An instrument-free, screen-printed paper microfluidic device that enables bio and chemical sensing

Multi-dimensional microfluidic paper-based analytical devices (μPADs) for noninvasive testing: A review of structural design and applications

The rapid emergence of microfluidic paper-based devices as point-of-care testing (POCT) tools for early disease diagnosis and health monitoring, particularly in resource-limited areas, holds immense potential for enhancing healthcare accessibility. Leveraging the numerous advantages of paper, such as capillary-driven flow, porous structure, hydrophilic functional groups, biodegradability, cost-effectiveness, and flexibility, it has become a pivotal choice for microfluidic substrates. The repertoire of microfluidic paper-based devices includes one-dimensional lateral flow assays (1D LFAs), two-dimensional microfluidic paper-based analytical devices (2D μPADs), and three-dimensional (3D) μPADs. In this comprehensive review, we provide and examine crucial information related to paper substrates, design strategies, and detection methods in multi-dimensional microfluidic paper-based devices. We also investigate potential applications of microfluidic paper-based devices for detecting viruses, metabolites and hormones in non-invasive samples such as human saliva, sweat and urine. Additionally, we delve into capillary-driven flow alternative theoretical models of fluids within the paper to provide guidance. Finally, we critically examine the potential for future developments and address challenges for multi-dimensional microfluidic paper-based devices in advancing noninvasive early diagnosis and health monitoring. This article showcases their transformative impact on healthcare, paving the way for enhanced medical services worldwide.

Advances and Progress in Automated Urine Analyzers

The clinical analysis of urine has classically focused on conventional chemical-based urinalysis and urine microscopy. Contemporary advances in both analysis subsets have started to employ new technologies such as automated image analysis, flow cytometry, and mass spectrometry. In addition to new detection technologies, current analyzers have incorporated more advanced imaging, automated sample handing, and machine learning analyses into their workflow. The most advanced semiautomated analyzers can be interfaced with hospital medical record systems, and in the point-of-care setting, smartphones can be used for image analysis. This review will discuss current technological advancements in the field of urinalysis and urine microscopy.

Fabrication of paper-based analytical devices using stencil-printed glass varnish barriers for colorimetric detection of salivary α-amylase

BACKGROUND

Developing disposable paper-based devices has positively impacted analytical science, particularly in developing countries. Some benefits of those devices include their versatility, affordability, environmentally friendly, and the possibility of being integrated with portable electrochemical or colorimetric detectors. Paper-based analytical devices (PADs) comprising circular zones and microfluidic networks have been successfully employed in the analytical chemistry reign. However, the combination of the stencil-printing method and alternative binder has not been satisfactorily explored for fabricating colorimetric paper devices.

RESULTS

We developed PADs exploring the stencil printing approach and glass varnish as the hydrophobic chemical agent. As a proof-of-concept, the colorimetric assay of salivary α-amylase (sAA) was performed in saliva samples. Through the scanning electron microscopy measurements, it was possible to indicate satisfactory definitions between native fibers and barrier, and that the measured values for the channel width revealed suitable fidelity (R2 = 0.99) with the nominal widths (ranging from 400 to 5000 μm). The proposed hydrophobic barrier exhibited excellent chemical resistance. The analytical applicability for detecting sAA revealed linear behavior in the range from 2 to 12 U mL-1 (R2 = 0.99), limit of detection of 0.75 U mL-1, reproducibility (RSD ≤2.4%), recovery experiments ranged from 89 to 108% and AGREE response (0.86). In addition, the colorimetric analysis of sAA in four different saliva samples demonstrated levels ranging from 202 to 2080 U mL-1, which enabled monitoring the absence and presence of periodontitis.

SIGNIFICANCE

This report has presented the first use of a self-adhesive mask and glass varnish for creating circular zones and microfluidic architectures on paper without using thermic or UV curing treatments. Also, the proposed analytical methodology for detecting sAA exhibited suitable ecological impact considering the AGREE tool. We believe the proposed fabrication of paper devices emerges as a novel, simple, high-fidelity microfluidic channel and portable analytical approach for colorimetric sensing.

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.

Portable dual-channel blood enzyme analyzer for point-of-care liver function detection

Because the liver is an important metabolic center in the human body, the reliability and timeliness of chronic liver disease diagnosis are particularly important. Alanine aminotransferase and aspartate transaminase are the two most important liver function indicators, and their test results are crucial in the diagnosis of liver diseases. However, the simultaneous detection of these two indicators is currently restricted by the need for expensive equipment and complicated detection processes. This study proposes a portable dual-channel blood enzyme analyzer (BEA) for point-of-care-testing. The device uses photometric reflectance to quantify the enzyme concentration by evaluating the reflected light intensity. The BEA also precisely controls and maintains the temperature at 37 °C ± 0.1 °C in the dual-channel assay. We assessed the responses of this system within a clinically relevant range by testing blood samples from a local hospital. The test verified that BEA for ALT and AST achieved a detection limit of 3.5 U L-1 and 4 U L-1, detection range of 4-350 U L-1 and 4-250 U L-1, coefficients of variation (CV) that were both less than 10%, and a linear correlation coefficient of 0.9827 and 0.9714 compared with a high-precision clinical biochemistry analyzer (Roche Cobas C702), respectively. We realized remote data analysis and storage through connection with smartphones, which can be applied to remote diagnostics and preventative personal disease management. Therefore, BEA has broad application prospects in the future internet of medical things.

