer factor analysis, and drug analysis. The review commences by introducing the basic transmission principles, fabrication methods, structural characteristics, detection techniques, and sample pretreatment process of modern lab-on-paper devices. A comprehensive review of the most recent applications of lab-on-paper devices to the diagnosis of common human diseases using blood samples is then presented. The review concludes with a brief summary of the main challenges and opportunities facing the lab-on-paper technology field in the coming years.

Rapid Distance-Based Cardiac Troponin Quantification Using Paper Analytical Devices for the Screening and the Follow-Up of Acute Myocardial Infarction, Using a Single Drop of Human Whole Blood

This work introduces the procedure of using non-immunoassay distance-based paper analytical devices (dPADs) to accurately measure any traces of the cardiac troponin I (TnI) in whole blood samples without the use of any external blood separation. This enables a rapid clinical diagnosis and the subsequent follow-up in regard to identifying acute myocardial infarction. These dPADs are designed and constructed to accommodate three parts: (1) a blood separation zone that is immobilized with a hemostatic agent, this no longer requires a blood separation membrane for the isolation of the plasma from the blood element, (2) a pretreatment zone, and (3) a detection zone coated with thymol blue. The quantitative TnI level in the whole blood was determined by measuring the blue color length found in the detection zone, which is proportional to the concentration, owing to the dry protein binding principle. Correspondingly, a mere single drop of human whole blood performs adequately within our proposed method. This reduces both the size of the collection process and the sample volumes needed in the respective medical fields. As we cover all of the optimization studies, our dPADs provide an evaluation of the linearity range from 0.025 to 2.5 ng/mL (R² = 0.9989) of TnI, with a detection limit as low as 0.025 ng/mL by use of an observation just using the naked eye. To validate the clinical utilities of our proposed method, our dPADs were then applied for the detection of TnI in humans using the whole blood sample of 15 volunteers. A great amount of accuracy was required in this assay because there was no significant difference between both methods, with the confidence level being as high as 95%. This technique also showed that the recoveries ranged from 99.40 to 104.27%, with the highest relative standard deviation being at 3.77%. Thus, our proposed dPADs offer more benefits for a rapid TnI determination.

Simultaneously Detecting Monoamine Oxidase A and B in Disease Cell/Tissue Samples Using Paper-Based Devices

As enzymes in the outer membrane of the mitochondrion, monoamine oxidases (MAOs) can catalyze the oxidative deamination of monoamines in the human body. According to different substrates, MAOs can be divided into MAO-A and MAO-B. The imbalance of the MAO-A is associated with neurological degeneration, while excess MAO-B activity is closely connected with Parkinson's disease (PD) and Alzheimer's disease (AD); therefore, detection of MAOs is of great significance for the diagnosis and treatment of these diseases. This work reports the multiplexed detection of MAO-A and MAO-B using paper-based devices based on chemiluminescence (CL). The detection limits were 5.01 pg/mL for MAO-A and 8.50 pg/mL for MAO-B in human serum. In addition, we used paper-based devices to detect MAOs in human cells and tissue samples and found that the results of paper-based detection and Western blotting (WB) showed the same trend. While only one antibody can be incubated on the same membrane by WB, multiple antibodies incubated on the same paper enabled simultaneous detection of MAO-A and MAO-B by paper-based devices. The paper-based assay could be used for preliminary early screening of clinical samples for MAOs and can be extended as an alternative to WB for multiplexed detection of various proteins in disease cell or tissue samples.

Molecularly imprinted polymer-enhanced biomimetic paper-based analytical devices: A review

The popularization of paper-based analytical devices (PADs) in analytical science has fostered research on enhancing their analytical performance for accurate and sensitive assays. With their superb recognition capability and structural stability, molecularly imprinted polymers (MIPs) have been extensively employed as biomimetic receptors for capturing target analytes in various complex matrices. The integration of MIPs as recognition elements with PADs (MIP-PADs) has opened new opportunities for advanced analytical devices with elevated selectivity and sensitivity, as well as a shorter assay time and a lower cost. This review covers recent advances in MIP-PAD fabrication and engineering based on multifarious signal transduction systems such as colorimetry, fluorescence, electrochemistry, photoelectrochemistry, and chemiluminescence. The application of MIP-PADs in the fields of biomedical diagnostics, environmental analysis, and food safety monitoring is also reviewed. Further, the advantages, challenges, and perspectives of MIP-PADs are discussed.

