Electrochemical sensors modified with iron oxide nanoparticles/nanocomposites for voltammetric detection of Pb (II) in water: A review

Permissible limits of Pb2+ in drinking water are being reduced from 10 μgL-1 to 5 μgL-1, which calls for rapid, and highly reliable detection techniques. Electrochemical sensors have garnered attention in detection of heavy metal ions in environmental samples due to their ease of operation, low cost, and rapid detection responses. Selectivity, sensitivity and detection capabilities of these sensors, can be enhanced by modifying their working electrodes (WEs) with iron oxide nanoparticles (IONPs) and/or their composites. Therefore, this review is an in-depth analysis of the deployment of IONPs/nanocomposites in modification of electrochemical sensors for detection of Pb2+ in drinking water over the past decade. From the analyzed studies (n = 23), the optimal solution pH, deposition potential, and deposition time ranged between 3 and 5.6, -0.7 to -1.4 V vs Ag/AgCl, and 100-400 s, respectively. Majority of the studies employed square wave anodic stripping voltammetry (n = 16), in 0.1 M acetate buffer solution (n = 19) for detection of Pb2+. Limits of detection obtained (2.5 x 10-9 - 4.5 μg/L) were below the permissible levels which indicated good sensitivities of the modified electrodes. Despite the great performance of these modified electrodes, the primary source of IONPs has always been commercial iron-based salts in addition to the use of so many materials as modifying agents of these IONPs. This may limit reproducibility and sustainability of the WEs due to lengthy and costly preparation protocols. Steel and/or iron industrial wastes can be alternatively employed in generation of IONPs for modification of electrochemical sensors. Additionally, biomass-based activated carbons enriched with surface functional groups are also used in modification of bare IONPs, and subsequently bare electrodes. However, these two areas still need to be fully explored.

A pleiotropy scan to discover new susceptibility loci for pancreatic ductal adenocarcinoma

Pleiotropic variants (i.e., genetic polymorphisms influencing more than one phenotype) are often associated with cancer risk. A scan of pleiotropic variants was successfully conducted ten years ago in relation to pancreatic ductal adenocarcinoma susceptibility. However, in the last decade, genetic association studies performed on several human traits have greatly increased the number of known pleiotropic variants. Based on the hypothesis that variants already associated with a least one trait have a higher probability of association with other traits, 61,052 variants reported to be associated by at least one genome wide association study (GWAS) with at least one human trait were tested in the present study consisting of two phases (discovery and validation), comprising a total of 16,055 pancreatic ductal adenocarcinoma (PDAC) cases and 212,149 controls. The meta-analysis of the two phases showed two loci (10q21.1-rs4948550 (P=6.52×10-5) and 7q36.3-rs288762 (P=3.03×10-5) potentially associated with PDAC risk. 10q21.1-rs4948550 shows a high degree of pleiotropy and it is also associated with colorectal cancer risk while 7q36.3-rs288762 is situated 28,558 base pairs upstream of the Sonic Hedgehog (SHH) gene, which is involved in the cell differentiation process and PDAC etiopathogenesis. In conclusion, none of the single nucleotide polymorphisms (SNPs) showed a formally statistically significant association after correction for multiple testing. However, given their pleiotropic nature and association with various human traits including colorectal cancer, the two SNPs showing the best associations with PDAC risk merit further investigation through fine mapping and ad hoc functional studies.

In-Memory Sensing and Computing for Cancer Diagnostics: A Perspective Paper

During the past two decades, a number of two-terminal switching devices have been demonstrated in the literature. They typically exhibit hysteric behavior in the current-to-voltage characteristics. These devices have often been also referred to as memristive devices. Their capacity to switch and exhibit electrical hysteresis has made them well-suited for applications such as data storage, in-memory computing, and in-sensor computing or in-memory sensing. The aim of this perspective paper is to is twofold. Firstly, it seeks to provide a comprehensive examination of the existing research findings in the field and engage in a critical discussion regarding the potential for the development of new non-Von-Neumann computing machines that can seamlessly integrate sensing and computing within memory units. Secondly, this paper aims to demonstrate the practical application of such an innovative approach in the realm of cancer medicine. Specifically, it explores the modern concept of employing multiple cancer markers simultaneously to enhance the efficiency of diagnostic processes in cancer medicine.

Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) methods for the therapeutic drug monitoring of cytotoxic anticancer drugs: An update

In the era of precision medicine, there is increasing evidence that conventional cytotoxic agents may be suitable candidates for therapeutic drug monitoring (TDM)- guided drug dosage adjustments and patient's tailored personalization of non-selective chemotherapies. To that end, many liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) assays have been developed for the quantification of conventional cytotoxic anticancer chemotherapies, that have been comprehensively and critically reviewed. The use of stable isotopically labelled internal standards (IS) of cytotoxic drugs was strikingly uncommon, accounting for only 48 % of the methods found, although their use could possible to suitably circumvent patients' samples matrix effects variability. Furthermore, this approach would increase the reliability of cytotoxic drug quantification in highly multi-mediated cancer patients with complex fluctuating pathophysiological and clinical conditions. LC-MS/MS assays can accommodate multiplexed analyses of cytotoxic drugs with optimal selectivity and specificity as well as short analytical times and, when using stable-isotopically labelled IS for quantification, provide concentrations measurements with a high degree of certainty. However, there are still organisational, pharmacological, and medical constraints to tackle before TDM of cytotoxic drugs can be more largely adopted in the clinics for contributing to our ever-lasting quest to improve cancer treatment outcomes.

A Frequency-Switching Inductive Power Transfer System for Wireless, Miniaturised and Large-Scale Neural Interfaces

Three-coil inductive power transfer is the state-of-the-art solution to power multiple miniaturised neural implants. However, the maximum delivered power is limited by the efficiency of the powering link and safety constrains. Here we propose a frequency-switching inductive link, where the passive resonator normally used in a three-coil link is replaced by an active resonator. It receives power from the external transmitter via a two-coil inductive link at the low frequency of 13.56 MHz. Then, it switches the operating frequency to the higher frequency of 433.92 MHz through a dedicated circuitry. Last, it transmits power to 1024 miniaturised implants via a three-coil inductive link using an array of 37 focusing resonators for a brain coverage of 163.84 mm 2. Our simulations reported a power transfer efficiency of 0.013% and a maximum power delivered to the load of 1970 μ W under safety-constrains, which are respectively two orders of magnitude and more than six decades higher compared to an equivalent passive three-coil link. The frequency-switching inductive system is a scalable and highly versatile solution for wireless, miniaturised and large-scale neural interfaces.