A Facile Method to Fabricate an Enclosed Paper-Based Analytical Device via Double-Sided Patterning for Ionic Contaminant Detection

Microfluidic paper-based analytical devices (μPADs) have been developed for use in a variety of diagnosis and analysis fields. However, conventional μPADs with an open-channel system have limitations for application as analytical platforms mainly because of the evaporation and contamination of the sample solution. This study demonstrates the design and fabrication of an enclosed three-dimensional(3D)-μPAD and its application as a primary early analysis platform for ionic contaminants. To generate the hydrophobic PDMS barrier, double-sided patterning is carried out using a PDMS blade-coated stamp mold that is fabricated using 3D printing. The selective PDMS patterning can be achieved with controlled PDMS permeation of the cellulose substrate using 3D-designed stamp molds. We find the optimal conditions enabling the formation of enclosed channels, including round shape pattern and inter-pattern distance of 10 mm of stamp design, contact time of 0.5 min, and spacer height of 300 µm of double-sided patterning procedure. As a proof of concept, this enclosed 3D-μPAD is used for the simultaneous colorimetric detection of heavy metal ions in a concentration range of 0.1-2000 ppm, including nickel (Ni2+), copper (Cu2+), mercury (Hg2+), and radioactive isotope cesium-137 ions (Cs+). We confirm that qualitative analysis and image-based quantitative analysis with high reliability are possible through rapid color changes within 3 min. The limits of detection (LOD) for 0.55 ppm of Ni2+, 5.05 ppm of Cu2+, 0.188 ppm of Hg2+, and 0.016 ppm of Cs+ are observed, respectively. In addition, we confirm that the analysis is highly reliable in a wide range of ion concentrations with CV values below 3% for Ni2+ (0.56%), Cu2+ (0.45%), Hg2+ (1.35%), and Cs+ (2.18%). This method could be a promising technique to develop a 3D-μPAD with various applications as a primary early analysis device in the environmental and biological industries.

The air-gap PAD: a roll-to-roll-compatible fabrication method for paper microfluidics

Paper-based analytical devices (PADs) offer a low-cost, user-friendly platform for rapid point-of-use testing. Without scalable fabrication methods, however, few PADs make it out of the academic laboratory and into the hands of end users. Previously, wax printing was considered an ideal PAD fabrication method, but given that wax printers are no longer commercially available, alternatives are needed. Here, we present one such alternative: the air-gap PAD. Air-gap PADs consist of hydrophilic paper test zones, separated by "air gaps" and affixed to a hydrophobic backing with double-sided adhesive. The primary appeal of this design is its compatibility with roll-to-roll equipment for large-scale manufacturing. In this study, we examine design considerations for air-gap PADs, compare the performance of wax-printed and air-gap PADs, and report on a pilot-scale roll-to-roll production run of air-gap PADs in partnership with a commercial test-strip manufacturer. Air-gap devices performed comparably to their wax-printed counterparts in Washburn flow experiments, a paper-based titration, and a 12-lane pharmaceutical screening device. Using roll-to-roll manufacturing, we produced 2700 feet of air-gap PADs for as little as $0.03 per PAD.

Development of Paper Microfluidics with 3D-Printed PDMS Barriers for Flow Control

Paper microfluidics has been extensively exploited as a powerful tool for environmental and medical detection applications. Both flow delay and compatibility with either polar or non-polar reagents are indispensable for the automation of detections requiring multiple reaction steps. This article reports the systematic studies of a 3D-printing protocol, characterization, and application of both the partially and fully penetrated polydimethylsiloxane (PDMS) barriers for flexible flow control in paper microfluidics. The physical parameters of PDMS barriers printed using a simple liquid dispenser were found related to the printing pressure, speed, diffusion time after printing, baking temperature, and PDMS viscosity. The capability of PDMS barriers to confine the flow of non-polar solvents was demonstrated using oil flow in both wax- and PDMS-surrounded channels. It was identified that the minimum width of channels to prevent leakage was 470 ± 54 μm, which was as narrow as that fabricated using stamps from lithography. Both the partially penetrated barriers (PPBs) and constriction channels were of the capability to delay flow in paper microfluidics. Additionally, an in silico investigation led to the further understanding that the reduction of channel cross-section resulting from PPBs was the primary reason for flow delay. Our results suggest that increasing the penetration depth of the barriers is more efficient in delaying flow than increasing the PPB length. Finally, devices with four inlet channels and 0-6 PPBs across each channel were successfully applied in flow delay for sequential fluid delivery. These results improve the understanding of the major factors, affecting the 3D PDMS barrier fabrication and the resulting flow control in paper microfluidics, providing practical implications for applications in various fields.