Recent advances in cardiac biomarkers detection: From commercial devices to emerging technologies

Although cardiac pathologies are the major cause of death in the world, it remains difficult to provide a reliable diagnosis to prevent heart attacks. Rapid patient care and management in emergencies are critical to prevent dramatic consequences. Thus, relevant biomarkers such as cardiac troponin and natriuretic peptides are currently targeted by commercialized Point-Of-Care immunoassays. Key points still to be addressed concern cost, lack of standardization, and poor specificity, which could limit the reliability of the assays. Consequently, alternatives are emerging to address these issues. New probe molecules such as aptamers or molecularly imprinted polymers should allow a reduction in cost of the assays and an increase in reproducibility. In addition, the assay specificity and reliability could be improved by enabling multiplexing through the detection of several molecular targets in a single device.

Indicator-Free Argentometric Titration for Distance-Based Detection of Chloride Using Microfluidic Paper-Based Analytical Devices

We described an indicator-free argentometric titration strategy using a microfluidic paper-based analytical device. This strategy was based on the formation of insoluble silver salts by reactions occurring between analytes and titrant (Ag⁺) on a paper channel. After the insoluble silver salts were formed and precipitated on the channel, the paper substrate modified with the surplus titrant on the channel turned reddish-brown by exposure of the devices to a simple and cheap UV light source for 5 min, generating a colored band on the channel. Distance-based detection of chloride was achieved by measuring the length of the colored band with a detection limit of 1.7 mg L^-1 Cl^-. This method was used to detect chlorides in tap water, with an analytical result (10.1 ± 1.2 mg L^-1) agreeing well with that obtained by a classical conventional precipitation titration (9.8 mg L^-1), which was based on the measurement of the consumed volume of titrant. This paper-based precipitation titration method is free of skilled personnel and has advantages of low reagent/sample consumption, disposability, portability, and simple operation over the conventional precipitation titration. More importantly, being free of any indicator, this method may be used to detect more species than the conventional precipitation titrations, which are limited by the indicator, for example, CO₃ ^2- and SO₄ ^2-, which could form insoluble silver salts in aqueous liquids. Additionally, comparing with most of those paper-based titrimetry reported previously, this presented precipitation titration is free of any indicator or ion selective electrode to detect the end point of titration.

Nanoscale Technologies in Highly Sensitive Diagnosis of Cardiovascular Diseases

Cardiovascular diseases (CVD) are the leading cause of death and morbidity in the world and are a major contributor to healthcare costs. Although enormous progress has been made in diagnosing CVD, there is an urgent need for more efficient early detection and the development of novel diagnostic tools. Currently, CVD diagnosis relies primarily on clinical symptoms based on molecular imaging (MOI) or biomarkers associated with CVDs. However, sensitivity, specificity, and accuracy of the assay are still challenging for early-stage CVDs. Nanomaterial platform has been identified as a promising candidate for improving the practical usage of diagnostic tools because of their unique physicochemical properties. In this review article, we introduced cardiac biomarkers and imaging techniques that are currently used for CVD diagnosis. We presented the applications of various nanotechnologies on diagnosis within cardiac immunoassays (CIAs) and molecular imaging. We also summarized and compared different cardiac immunoassays based on their sensitivities and working ranges of biomarkers.

Sustainable and Transparent Fish Gelatin Films for Flexible Electroluminescent Devices

In the past decades, various alternating current electroluminescent (ACEL) devices, especially the flexible ones, have been developed and used in flat panel display, large-scale decorating, logo display lighting, optical signaling, etc. Transparent plastics are usually used as substrates in ACEL devices; however, they are undegradable and may cause serious environmental pollution. Herein, we have developed a flexible transient ACEL device based on transparent fish gelatin (FG) films. The FG films were made from fish scales, which are sustainable, cost-efficient, and eco-friendly. These films could dissolve in water within seconds at 60 °C and degrade completely within 24 days in soil. The transmittance of these FG films was up to 91.1% in the visible spectrum, comparable to that of polyethylene terephthalate (PET) (90.4%). After forming a composite with silver nanowires (Ag NWs), the Ag NWs-FG film showed a transmittance up to 82.3% and a sheet resistance down to 22.4 Ω sq^-1. The fabricated ACEL device based on the Ag NWs-FG film exhibited high flexibility and luminance up to 56.0 cd m^-2. The device could be dissolved in water within 3 min. Our work demonstrates that the sustainable, flexible, and transparent FG films are a promising alternative for green and degradable substrates in the field of flexible electronics, including foldable displays, wearable devices, and health monitoring.