A Wearable Real-Time System for Simultaneous Wireless Power and Data Transmission to Cortical Visual Prosthesis

Wireless, miniaturised and distributed neural interfaces are emerging neurotechnologies. Although extensive research efforts contribute to their technological advancement, the need for real-time systems enabling simultaneous wireless information and power transfer toward distributed neural implants remains crucial. Here we present a complete wearable system including a software for real-time image capturing, processing and digital data transfer; an hardware for high radiofrequency generation and modulation via amplitude shift keying; and a 3-coil inductive link adapt to operate with multiple miniaturised receivers. The system operates in real-time with a maximum frame rate of 20 Hz, reconstructing each frame with a matrix of 32 × 32 pixels. The device generates a carrier frequency of 433.92 MHz. It transmits the highest power of 32 dBm with a data rate of 6 Mbps and a variable modulation index as low as 8 %, thus potentially enabling wireless communication with 1024 miniaturised and distributed intracortical microstimulators. The system is primarily conceived as an external wearable device for distributed cortical visual prosthesis covering a visual field of 20 °. At the same time, it is modular and versatile, being suitable for multiple applications requiring simultaneous wireless information and power transfer to large-scale neural interfaces.

Soft Epidermal Paperfluidics for Sweat Analysis by Ratiometric Raman Spectroscopy

The expanding interest in digital biomarker analysis focused on non-invasive human bodily fluids, such as sweat, highlights the pressing need for easily manufactured and highly efficient soft lab-on-skin solutions. Here, we report, for the first time, the integration of microfluidic paper-based devices (μPAD) and non-enhanced Raman-scattering-enabled optical biochemical sensing (Raman biosensing). Their integration merges the enormous benefits of μPAD, with high potential for commercialization and use in resource-limited settings, with biorecognition-element-free (but highly selective) optical Raman biosensing. The introduced thin (0.36 mm), ultra-lightweight (0.19 g), and compact footprint (3 cm2) opto-paperfluidic sweat patch is flexible, stretchable, and conforms, irritation-free, to hairless or minimally haired body regions to enable swift sweat collection. As a great advantage, this new bio-chemical sensory system excels through its absence of onboard biorecognition elements (bioreceptor-free) and omission of plasmonic nanomaterials. The proposed easy fabrication process is adaptable to mass production by following a fully sustainable and cost-effective process utilizing only basic tools by avoiding typically employed printing or laser patterning. Furthermore, efficient collection and transportation of precise sweat volumes, driven exclusively by the wicking properties of porous materials, shows high efficiency in liquid transportation and reduces biosensing latency by a factor of 5 compared to state-of-the-art epidermal microfluidics. The proposed unit enables electronic chip-free and imaging-less visual sweat loss quantification as well as optical biochemical analysis when coupled with Raman spectroscopy. We investigated the multimodal quantification of sweat urea and lactate levels ex vivo (with syntactic sweat including +30 sweat analytes on porcine skin) and achieved a linear dynamic range from 0 to 100 mmol/L during fully dynamic continuous flow characterization.

Portable impedance-sensing device for microorganism characterization in the field

A variety of biosensors have been proposed to quickly detect and measure the properties of individual microorganisms among heterogeneous populations, but challenges related to cost, portability, stability, sensitivity, and power consumption limit their applicability. This study proposes a portable microfluidic device based on impedance flow-cytometry and electrical impedance spectroscopy that can detect and quantify the size of microparticles larger than 45 µm, such as algae and microplastics. The system is low cost ($300), portable (5 cm [Formula: see text] 5 cm), low-power (1.2 W), and easily fabricated utilizing a 3D-printer and industrial printed circuit board technology. The main novelty we demonstrate is the use of square wave excitation signal for impedance measurements with quadrature phase-sensitive detectors. A linked algorithm removes the errors associated to higher order harmonics. After validating the performance of the device for complex impedance models, we used it to detect and differentiate between polyethylene microbeads of sizes between 63 and 83 µm, and buccal cells between 45 and 70 µm. A precision of 3% is reported for the measured impedance and a minimum size of 45 µm is reported for the particle characterization.

Changes over Time in the Electrode/Brain Interface Impedance: An Ex-vivo Study

Closed-loop neural implants based on continuous brain activity recording and intracortical microstimulation are extremely effective and promising devices to monitor and address many neurodegenerative diseases. The efficiency of these devices depends on the robustness of the designed circuits which rely on precise electrical equivalent models of the electrode/brain interface. This is true in the case of amplifiers for differential recording, voltage or current drivers for neurostimulation, and potentiostats for electrochemical bio-sensing. This is of paramount importance, especially for the next generation of wireless and ultra-miniaturised CMOS neural implants. Circuits are usually designed and optimized considering the electrode/brain impedance with a simple electrical equivalent model whose parameters are stationary over time. However, the electrode/brain interfacial impedance varies simultaneously in frequency and in time after implantation. The aim of this study is to monitor the impedance changes occurring on microelectrodes inserted in ex-vivo porcine brains to derive an opportune electrode/brain model describing the system and its evolution in time. In particular, impedance spectroscopy measurements have been performed for 144 hours to characterise the evolution of the electrochemical behaviour in two different setups analysing both the neural recording and the chronic stimulation scenarios. Then, different equivalent electrical circuit models have been proposed to describe the system. Results showed a decrease in the resistance to charge transfer, attributed to the interaction between biological material and the electrode surface. These findings are crucial to support circuit designers in the field of neural implants.