A simple epoxy resin screen-printed paper-based analytical device for detection of phosphate in soil

This study develops a simple and low-cost 3D paper-based analytical device (3D PAD) for the detection of available phosphate in soil. Epoxy resin is presented as a new hydrophobic material for low-cost mass production of PADs using the screen-printing method. An optimized concentration of epoxy resin solution is screen printed onto Whatman filter paper no. 1 in an easy one-step process to create hydrophobic patterns on PADs. The epoxy resin is air dried at room temperature, without heating or UV curing. This method delivers high reproducibility, resolution, and stability, and the epoxy resin barrier is compatible with both organic solvents and aqueous solutions. The molybdenum blue method is used in this PAD to measure phosphate in a colorimetric assay. The developed 3D PAD attains a linear range of 0.5-40 mg L^-1, with a limit of detection (LOD) of 0.25 mg L^-1, and a limit of quantitation (LOQ) of 0.83 mg L^-1. The relative standard deviation of intra-day measurements is 1.52-2.46%, and the inter-day standard deviation is 1.89-2.74%, indicating satisfactory reproducibility. This 3D PAD was tested for its ability to detect phosphate in a variety of actual soil samples and the results were validated against spectrophotometric analysis using a paired t-test, which showed high accuracy. In short, the new analytical device described in this study is simple, fast, and inexpensive to make and use, providing a versatile phosphate detection tool for many soil types, even in situations when resources are limited.

Fabrication of Paper-Based Microfluidics by Spray on Printed Paper

Since the monumental work conducted by Whitesides et al. in 2007, research and development of paper-based microfluidics has been widely carried out, with its applications ranging from chemical and biological detection and analysis, to environmental monitoring and food-safety inspection. Paper-based microfluidics possesses several competitive advantages over other substrate materials, such as being simple, inexpensive, power-free for fluid transport, lightweight, biodegradable, biocompatible, good for colorimetric tests, flammable for easy disposal of used paper-based diagnostic devices by incineration, and being chemically modifiable. Myriad methods have been demonstrated to fabricate paper-based microfluidics, such as solid wax printing, cutting, photolithography, microembossing, etc. In this study, fabrication of paper-based microfluidics was demonstrated by spray on the printed paper. Different from the normally used filter papers, printing paper, which is much more accessible and cheaper, was utilized as the substrate material. The toner was intended to serve as the mask and the patterned hydrophobic barrier was formed after spray and heating. The processing parameters such as toner coverage on the printing paper, properties of the hydrophobic spray, surface properties of the paper, and curing temperature and time were systematically investigated. It was found that, after repetitive printing four times, the toner was able to prevent the hydrophobic spray (the mixture of PDMS and ethyl acetate) from wicking through the printing paper. The overall processing time for fabrication of paper-based microfluidic chips was less than 10 min and the technique is potentially scalable. Glucose detection was conducted using the microfluidic paper-based analytical devices (µPADs) as fabricated and a linear relationship was obtained between 1 and 10 mM.

Colorimetric and Electrochemical Screening for Early Detection of Diabetes Mellitus and Diabetic Retinopathy-Application of Sensor Arrays and Machine Learning

In this review, a selection of works on the sensing of biomarkers related to diabetes mellitus (DM) and diabetic retinopathy (DR) are presented, with the scope of helping and encouraging researchers to design sensor-array machine-learning (ML)-supported devices for robust, fast, and cost-effective early detection of these devastating diseases. First, we highlight the social relevance of developing systematic screening programs for such diseases and how sensor-arrays and ML approaches could ease their early diagnosis. Then, we present diverse works related to the colorimetric and electrochemical sensing of biomarkers related to DM and DR with non-invasive sampling (e.g., urine, saliva, breath, tears, and sweat samples), with a special mention to some already-existing sensor arrays and ML approaches. We finally highlight the great potential of the latter approaches for the fast and reliable early diagnosis of DM and DR.

Paper based microfluidics: A forecast toward the most affordable and rapid point-of-care devices

The microfluidic industry has evolved through years with acquired scientific knowledge from different, and already developed industries. Consequently, a wide range of materials like silicon from the electronic industry to all the way, silicone, from the chemical engineering industry, has been spotted to solve similar challenges. Although a typical microfluidic chip, fabricated from glass or polymer substrates offers definite benefits, however, paper-based microfluidic analytical devices (μPADs) possess numerous special benefits for practical implementation at a lower price. Owing to these features, in recent years, paper microfluidics has drawn immense interest from researchers in industry and academia alike. These devices have wider applications with advantages like lower cost, speedy detection, user-easiness, biocompatibility, sensitivity, and specificity etc. when compared to other microfluidic devices. Therefore, these sensitive but affordable devices fit themselves into point-of-care (POC) testing with features in demand like natural disposability, situational flexibility, and the capability to store and analyze the target at the point of requirement. Gradually, advancements in fabrication technologies, assay development techniques, and improved packaging capabilities, have contributed significantly to the real-time identification and health investigation through paper microfluidics; however, the growth has not been limited to the biomedical field; industries like electronics, energy storage and many more have expanded substantially. Here, we represent an overall state of the paper-based microfluidic technology by covering the fundamentals, working principles, different fabrication procedures, applications for various needs and then to make things more practical, the real-life scenario and practical challenges involved in launching a device into the market have been revealed. To conclude, recent contribution of μPADs in the 2020 pandemic and potential future possibilities have been reviewed.