Iron oxide nanoparticles/nanocomposites derived from steel and iron wastes for water treatment: A review

Iron oxide nanoparticles (IONPs) are characterized by superior magnetic properties, high surface area to volume ratio, and active surface functional groups. These properties aid in removal of pollutants from water, through adsorption and/or photocatalysis, justifying the choice of IONPs in water treatment systems. IONPs are usually developed from commercial chemicals of ferric and ferrous salts alongside other reagents, a procedure that is costly, environmentally unfriendly and limits their mass production. On the other hand, steel and iron industries produce both solid and liquid wastes which in most cases are piled, discharged into water streams or landfilled as strategies to dispose them off. Such practices are detrimental to environmental ecosystems. Given the high content of iron present in these wastes, they can be used to generate IONPs. This work reviewed published literature through selected key words on the deployment of steel and/or iron-based wastes as IONPs precursors for water treatment. The findings reveal that steel waste-derived IONPs have properties such as specific surface area, particle sizes, saturation magnetization, and surface functional groups that are comparable or sometimes better than those synthesized from commercial salts. Furthermore, the steel waste-derived IONPs have high removal efficacy for heavy metals and dyes from water with possibilities of being regenerated. The performance of steel waste-derived IONPs can be enhanced by functionalization with different reagents such as chitosan, graphene, and biomass based activated carbons. Nonetheless, there is need to explore the potential of steel waste-based IONPs in removing contaminants of emerging concern, modifying pollutant detection sensors, their techno-economic feasibility in large treatment plants, toxicity of these nanoparticles when ingested into the human body, among other areas.

Biocompatible and Biodegradable 3D Printing from Bioplastics: A Review

There has been a lot of interest in developing and producing biodegradable polymers to address the current environmental problem caused by the continued usage of synthetic polymers derived from petroleum products. Bioplastics have been identified as a possible alternative to the use of conventional plastics since they are biodegradable and/or derived from renewable resources. Additive manufacturing, also referred to as 3D printing, is a field of growing interest and can contribute towards a sustainable and circular economy. The manufacturing technology also provides a wide material selection with design flexibility increasing its usage in the manufacture of parts from bioplastics. With this material flexibility, efforts have been directed towards developing 3D printing filaments from bioplastics such as Poly (lactic acid) to substitute the common fossil- based conventional plastic filaments such as Acrylonitrile butadiene styrene. Plant biomass is now utilized in the development of biocomposite materials. A lot of literature presents work done toward improving the biodegradability of printing filaments. However, additive manufacture of biocomposites from plant biomass is faced with printing challenges such as warping, low agglomeration between layers and poor mechanical properties of the printed parts. The aim of this paper is to review the technology of 3D printing using bioplastics, study the materials that have been utilized in this technology and how challenges of working with biocomposites in additive manufacture have been addressed.

Precision Oncology by Point-of-Care Therapeutic Drug Monitoring and Dosage Adjustment of Conventional Cytotoxic Chemotherapies: A Perspective

Therapeutic drug monitoring (TDM) of conventional cytotoxic chemotherapies is strongly supported yet poorly implemented in daily practice in hospitals. Analytical methods for the quantification of cytotoxic drugs are instead widely presented in the scientific literature, while the use of these therapeutics is expected to keep going for longer. There are two main issues hindering the implementation of TDM: turnaround time, which is incompatible with the dosage profiles of these drugs, and exposure surrogate marker, namely total area under the curve (AUC). Therefore, this perspective article aims to define the adjustment needed from current to efficient TDM practice for cytotoxics, namely point-of-care (POC) TDM. For real-time dose adjustment, which is required for chemotherapies, such POC TDM is only achievable with analytical methods that match the sensitivity and selectivity of current methods, such as chromatography, as well as model-informed precision dosing platforms to assist the oncologist with dose fine-tuning based on quantification results and targeted intervals.

Electrochemiluminescent immunosensor for detection of carcinoembryonic antigen using luminol-coated silver nanoparticles

Recently, electrochemiluminescent (ECL) immunosensors have received much attention in the field of biomarker detection. Here, a highly enhanced ECL immunosensing platform was designed for ultrasensitive detection of carcinoembryonic antigen (CEA). The surface of the glassy carbon electrode was enhanced by applying functional nanostructures such as thiolated graphene oxide (S-GO) and streptavidin-coated gold nanoparticles (SA-AuNPs). The selectivity and sensitivity of the designed immunosensor were improved by entrapping CEA biomolecules using a sandwich approach. Luminol/silver nanoparticles (Lu-SNPs) were applied as the main core of the signaling probe, which were then coated with streptavidin to provide overloading of the secondary antibody. The highly ECL signal enhancement was obtained due to the presence of horseradish peroxidase (HRP) in the signaling probe, in which the presence of H₂O₂ further amplified the intensity of the signals. The engineered immunosensor presented excellent sensitivity for CEA detection, with limit of detection (LOD) and linear detection range (LDR) values of 58 fg mL^-1 and 0.1 pg mL^-1 to 5 pg mL^-1 (R² = 0.9944), respectively. Besides its sensitivity, the fabricated ECL immunosensor presented outstanding selectivity for the detection of CEA in the presence of various similar agents. Additionally, the developed immunosensor showed an appropriate repeatability (RSD 3.8%) and proper stability (2 weeks). Having indicated a robust performance in the real human serum with stated LOD and LDR, the engineered immunosensor can be considered for the detection and monitoring of CEA in the clinic.

Real-Time Multi-Ion-Monitoring Front-End With Interference Compensation by Multi-Output Support Vector Regressor

Ion-sensors play a major role in physiology and healthcare monitoring since they are capable of continuously collecting biological data from body fluids. Nevertheless, ion interference from background electrolytes present in the sample is a paramount challenge for a precise multi-ion-monitoring. In this work, we propose the first system combining a battery-powered portable multi-channel electronic front-end, and an embedded Multi-output Support Vector Regressor (M-SVR), that supplies an accurate, continuous, and real-time monitoring of sodium, potassium, ammonium, and calcium ions. These are typical analytes tracked during physical exercise. The front-end interface was characterized through a sensor array built with screen-printed electrodes. Nernstian sensitivity and limit of detection comparable to a bulky laboratory potentiometer were achieved in both water and artificial sweat. The multivariate calibration model was deployed on a Raspberry Pi where the activity of the target ions were locally computed. The M-SVR model was trained, optimized, and tested on an experimental dataset acquired following a design of experiments. We demonstrate that the proposed multivariate regressor is a compact, low-complexity, accurate, and unbiased estimator of sodium and potassium ions activity. A global normalized root mean-squared error improvement of 6.97%, and global mean relative error improvement of 10.26%, were achieved with respect to a standard Multiple Linear Regressor (MLR). Within a real-time multi-ion-monitoring task, the overall system enabled the continuous monitoring and accurate determination of the four target ions activity, with an average accuracy improvement of 27.73% compared to a simple MLR, and a prediction latency of [Formula: see text].

All-in-Fiber Electrochemical Sensing

Electrochemical sensors have found a wide range of applications in analytical chemistry thanks to the advent of high-throughput printing technologies. However, these techniques are usually limited to two-dimensional (2D) geometry with relatively large minimal feature sizes. Here, we report on the scalable fabrication of monolithically integrated electrochemical devices with novel and customizable fiber-based architectures. The multimaterial thermal drawing technique is employed to co-process polymer composites and metallic glass into uniform electroactive and pseudoreference electrodes embedded in an insulating polymer cladding fiber. To demonstrate the versatility of the process, we tailor the fiber microstructure to two configurations: a small-footprint fiber tip sensor and a high-surface-area capillary cell. We demonstrate the performance of our devices using cyclic voltammetry and chronoamperometry for the direct detection and quantification of paracetamol, a common anesthetic drug. Finally, we showcase a fully portable pipet-based analyzer using low-power electronics and an "electrochemical pipet tip" for direct sampling and analysis of microliter-range volumes. Our approach paves the way toward novel materials and architectures for efficient electrochemical sensing to be deployed in existing and novel personal care and surgical configurations.

Long-term outcomes after pancreatoduodenectomy for ampullary cancer: The influence of the histological subtypes and comparison with the other periampullary neoplasms

BACKGROUND

Ampullary carcinoma (AC) is histologically classified as intestinal (In-AC), pancreaticobiliary (Pb-AC) or mixed-AC. The prognostic role of AC subtypes has been debated and remains unclear. The aims of this study were to evaluate outcomes after pancreatoduodenectomy (PD) for each subtype of AC and to compare these with pancreatic ductal adenocarcinoma [PDAC] and distal cholangiocarcinoma [DCC].

METHODS

PDs performed for AC between 2010 and 2018 were retrospectively evaluated. Histological subtype was obtained for all patients. One-year, 3-year and 5-year disease-free-survival (DFS) and overall survival (OS) rates were calculated. Kaplan-Meier survival analysis was performed to compare Pb-AC, In-AC and mixed-AC. Comparison with PDs performed for PDAC and DCC during the same period was also performed.

RESULTS

A total of 97 patients undergoing PD for AC were evaluated: 34 (35.1%) In-AC, 54 (55.7%) Pb-AC and 9 mixed-AC (9.3%). DFS and OS rates for Pb-AC were significantly lower compared to In-AC (p < 0.05 and p < 0.01), but similar to mixed-AC (p = 0.3 and p = 0.4). Adjuvant therapy was not associated with increased survival, regardless of the histological subtype (p > 0.05). During the same period, 337 and 53 PDs for PDAC and DCC, respectively, were performed. In-AC was associated with significantly better outcomes compared to PDAC and DCC (p < 0.001); DFS and OS rates for Pb-AC and mixed AC were significantly higher compared to PDAC (p < 0.001), but similar to DCC (p > 0.05).

CONCLUSIONS

Pb-AC has significantly worse survival compared to In-AC. Moreover, mixed-AC should be considered as Pb-AC. Pb-AC and mixed-AC seem to have better prognosis compared to PDAC, but similar to DCC.

New Approach for Making Standard the Development of Biosensing Devices by a Modular Multi-Purpose Design

The fast widening of biosensing applications, such as healthcare, drug delivery, food, and military industries, is increasing the need for generality and compatibility among different sensors. To address this challenge, we present here an innovative approach for the fast development of new electronic biosensing systems, linking a custom-designed front-end with a multi-purpose system. We envision an open tool to help designers to focus on the target molecule and related detection method instead of designing each time a dedicated electronic device. The architecture of the proposed system is based on a modular approach, where only the front-end and the software need to be custom re-designed according to the application. Considering current research and applying a rigorous definition of the technical requirements, the core of the system is designed to fit the highest number of biosensing methods. The flexibility of this approach is successfully demonstrated with three different types of biosensors, i.e., amperometric, ion-sensitive, and memristive.

Very Selective Detection of Low Physiopathological Glucose Levels by Spontaneous Raman Spectroscopy with Univariate Data Analysis

After decades of research on non-invasive glucose monitoring, invasive devices based on finger blood sampling are still the predominant reference for diabetic patients for accurately measuring blood glucose levels. Meanwhile, research continues improving point-of-care technology toward the development of painless and more accurate devices. Raman spectroscopy is well-known as a potentially valuable and painless approach for measuring glucose levels. However, previous Raman studies deal with glucose concentrations that are still order of magnitudes away with respect to human tissues’ physiological concentrations, or they propose enhancement methodologies either invasive or much complex to assure sufficient sensitivity in the physiological range. Instead, this study proposes an alternative non-enhanced Raman spectroscopy approach sensitive to glucose concentrations from 1 to 5 mmol/l, which correspond to the lowest physiopathological glucose level in human blood. Our findings suggest a very selective detection of glucose with respect to other typical metabolites, usually interfering with Raman spectroscopy’s glucose detection. We validate the proposed univariate sensing methodology on glucose solutions mixed with lactate and urea, the two most common molecules found in human serum with concentrations similar to glucose and similar features in the Raman spectra. Our findings clearly illustrate that reliable detection of glucose by Raman spectroscopy is feasible by exploiting the shifted peak at 1125 ± 10 cm–1 within physiopathological ranges.