Paper-Based Ionic Thermocouples for Inexpensive and High-Precision Measurement of Temperature

Accurate and yet cost-effective temperature measurements are required in various sectors of academia and industry. Thermocouples (TCs) are most widely used for temperature measurements; however, their low temperature sensitivity and high thermal conductivity should be improved to ensure the reliable measurement of output voltage for small temperature differences. To address this, a paper-based ionic thermocouple (P-iTC) presented here utilizes a pair of paper strips soaked with the electrolytes of potassium ferri-/ferrocyanide and iron (II/III) chloride redox couples, which are used as p- and n-type elements, respectively. The fabricated P-iTC provides 70× higher temperature sensitivity (α, 2.8 mV/K) and 30× lower thermal conductivity (k, 0.8 W/m K) than those of commercial K-type TCs, thereby yielding a remarkably high α/k ratio of 3.5 mV m/W. Reliable sensing performance is measured during three weeks of operation, which indicates that the P-iTC should be stable in long-term operation. To demonstrate the practicality of the P-iTC, a 3 × 3 planar array of P-iTCs is fabricated to monitor the temperature profile of a surface in contact with heat sources. Using pencil-drawn graphite electrodes on paper, a highly cost-effective P-iTC with the material cost of ∼0.5 cents per device is also fabricated, which is successfully used to monitor cold chain temperatures while retaining its excellent temperature-sensing performance.

The pursuit of further miniaturization of screen printed micro paper-based analytical devices utilizing controlled penetration towards optimized channel patterning

One of the main objectives of microfluidic paper-based analytical devices is to present solutions particularly, for applications in low-resource settings. Therefore, screen-printing appears to be an attractive fabrication technique in the field, due to its overall simplicity, affordability, and high-scalability potential. Conversely, the minimum feature size attained using screen-printing is still rather low, especially compared to other fabrication methods, mainly attributed to the over-penetration of hydrophobic agents, underneath defined patterns on masks, into the fiber matrix of paper substrates. In this work, we propose the use of the over-penetration to our advantage, whereby an appropriate combination of hydrophobic agent temperature and substrate thickness, allows for the proper control of channel patterning, rendering considerably higher resolutions than prior arts. The implementation of Xuan paper and nail oil as novel substrate and hydrophobic agent, respectively, is proposed in this work. Under optimum conditions of temperature and substrate thickness, the resolution of the screen-printing method was pushed up to 97.83 ± 16.34 μm of channel width with acceptable repeatability. It was also found that a trade-off exists between achieving considerably high channel resolutions and maintaining high levels of repeatability of the process. Lastly, miniaturized microfluidic channels were successfully patterned on pH strips for colorimetric pH measurement, demonstrating its advantage on negligible sample-volume consumption in nano-liter range during chemical measurement and minimal interference on manipulation of precious samples, which for the first time, is realized on screen-printed microfluidic paper-based analytical devices.

Nucleic acid analysis on paper substrates (NAAPs): an innovative tool for Point of Care (POC) infectious disease diagnosis

The cost-effective rapid diagnosis of infectious diseases is an essential and important factor for curing such diseases in the global public health care picture. Owing to poor infrastructure and lack of sanitation, these diseases have an extreme impact on remote and rural areas, especially in developing countries, and there are unresolved challenges. Molecular diagnosis, such as nucleic acid analysis, plays a key role in the significant treatment of numerous infectious diseases. Current molecular diagnostic assays require a sophisticated laboratory setup with expensive components. Molecular diagnosis on a microfluidic point-of-care (POC) platform is attractive to researchers for disease detection with proper prevention. Compared to various microfluidic substrate materials, paper-based POC technologies offer significant cost-effective solutions over high-cost clinical instruments to fill the gap between the needs of users and affordability. Low-cost paper-based microfluidic POC technologies provide portable and disposable diagnostic systems for multiple disease detection that may be extremely useful in remote areas. This article presents a critical review of paper-based microfluidic device technology which has become an imminent platform to adjust the current health scenario for the detection of diseases using different stages of nucleic acid analysis, such as extraction, amplification and detection of nucleic acid, with future perspectives for paper substrates.

Telemedicine for Pre-Employment Medical Examinations and Follow-Up Visits on Board Ships: A Narrative Review on the Feasibility

BACKGROUND

Telemedicine has already been applied to various medical specialties for diagnosis, treatment, and follow-up visits for the general population. Telemedicine has also proven effective by providing advice, diagnosis, and treatment to seafarers during emergency medical events onboard ships. However, it has not yet been applied for pre-employment medical examinations and follow-up visits on board ships.

OBJECTIVE

This review aimed to assess the possibility of using telemedicine during periodic visits between one pre-employment medical examination and others on board ships, and to recommend necessary medical examination tests with screening intervals for seafarers.

METHODS

Various databases including PubMed, EMBASE, Scopus, CINAHL, and Cochrane Library were explored using different keywords, titles, and abstracts. Studies published between 1999 and 2019, in English, in peer-reviewed journal articles, and that are conference proceedings were considered. Finally, the studies included in this review were chosen on the basis of the eligibility criteria.

RESULTS

Out of a total of 168 studies, 85 studies were kept for further analysis after removing the duplicates. A further independent screening based on the inclusion and exclusion criteria resulted in the withdrawal of 51 studies that were not further considered for our analysis. Finally, 32 studies were left, which were critically reviewed. Out of 32 accepted studies, 10 studies demonstrated the effectiveness of the electrocardiogram (ECG) in monitoring and managing remote patients with heart failure, early diagnosis, and postoperative screening. In 15 studies, telespirometry was found to be effective in diagnosing and ruling out diseases, detecting lung abnormalities, and managing patients with chronic obstructive pulmonary disease (COPD) and asthma. Seven studies reported that telenephrology was effective, precise, accurate, and usable by non-medical personnel and that it reduced sample analysis times and procedures in laboratories.