Electrochemical Sensing of Adenosin Triphosphate by Specific Binding to Dipicolylamine Group in Cyclodextrin Supramolecular Complex

Electrochemical detection based on cyclodextrin supramolecular complexes is founded on the competitive binding between electroactive probes and target molecules. This limits their versatility to be used for sensing a broad range of metabolites. In this work, we demonstrate the significant role of zinc ions as well as of β-cyclodextrins modified with dipicolylamine and of a phenylboronic acid-modified ferrocene probe to address a selective electrochemical detection of adenosin triphosphate (ATP). Our findings will definitively have an impact in oncological point-of-care systems, since a high level of extracellular ATP reveals the inflammatory response due to chemotherapeutic treatments.

Smart Portable Pen for Continuous Monitoring of Anaesthetics in Human Serum With Machine Learning

Continuous monitoring of anaesthetics infusion is demanded by anaesthesiologists to help in defining personalized dose, hence reducing risks and side effects. We propose the first piece of technology tailored explicitly to close the loop between anaesthesiologist and patient with continuous drug monitoring. Direct detection of drugs is achieved with electrochemical techniques, and several options are present in literature to measure propofol (widely used anaesthetics). Still, the sensors proposed do not enable in-situ detection, they do not provide this information continuously, and they are based on bulky and costly lab equipment. In this paper, we present a novel smart pen-shaped electronic system for continuous monitoring of propofol in human serum. The system consists of a needle-shaped sensor, a quasi digital front-end, a smart machine learning data processing, in a single wireless battery-operated embedded device featuring Bluetooth Low Energy (BLE) communication. The system has been tested and characterized in real, undiluted human serum, at 37  ^°C. The device features a limit of detection of 3.8  μM, meeting the requirement of the target application, with an electronics system 59% smaller and 81% less power consuming w.r.t. the state-of-the-art, using a smart machine learning classification for data processing, which guarantees up to twenty continuous measure.

Miniaturised Wireless Power Transfer Systems for Neurostimulation: A Review

In neurostimulation, wireless power transfer is an efficient technology to overcome several limitations affecting medical devices currently used in clinical practice. Several methods were developed over the years for wireless power transfer. In this review article, we report and discuss the three most relevant methodologies for extremely miniaturised implantable neurostimulators: ultrasound coupling, inductive coupling and capacitive coupling. For each powering method, the discussion starts describing the physical working principle. In particular, we focus on the challenges given by the miniaturisation of the implanted integrated circuits and the related ad-hoc solutions for wireless power transfer. Then, we present recent developments and progresses in wireless power transfer for biomedical applications. Last, we compare each technique based on key performance indicators to highlight the most relevant and innovative solutions suitable for neurostimulation, with the gaze turned towards miniaturisation.

Electrochemical Assay for Extremely Selective Recognition of Fructose Based on 4-Ferrocene-Phenylboronic Acid Probe and β-Cyclodextrins Supramolecular Complex

The aim of the present paper is to highlight a novel electrochemical assay for an extremely-selective detection of fructose thanks to the use of a supramolecular complex between β-cyclodextrins (β-CDs) and a chemically modified ferrocene with boronic acid named 4-Fc-PB/natural-β-CDs. Another kind of β-CDs, the 4-Fc-PB/3-phenylboronic-β-CDs, is proposed for the detection of glucose. The novel electrochemical probe is fully characterized by ¹ H nuclear magnetic resonance, mass spectroscopy, and elemental analysis, while the superior electrochemical performance is assessed in terms of sensitivity and detection limit. The novelty of the present work consists in the role of CDs that for the first time are employed in electrochemistry with a unique detection mechanism based on specific chemical interactions with the target molecule by the introduction of proper binding groups. A highly selective detection of fructose is obtained and it is believed that the proposed mechanism of detection represents a new way to electrochemically sense other molecules by varying the combination of specific groups of the supramolecular complex. The findings are of impactful importance since a quick, easy, cheap, and extremely selective detection of fructose is not yet available in the market, here achieved by using electrochemical methods which are a very growing field.

Microfluidics by Additive Manufacturing for Wearable Biosensors: A Review

Wearable devices are nowadays at the edge-front in both academic research as well as in industry, and several wearable devices have been already introduced in the market. One of the most recent advancements in wearable technologies for biosensing is in the area of the remote monitoring of human health by detection on-the-skin. However, almost all the wearable devices present in the market nowadays are still providing information not related to human ‘metabolites and/or disease’ biomarkers, excluding the well-known case of the continuous monitoring of glucose in diabetic patients. Moreover, even in this last case, the glycaemic level is acquired under-the-skin and not on-the-skin. On the other hand, it has been proven that human sweat is very rich in molecules and other biomarkers (e.g., ions), which makes sweat a quite interesting human liquid with regards to gathering medical information at the molecular level in a totally non-invasive manner. Of course, a proper collection of sweat as it is emerging on top of the skin is required to correctly convey such liquid to the molecular biosensors on board of the wearable system. Microfluidic systems have efficiently come to the aid of wearable sensors, in this case. These devices were originally built using methods such as photolithographic and chemical etching techniques with rigid materials. Nowadays, fabrication methods of microfluidic systems are moving towards three-dimensional (3D) printing methods. These methods overcome some of the limitations of the previous method, including expensiveness and non-flexibility. The 3D printing methods have a high speed and according to the application, can control the textures and mechanical properties of an object by using multiple materials in a cheaper way. Therefore, the aim of this paper is to review all the most recent advancements in the methods for 3D printing to fabricate wearable fluidics and provide a critical frame for the future developments of a wearable device for the remote monitoring of the human metabolism directly on-the-skin.

Electrochemical detection of different p53 conformations by using nanostructured surfaces

Protein electrochemistry represents a powerful technique for investigating the function and structure of proteins. Currently available biochemical assays provide limited information related to the conformational state of proteins and high costs. This work provides novel insights into the electrochemical investigation of the metalloprotein p53 and its redox products using label-free direct electrochemistry and label-based antibody-specific approaches. First, the redox activities of different p53 redox products were qualitatively investigated on carbon-based electrodes. Then, focusing on the open p53 isoform (denatured p53), a quantitative analysis was performed, comparing the performances of different bulk and nanostructured materials (carbon and platinum). Overall, four different p53 products could be successfully discriminated, from wild type to denatured. Label-free analysis suggested a single electron exchange with electron transfer rate constants on the order of 1 s-1. Label-based analysis showed decreasing affinity of pAb240 towards denatured, oxidized and nitrated p53. Furthermore, platinum nanostructured electrodes showed the highest enhancement of the limit of detection in the quantitative analysis (100 ng/ml). Overall, the obtained results represent a first step towards the implementation of highly requested complex integrated devices for clinical practices, with the aim to go beyond simple protein quantification.

A novel electrochemical sensor for non-invasive monitoring of lithium levels in mood disorders

Lithium is the main drug for the treatment of mood disorders. Due to its narrow therapeutic window, Therapeutic Drug Monitoring (TDM) is a norm during therapy in order to avoid adverse effects. Consequently, patients are obliged to frequent check-ups in hospitals to determine their serum concentration and optimize accordingly the drug dose. Wearable sensors have attracted a growing interest in the research community in recent years owing to their promising impact in personalized healthcare. In particular, sweat diagnosis has seen an enormous expansion and is currently entering the market thanks to the large availability and simple collection of this fluid. In this paper a novel approach for non-invasive decentralized monitoring of lithium drug concentration through sweat analysis is proposed for the first time. An all-solid-state Ion- Selective Electrode (ISE) with a nanostructured Solid-Contact (SC) is used to detect lithium ions in sweat. The sensor offers near-Nernstian behaviour (57:6±2:1 mV/decade) in the concentration range of interest. In addition, it shows fast response (15-30 s), good reversibility and small potential drift over time. A wide pH stability window (pH 4-12) is also proved.

An IoT Solution for Online Monitoring of Anesthetics in Human Serum Based on an Integrated Fluidic Bioelectronic System

In this paper, we present the design, the implementation and the validation of a novel Internet of Things (IoT) drug monitoring system for the online continuous and simultaneous detection of two main anesthetics, e.g., propofol and paracetamol, in undiluted human serum. The described full system consists of a custom-built electronic Raspberry Pi (RPi) based Printed Circuit Board (PCB) that drives and reads out the signal from an electrochemical sensing platform integrated into a fluidic system. Thanks to the Polydimethylsiloxane (PDMS) fluidic device, the analyzed sample is automatically fluxed on the sensing site. The IoT network is supported by a Cloud system, which allows the doctor to control and share all the patient's data through a dedicated Android application and a smart watch. The validation closes with the first ever demonstration that our system successfully works for the simultaneous monitoring of propofol and paracetamol in undiluted human serum by measuring the concentration trends of these two drugs in fluxing conditions over time.

Nanowire Sensors in Cancer

In 2006, the group of Dr C.M. Lieber pioneered the field of nanowire sensors by fabricating devices for the ultra-sensitive label-free detection of biological macromolecules. Since then, nanowire sensors have demonstrated their ability to detect cancer-associated analytes in peripheral blood, tumor tissue, and the exhaled breath of cancer patients. These innovative developments have marked a new era with unprecedented detection performance, capable of addressing crucial needs such as cancer diagnosis and monitoring disease progression and patient response to therapy. The ability of nanowire sensors to identify molecular features of patient tumor represents a first step toward precision medicine, and their integration into portable devices has the potential to revolutionize cancer diagnosis and patient monitoring.

Label-free detection of hypoxia-induced extracellular vesicle secretion from MCF-7 cells

Nanoscale extracellular vesicles (EVs) including exosomes (50-150 nm membrane particles) have emerged as promising cancer biomarkers due to the carried genetic information about the parental cells. However the sensitive detection of these vesicles remains a challenge. Here we present a label-free electrochemical sensor to measure the EVs secretion levels of hypoxic and normoxic MCF-7 cells. The sensor design includes two consecutive steps; i) Au electrode surface functionalization for anti-CD81 Antibody and ii) EVs capture. The label-free detection of EVs was done via Differential Pulse Voltammetry (DPV) and Electrochemical Impedance Spectroscopy (EIS). The working linear range for the sensor was 102-109 EVs/ml with an LOD 77 EVs/mL and 379 EVs/ml for EIS and DPV based detection. A blood-abundant protein, RhD was used for the selectivity test. In order to assess the performance of the biosensor, the level of EVs secretion by the human breast cancer MCF-7 cell line was compared with enzyme-linked immunosorbent assays (ELISA) and Nanoparticle Tracking Analysis (NTA). Designed label-free electrochemical sensors utilized for quantification of EVs secretion enhancement due to CoCl2-induced hypoxia and 1.23 fold increase with respect to normoxic conditions was found.

Highly-stable Li+ ion-selective electrodes based on noble metal nanostructured layers as solid-contacts

Nowadays the development of stable and highly efficient Solid-Contact Ion-Selective Electrodes (SC-ISEs) attracts much attention in the research community because of the great expansion of portable analytical devices. In this work, we present highly stable Li⁺ all-solid-state ISEs exploiting noble metals nanostructures as ion-to-electron transducers. The detection of lithium is essential for therapeutic drug monitoring of bipolar patients. In addition, greater environmental exposure to this ion is occurring due to the large diffusion of lithium-ion batteries. However, only a limited number of SC Li⁺ ISEs already exists in literature based on Conductive Polymers (CPs) and carbon nanotubes. The use of noble metals for ion-to-electron transduction offers considerable advantages over CPs and carbon materials, including fast and conformal one-step deposition by electrochemical means, non-toxicity and high stability. We investigate for the first time the use of gold nanocorals obtained by means of a one-step electrodeposition process to improve sensor performance and we compare it to all-solid-state ISEs based on electrodeposited platinum nanoflowers. In addition, the effect of substrate electrode material, membrane thickness and conditioning concentration on the potentiometric response is carefully analysed. Scanning Electron Microscopy (SEM) and Current Reversal Chronopotentiometry (CRC) techniques are used to characterize the morphology and the electrochemical behaviour of the different ISEs. The use of nanostructured gold and platinum contacts allows the increase of the SC capacitance by one or two orders of magnitude, respectively, with respect to the flat metal, while the SC resistance is significantly reduced. We show that the microfabricated sensors offer Nernstian behaviour (58.7±0.8 mV/decade) in the activity range from 10^-5 to 0.1 M, with short response time (∼15 s) and small potential drift during CRC measurements (dEdt=3×10^-5±2×10^-5 V/s). The exceptional response stability is verified also when no potential is applied. The sensor shows high selectivity towards all clinically important ions, with values very similar to conventional ISEs. Furthermore, to our knowledge, the selectivity towards Ca⁺² is the best ever reported for SC-ISEs. In conclusion, the present study opens up new interesting perspectives towards the development of simple and reproducible fabrication protocols to obtain high-quality and high-stability all-solid-state ISEs.