CONCLUSION

using new technologies such as high-speed internet, video conferencing, and digital examination, personnel are able to make the necessary tests and perform virtual medical examination on board ships with necessary training.

Enhanced selectivity and sensitivity for colorimetric determination of glyphosate using Mn-ZnS quantum dot embedded molecularly imprinted polymers combined with a 3D-microfluidic paper-based analytical device

We report a novel three-dimensional microfluidic paper-based analytical device (3D-μPAD) with colorimetric detection, using Mn-ZnS quantum dot embedded molecularly imprinted polymer (Mn-ZnS QD-MIP), for selective glyphosate determination in whole grain samples. Detection is based on the catalytic activity of Mn-ZnS QD-MIP in the H₂O₂ oxidation of ABTS. Glyphosate imprinted polymer is successfully synthesized on the Mn-ZnS QD surface using a poly (N-isopropylacrylamide) (NIPAM) and N, N'-Methylenebisacrylamide (MBA) as the functional monomers. The catalytic activity depends on binding or non-binding of glyphosate molecules on the synthetic recognition sites of the Mn-ZnS QD-MIP. Glyphosate selectively binds to the cavities embedded on the Mn-ZnS QD surface, and subsequently turns-off or inhibits the ABTS oxidation and color change to light green. The change of reaction color from dark green to light green depends on the concentration of glyphosate. We report, for the first time, using the relatively new penguard enamel colour to create a hydrophobic barrier. The foldable 3D-μPAD comprises three layers (top/center/bottom), named as the detection zone, immobilized Mn-ZnS QD-MIP disc, and sample loading. Assay on the 3D-μPAD can determine glyphosate by ImageJ detection, over an operating range of 0.005-50 μg mL^-1 and with a detection limit of 0.002 μg mL^-1. Our 3D-μPAD exhibits high accuracy, with a 0.4% (intra-day) and 0.7% (inter-day) relative difference from the certified CRM value. Moreover, the fabricated 3D-μPAD provides good reproducibility (1.7% RSD for ten devices). The developed 3D-μPAD was successfully applied to determine the glyphosate concentration in whole grain samples and shows great promise as an alternative highly selective and sensitive colorimetric method. The 3D-μPAD is well suited to food-quality control and onsite environmental-monitoring applications, without sophisticated instrumentation.

Nanocellulose Films to Improve the Performance of Distance-based Glucose Detection in Paper-based Microfluidic Devices

We report on a simple, cost-effective, instrument-free, and portable distance-based paper device coupled with NFs for the determination of glucose. The analysis reaction is based upon the oxidative etching reaction of silver nanoparticles (AgNPs) in the presence of H₂O₂ that is produced from glucose after a glucose oxidase (GOx) catalytic reaction leading to a morphological transformation of AgNPs. A color band length of AgNPs is coated on to a detection channel and then etched by H₂O₂, and these were changed from a purple color to colorless as a correlate of the glucose concentration. To improve the performance of the enzyme immobilization, NFs, which are biocompatible without compromising their structure and biological activity, were then placed onto the sample zone. The naked-eye detection limit was 0.1 mM for 40 min of analysis time. The recoveries of glucose spiked in the artificial urine samples and control urine samples were then verified by our device and were in the acceptable range of 96 - 100%.

Paper-Based Device for the Facile Colorimetric Determination of Lithium Ions in Human Whole Blood

Lithium carbonate is an effective medicine for the treatment of the bipolar disorder, but the concentration of lithium in the patient's blood must be frequently monitored because of its toxicity. To date, no colorimetric methods of lithium ion detection in whole blood without pretreatment have been reported. Here, we report a colorimetric paper-based device that allows point-of-care testing in one step. This device is composed of two paper-based elements linked to each other: a blood cell separation unit and a colorimetric detection unit. After a portion of whole blood has been placed on the end of the separation unit, plasma in the sample is automatically transported to the detection unit, which displays a diagnostic color. The key feature of this device is its simple, user-friendly operation. The limit of detection is 0.054 mM and the coefficient of variance is below 6.1%, which are comparable to those of conventional instruments using the same colorimetric reaction. Furthermore, we achieved high recovery (>90%) and reproducibility (<9.8%) with spiked human blood samples. Thus, the presented device provides an alternative method for the regular monitoring of lithium concentrations in the treatment of bipolar disorder by augmenting the coefficient of variation (maximum value, 6.1%).

One-Step Polylactic Acid Screen-Printing Microfluidic Paper-Based Analytical Device: Application for Simultaneous Detection of Nitrite and Nitrate in Food Samples

In this work, we report a one-step approach for fabricating screened-printed microfluidic paper-based analytical devices (μPADs) using polylactic acid as a new hydrophobic material. A polylactic acid solution was screen printed onto chromatography papers to create hydrophobic patterns for fluidic channels. The optimal polylactic acid concentration for successful device fabrication is 9% w/v. The μPADs were fabricated within 2 min and provided high reproducibility and stability. The utility of polylactic acid screen-printing was demonstrated for the simultaneous detection of nitrite and nitrate using colorimetric detection. Under optimized experimental conditions, the detection limits and the linear ranges, respectively, were 1.2 mg L−1 and 2–10 mg L−1 for nitrite and 3.6 mg L−1 and 10–50 mg L−1 for nitrate. The detection times for both ions were found to be within 12 min. The developed μPAD was applied for the simultaneous determination of these ions in food samples, and no significant differences in the analytical results were observed compared to those of the reference method. The polylactic acid screen-printing approach presented here provides a simple, rapid, and cost-effective alternative fabrication method for fabricating μPADs.