A Differential Electrochemical Readout ASIC With Heterogeneous Integration of Bio-Nano Sensors for Amperometric Sensing

A monolithic biosensing platform is presented for miniaturized amperometric electrochemical sensing in CMOS. The system consists of a fully integrated current readout circuit for differential current measurement as well as on-die sensors developed by growing platinum nanostructures (Pt-nanoS) on top of electrodes implemented with the top metal layer. The circuit is based on the switch-capacitor technique and includes pseudodifferential integrators for concurrent sampling of the differential sensor currents. The circuit further includes a differential to single converter and a programmable gain amplifier prior to an ADC. The system is fabricated in [Formula: see text] technology and measures current within [Formula: see text] with minimum input-referred noise of [Formula: see text] and consumes [Formula: see text] from a [Formula: see text] supply. Differential sensing for nanostructured sensors is proposed to build highly sensitive and offset-free sensors for metabolite detection. This is successfully tested for bio-nano-sensors for the measurement of glucose in submilli molar concentrations with the proposed readout IC. The on-die electrodes are nanostructured and cyclic voltammetry run successfully through the readout IC to demonstrate detection of [Formula: see text].

The memristive effect as a novelty in drug monitoring

Nanoscale devices exhibiting memristive properties show great potential in a plethora of applications. In this work, memristive nanowires are presented for the first time as ideal candidates for absolutely novel, ultrasensitive, highly specific and selective drug-biosensors, also paving the way for real-time monitoring applications, in coupling with the restoration properties of DNA-aptamers. The hysteretic properties exhibited by the hereby-presented special nanodevices, modified via surface treatments, are leveraged along the complete cycle consisting of DNA-aptamer immobilization, target binding, and DNA-aptamer regeneration for successful and effective detection of Tenofovir, an antiviral drug for HIV treatment, in buffer as well as in non-diluted human serum. This results in ultrasensitive, label-free monitoring of the therapeutic compound with a limit of detection of 3.09 pM in buffer and 1.38 nM in full serum. These LODs demonstrate 10 times higher sensitivity for the in-buffer drug detection, and twice better performance for drug sensing in full human serum, ever obtained. The selectivity of the memristive biosensor for Tenofovir detection was verified through both positive and negative controls in full human serum. In addition, the DNA-aptamer regeneration character is portrayed for the first time through a memristive effect, and scanning electron microscopy throws more light on the binding mechanism efficiency through the variation of the nanodevice surface properties at the nanoscale.The results presented in this work demonstrate that the coupling of the memristive effect and aptamer regeneration provides the best ever realized nano-biosensor for drug detection also in full human serum.

A bimetallic nanocoral Au decorated with Pt nanoflowers (bio)sensor for H2O2 detection at low potential

In this work, we have developed for the first time a method to make novel gold and platinum hybrid bimetallic nanostructures differing in shape and size. Au-Pt nanostructures were prepared by electrodeposition in two simple steps. The first step consists of the electrodeposition of nanocoral Au onto a gold substrate using hydrogen as a dynamic template in an ammonium chloride solution. After that, the Pt nanostructures were deposited onto the nanocoral Au organized in pores. Using Pt (II) and Pt (IV), we realized nanocoral Au decorated with Pt nanospheres and nanocoral Au decorated with Pt nanoflowers, respectively. The bimetallic nanostructures showed better capability to electrochemically oxidize hydrogen peroxide compared with nanocoral Au. Moreover, Au-Pt nanostructures were able to lower the potential of detection and a higher performance was obtained at a low applied potential. Then, glucose oxidase was immobilized onto the bimetallic Au-Pt nanostructure using cross-linking with glutaraldehyde. The biosensor was characterized by chronoamperometry at +0.15V vs. Ag pseudo-reference electrode (PRE) and showed good analytical performances with a linear range from 0.01 to 2.00mM and a sensitivity of 33.66µA/mMcm². The good value of K_m^app (2.28mM) demonstrates that the hybrid nanostructure is a favorable environment for the enzyme. Moreover, the low working potential can minimize the interference from ascorbic acid and uric acid as well as reducing power consumption to effect sensing. The simple procedure to realize this nanostructure and to immobilize enzymes, as well as the analytical performances of the resulting devices, encourage the use of this technology for the development of biosensors for clinical analysis.

Aptamer-based Field-Effect Biosensor for Tenofovir Detection

During medical treatment it is critical to maintain the circulatory concentration of drugs within their therapeutic range. A novel biosensor is presented in this work to address the lack of a reliable point-of-care drug monitoring system in the market. The biosensor incorporates high selectivity and sensitivity by integrating aptamers as the recognition element and field-effect transistors as the signal transducer. The drug tenofovir was used as a model small molecule. The biointerface of the sensor is a binary self-assembled monolayer of specific thiolated aptamer and 6-mercapto-1-hexanol (MCH), whose ratio was optimized by electrochemical impedance spectroscopy measurements to enhance the sensitivity towards the specific target. Surface plasmon resonance, performed under different buffer conditions, shows optimum specific and little non-specific binding in phosphate buffered saline. The dose-response behavior of the field-effect biosensor presents a linear range between 1 nM and 100 nM of tenofovir and a limit of detection of 1.2 nM. Two non-specific drugs and one non-specific aptamer, tested as stringent control candidates, caused negligible responses. The applications were successfully extended to the detection of the drug in human serum. As demonstrated by impedance measurements, the aptamer-based sensors can be used for real-time drug monitoring.