Programmable Paper-Based Microfluidic Devices for Biomarker Detections

Recent advanced paper-based microfluidic devices provide an alternative technology for the detection of biomarkers by using affordable and portable devices for point-of-care testing (POCT). Programmable paper-based microfluidic devices enable a wide range of biomarker detection with high sensitivity and automation for single- and multi-step assays because they provide better control for manipulating fluid samples. In this review, we examine the advances in programmable microfluidics, i.e., paper-based continuous-flow microfluidic (p-CMF) devices and paper-based digital microfluidic (p-DMF) devices, for biomarker detection. First, we discuss the methods used to fabricate these two types of paper-based microfluidic devices and the strategies for programming fluid delivery and for droplet manipulation. Next, we discuss the use of these programmable paper-based devices for the single- and multi-step detection of biomarkers. Finally, we present the current limitations of paper-based microfluidics for biomarker detection and the outlook for their development.

Screen-printed microfluidic paper-based analytical device (μPAD) as a barcode sensor for magnesium detection using rubber latex waste as a novel hydrophobic reagent

This work reports the first use of cis-1,4-polyisoprene obtained from rubber latex (RL) waste as the hydrophobic reagent for the fabrication of a microfluidic paper-based analytical device (μPAD), providing a user-friendly means for magnesium detection. The μPAD was fabricated using a screen printing technique and the barcode-like paper sensor was then used for the detection of Mg(II) ions in RL and water samples. Using different types of paper media (paper towel, Whatman No.1 and Whatman No.4), the results indicate that the key factors in optimizing the quality of the fabricated μPAD include the viscosity of cis-1,4-polyisoprene solution which could be adjusted using different solvents and heating temperatures, the mesh screen size, the pore size of the paper substrates, and the dimension of the sample zone. The fabricated μPAD, which showed high chemical resistance, durability and design flexibility, was tested for the detection of Mg(II) ions using the reaction based on complexometric titration with EDTA where Eriochrome Black T was used as an indicator. An Android application "UBU OMg Sensor" was also developed to provide a simple, fast, and accurate means for end-users to interpret results generated by our developed μPAD.

T-shirt ink for one-step screen-printing of hydrophobic barriers for 2D- and 3D-microfluidic paper-based analytical devices

This work presents the use of polyvinyl chloride (PVC) fabric ink, commonly employed for screening t-shirts, as new and versatile material for printing hydrophobic barrier on paper substrate for microfluidic paper-based analytical devices (μPADs). Low-cost, screen-printing apparatus (e.g., screen mesh, squeegee, and printing table) and materials (e.g. PVC ink and solvent) were employed to print the PVC ink solution onto Whatman filter paper No. 4. This provides a one-step strategy to print flow barriers without the need of further processing except evaporation for 3-5 min in a fume hood to remove the solvent. The production of the single layer μPADs is reasonably high with up to 77 devices per screening with 100% success rate. This method produces very narrow fluidic channel 486 ± 14 μm in width and hydrophobic barrier of 642 ± 25 μm thickness. Reproducibility of the production of fluidic channels and zones is satisfactory with RSDs of 2.9% (for 486-μm channel, n = 10), 3.7% (for 2-mm channel, n = 50) and 1.5% (for 6-mm diameter circular zone, n = 80). A design of a 2D-μPAD produced by this method was employed for the colorimetric dual-measurements of thiocyanate and nitrite in saliva. A 3D-μPADs with multiple layers of ink-screened paper was designed and constructed to demonstrate the method's versatility. These 3D-μPADs were designed for gas-liquid separation with in-situ colorimetric detection of ethanol vapor on the μPADs. The 3D-μPADs were applied for direct quantification of ethanol in beverages and highly colored pharmaceutical products. The printed barrier was resistant up to 8% (v/v) ethanol without liquid creeping out of the barrier.

Advanced Colorimetric Paper Sensors Using Color Focusing Effect Based on Asymmetric Flow of Fluid

Although paper-based colorimetric sensors utilizing enzymatic reactions are well suited for real-field diagnosis, their widespread use is hindered by signal blurring at the detection spot due to the action of capillary forces on the liquid and the corresponding membrane. In this study, we eliminated signal losses commonly observed during enzyme-mediated colorimetric sensing and achieved pattern-free quantitative analysis of glucose and uric acid by mixing enzymes and color-forming reagents with chitosan oligosaccharide lactate (COL), which resulted in perfectly focused colorimetric signals at the detection spot, using asymmetric flow induced by changing the flow rate of the COL-treated paper. The targets were calibrated with 0-500 mg/dL of glucose and 0-200 mg/dL of uric acid, and the limit of detection was calculated to be 0.6 and 0.03 mg/dL, respectively. In human urine, the correlation has a high response between the measured and spiked concentrations, and the stability of the enzyme mixture including COL increased by 41% for glucose oxidase mixture and 29% for uricase mixture, compared to the corresponding mixtures without COL. Thus, the color focusing and pattern-free sensor, which have the advantages of easy fabrication, easy handling, and high stability, should be applied to real-field diagnosis.

Low-cost fabrication of a paper-based microfluidic using a folded pattern paper

Despite that microfluidic paper-based analytical devices (μPADs) provide effective analytical platforms for point-of-care diagnosis in resource-limited areas, it remains challenging to achieve simple and low-cost fabrication of μPADs. A novel method for fabrication of μPADs is developed in this study using a folded polydimethylsiloxane (PDMS)-coated paper mask with a specific pattern to form a sandwich structure with inserted chromatographic paper. PDMS penetrates the target paper from the front and the back sides, and then is cured in the target paper to form legible channels. This method for prototyping μPADs has many favorable merits including simple operation without the need of trained personnel, fast fabrication and low cost. We further investigated colorimetric detection of melamine in the μPADs, and it showed a remarkable measurement with a detection limit of 0.1 ppm in aqueous solutions and liquid milk discriminated by the naked eye, which meets the detection limit required by USA and China. The fabricating strategy developed in this study is very promising and attractive for the development of simple μPADs for point-of-care applications, including diagnostic testing, food safety control and environmental monitoring.

Progress in Automated Urinalysis

New technological advances have paved the way for significant progress in automated urinalysis. Quantitative reading of urinary test strips using reflectometry has become possible, while complementary metal oxide semiconductor (CMOS) technology has enhanced analytical sensitivity and shown promise in microalbuminuria testing. Microscopy-based urine particle analysis has greatly progressed over the past decades, enabling high throughput in clinical laboratories. Urinary flow cytometry is an alternative for automated microscopy, and more thorough analysis of flow cytometric data has enabled rapid differentiation of urinary microorganisms. Integration of dilution parameters (e.g., creatinine, specific gravity, and conductivity) in urine test strip readers and urine particle flow cytometers enables correction for urinary dilution, which improves result interpretation. Automated urinalysis can be used for urinary tract screening and for diagnosing and monitoring a broad variety of nephrological and urological conditions; newer applications show promising results for early detection of urothelial cancer. Concomitantly, the introduction of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) has enabled fast identification of urinary pathogens. Automation and workflow simplification have led to mechanical integration of test strip readers and particle analysis in urinalysis. As the information obtained by urinalysis is complex, the introduction of expert systems may further reduce analytical errors and improve the quality of sediment and test strip analysis. With the introduction of laboratory-on-a-chip approaches and the use of microfluidics, new affordable applications for quantitative urinalysis and readout on cell phones may become available. In this review, we present the main recent developments in automated urinalysis and future perspectives.

Comparison of Direct and Indirect Laser Ablation of Metallized Paper for Inexpensive Paper-Based Sensors

In this work, we present a systematic study of laser processing of metallized papers (MPs) as a simple and scalable alternative to conventional photolithography-based processes and printing technologies. Two laser-processing methods are examined in terms of selectivity for the removal of the conductive aluminum film (25 nm) of an MP substrate; these processes, namely direct and indirect laser ablation (DLA and ILA), operate at wavelengths of 1.06 μm (neodymium-doped yttrium aluminum garnet) and 10.6 μm (CO₂), respectively. The required threshold energy for each laser processing method was systematically measured using electrical, optical, and mechanical characterization techniques. The results of these investigations show that the removal of the metal coating using ILA is only achieved through partial etching of the paper substrate. The ILA process shows a narrow effective set of laser settings capable of removing the metal film while not completely burning through the paper substrate. By contrast, DLA shows a more defined and selective removal of the aluminum layer without damaging the mechanical and natural fibular structure of the paper substrate. Finally, as a proof of concept, interdigitated capacitive moisture sensors were fabricated by means of DLA and ILA onto the MP substrate, and their performance was assessed in the humidity range of 2-85%. The humidity sensitivity results show that the DLA sensors have a superior humidity sensing performance compared to the ILA sensors. The observed behavior is attributed to the higher water molecule absorption and induced capillary condensation within the intact cellulose network resulting from the DLA process (compared to the damaged one from the ILA process). The DLA process of MP should enable scalable production of low-cost, paper-based physical and chemical sensing systems for potential use in point-of-care diagnostics and food packaging.

Fluorometric determination of dopamine by using molybdenum disulfide quantum dots

A method is described for the rapid fluorometric determination of dopamine (DA) by using molybdenum disulfide quantum dots (MoS₂ QDs) that were fabricated via an ammonium hydroxide etching method. The probe has a fluorescence (with excitation/emission peaks at 267/380 nm) that is quenched by DA with high selectivity over various interferences. This is attributed to a reaction that occurs between DA and the molybdate ions in pH 9 solutions of MoS₂ QDs. The formation of organic molybdate complexes and of dopamine-quinone results in strong quenching of the fluorescence of the QDs which is due to both electron transfer and an inner filter effect. Under the optimum conditions, the assay works in the 0.1-100 μM DA concentration range, with two linear ranges and a 10 nM detection limit. The method was applied to the determination of DA in spiked artificial urine samples, where it gave recoveries ranging from 97.6 to 102.2%, demonstrating that the method a promising tool for rapid and selective detection of DA. Graphical abstract MoS₂ QDs are facilely synthesized via the etching effect of ammonium hydroxide for highly selective fluorometric detection of dopamine.

3,3',5,5'-Tetramethylbenzidine Oxidation on Paper Devices for Horseradish Peroxidase-based Assays

We report on the colorimetric oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) by hydrogen peroxide using horseradish peroxidase on photolithography-fabricated (P-PAD) and wax-printed (W-PAD) paper-based analytical devices. Fabricating PADs via photolithography exposes the hydrophilic areas to polymers (photoresists) and solvents, not only reducing the hydrophilicity, but also affecting the TMB-H2O2 assay system with an unavoidable incomplete elimination of photoresist during fabrication. Detection signals are then observed in the presence of photoresist residues on the P-PAD, even at a blank HRP concentration.

Patterned polycaprolactone-filled glass microfiber microfluidic devices for total protein content analysis

Membrane based microfluidic devices have gained much popularity in recent years, as they make possible rapid, inexpensive analytical techniques that can be applied to a wide variety of areas. The ability to modify device hydrophilicity and hydrophobicity is critically important in fabricating membrane based microfluidic devices. Polar hydrophilic membranes, such as glass microfiber (GMF) membranes, hold great potential as they are inexpensive, chemically inert, and stable. Filling of these membranes with non-polar polymers such as polycaprolactone (PCL) converts the hydrophilic GMF into a hydrophobic medium. Controlled alteration of the surface chemistry of PCL/GMF substrates allows for the fabrication of microfluidic patterns on the surface. Using this approach, we have developed a simple and rapid technique for fabrication of highly adaptable complex multidimensional (2D and 3D) microfluidic pathways on a single membrane. PCL-filled GMF media were masked and selectively exposed to oxygen radicals so that the exposed surface became permanently superhydrophilic in its behavior. The desired microfluidic pattern was cut into the mask prior to assembly and exposure, and the mask was removed after exposure to reveal the ready-to-use microfluidic device. To verify and demonstrate the performance of this novel fabrication method, a colorimetric total protein assay was applied to the determination of protein concentrations in real samples.

Microfluidic PDMS on paper (POP) devices

In this paper, we propose a generalized concept of microfluidic polydimethylsiloxane (PDMS) on paper (POP) devices, which combines well the merits of paper chips and PDMS chips. First, we optimized the conditions for accurate PDMS spatial patterning on paper, based on screen printing and a high temperature enabled superfast curing technique, which enables PDMS patterning to an accuracy of tens of microns in less than ten seconds. This, in turn, makes it available for seamless, reversible and reliable integration of the resulting paper layer with other PDMS channel structures. The integrated POP devices allow for both porous paper and smooth channels to be spatially defined on the devices, greatly extending the flexibility for designers to be able to construct powerful functional structures. To demonstrate the versatility of this design, a prototype POP device for the colorimetric analysis of liver function markers, serum protein, alkaline phosphatase (ALP) and aspartate aminotransferase (AST), was constructed. On this POP device, quantitative sample loading, mixing and multiplex analysis have all been realized.

A Review on Microfluidic Paper-Based Analytical Devices for Glucose Detection

Glucose, as an essential substance directly involved in metabolic processes, is closely related to the occurrence of various diseases such as glucose metabolism disorders and islet cell carcinoma. Therefore, it is crucial to develop sensitive, accurate, rapid, and cost effective methods for frequent and convenient detections of glucose. Microfluidic Paper-based Analytical Devices (μPADs) not only satisfying the above requirements but also occupying the advantages of portability and minimal sample consumption, have exhibited great potential in the field of glucose detection. This article reviews and summarizes the most recent improvements in glucose detection in two aspects of colorimetric and electrochemical μPADs. The progressive techniques for fabricating channels on μPADs are also emphasized in this article. With the growth of diabetes and other glucose indication diseases in the underdeveloped and developing countries, low-cost and reliably commercial μPADs for glucose detection will be in unprecedentedly demand.

Advances in Microfluidic Paper-Based Analytical Devices for Food and Water Analysis

Food and water contamination cause safety and health concerns to both animals and humans. Conventional methods for monitoring food and water contamination are often laborious and require highly skilled technicians to perform the measurements, making the quest for developing simpler and cost-effective techniques for rapid monitoring incessant. Since the pioneering works of Whitesides' group from 2007, interest has been strong in the development and application of microfluidic paper-based analytical devices (μPADs) for food and water analysis, which allow easy, rapid and cost-effective point-of-need screening of the targets. This paper reviews recently reported μPADs that incorporate different detection methods such as colorimetric, electrochemical, fluorescence, chemiluminescence, and electrochemiluminescence techniques for food and water analysis.

Image analysis for a microfluidic paper-based analytical device using the CIE L*a*b* color system

A quantitative method based on image analysis of multiple color changes in microfluidic paper-based analytical devices using CIE L*a*b* color difference is presented.

A competitive immunoassay system for microfluidic paper-based analytical detection of small size molecules

A colorimetric competitive immunoassay system involving the catalytic oxidation of TMB by H₂O₂ was developed for the microfluidic paper-based detection of small size molecules.