In-Vivo Validation of Fully Implantable Multi-Panel Devices for Remote Monitoring of Metabolism

This paper presents the in-vivo tests on a Fully Implantable Multi-Panel Devices for Remote Monitoring of endogenous and exogenous analytes. To investigate issues on biocompatibility, three different covers have been designed, realized and tested in mice for 30 days. ATP and neutrophil concentrations have been measured, at the implant site after the device was explanted, to assess the level of biocompatibility of the device. Finally, fully working prototypes of the device were implanted in mice and tested. The implanted devices were used to detect variations in the physiological concentrations of glucose and paracetamol. Data trends on these analytes have been successfully acquired and transmitted to the external base station. Glucose and paracetamol (also named acetaminophen) have been proposed in this research as model molecules for applications to personalized and translational medicine.

Enzymatic and Nonenzymatic Electrochemical Interaction of Abiraterone (Antiprostate Cancer Drug) with Multiwalled Carbon Nanotube Bioelectrodes

Unexplored electrochemical behavior of abiraterone, a recent and widely used prostate cancer drug, in interaction with cytochrome P450 3A4 (CYP3A4) enzyme and multiwalled carbon nanotubes (MWCNTs) is investigated in this work. The results reported in this work are significant for personalized medicine and point-of-care chemical treatment, especially to improve the life expectancy and quality of life of patients with prostate-cancer. To this purpose, enzymatic and nonenzymatic electrochemical biosensors were developed and characterized with different concentrations of abiraterone. Nonenzymatic biosensors were functionalized with MWCNTs as a catalyst for signal enhancement, while enzymatic biosensors have been obtained with CYP3A4 protein immobilized on MWCNTs as recognition biomolecule. Enzymatic electrochemical experiments demonstrated an inhibition effect on the CYP3A4, clearly observed as a diminished electrocatalytic activity of the enzyme. Electrochemical responses of nonenzymatic biosensors clearly demonstrated the direct electroactivity of abiraterone when reacting with MWCNT as well as an electrode-fouling effect.

Surface trap mediated electronic transport in biofunctionalized silicon nanowires

Silicon nanowires (SiNWs), fabricated via a top-down approach and then functionalized with biological probes, are used for electrically-based sensing of breast tumor markers. The SiNWs, featuring memristive-like behavior in bare conditions, show, in the presence of biomarkers, modified hysteresis and, more importantly, a voltage memory component, namely a voltage gap. The voltage gap is demonstrated to be a novel and powerful parameter of detection thanks to its high-resolution dependence on charges in proximity of the wire. This unique approach of sensing has never been studied and adopted before. Here, we propose a physical model of the surface electronic transport in Schottky barrier SiNW biosensors, aiming at reproducing and understanding the voltage gap based behavior. The implemented model describes well the experimental I-V characteristics of the device. It also links the modification of the voltage gap to the changing concentration of antigens by showing the decrease of this parameter in response to increasing concentrations of the molecules that are detected with femtomolar resolution in real human samples. Both experiments and simulations highlight the predominant role of the dynamic recombination of the nanowire surface states, with the incoming external charges from bio-species, in the appearance and modification of the voltage gap. Finally, thanks to its compactness, and strict correlation with the physics of the nanodevice, this model can be used to describe and predict the I-V characteristics in other nanostructured devices, for different than antibody-based sensing as well as electronic applications.

Nano-fabricated memristive biosensors for biomedical applications with liquid and dried samples

Nanowire based platforms are widely reported for sensing applications and for their potential in the bio-detection field. In the present work, memristive nanowire devices are implemented for label-free sensing in liquid samples as well as in dried samples via leveraging the modification of the hysteresis in the devices electrical response as a consequence of the surface modification. First, pH sensing in liquid conditions is demonstrated. In addition, the memristive devices are bio-functionalized using antibodies for Prostate Specific Antigen (PSA) as case of study. In this way, the nanowires are converted to memristive biosensors paving the way for future molecular diagnostics applications in general, and for detection of prostate cancer disease in particular.

Label-Free Ultrasensitive Memristive Aptasensor

We present the very first worldwide ever-reported electrochemical biosensor based on a memristive effect and DNA aptamers. This novel device is developed to propose a completely new approach in cancer diagnostics. In this study, an affinity-based technique is presented for the detection of the prostate specific antigen (PSA) using DNA aptamers. The hysteretic properties of memristive silicon nanowires functionalized with these DNA aptamers provide a label-free and ultrasensitive biodetection technique. The ultrasensitive detection is hereby demonstrated for PSA with a limit of detection down to 23 aM, best ever published value for electrochemical biosensors in PSA detection. The effect of polyelectrolytes on our memristive devices is also reported to further show how positive or negative charges affect the memristive hysteresis. With such an approach, combining memristive nanowires and aptamers, memristive aptamer-based biosensors can be proposed to detect a wide range of cancer markers with unprecedent ultrasensitivities to also address the issue of an early detection of cancer.

Electrochemical biochip for applications to wireless and batteryless monitoring of free-moving mice

A multi-sensing platform for applications in wireless and batteryless monitoring of free-moving small animals is presented in this paper. The proposed platform hosts six sensors: four biosensors for sensing of both disease biomarkers and therapeutic compounds, and two further sensors (T and pH) for biosensor calibration. Electrodeposition of Multi-Walled Carbon Nanotubes (MWCNTs) and the subsequent function-alization with proper enzymes is used to assure sensitivity and specificity in electrochemical biosensing. The realized sensors are demonstrated to be capable of measuring several parameters: lactate with a sensitivity of 77±26 μA/mM· cm(2) and a limit of detection (LOD) of 4±1 μM; glucose with a sensitivity of 63±15 μA/mM· cm(2) and a LOD of 8±2 μM; Etoposide (a well known anti-cancer agent) with a sensitivity of 0.15±0.04 mA/mM· cm(2) and a LOD of 4±1 μM; Open Circuit Potential (OCP) measurements are used on a Pt/IrOx junction to sense pH with a sensitivity of around -75±5mV/pH; while a Pt resistive thermal device is used to measure physiological temperature-range with an average sensitivity of 0.108±0.001 kΩ/°C.

Electrochemical biosensors and nanobiosensors

Electrochemical techniques have great promise for low-cost miniaturised easy-to-use portable devices for a wide range of applications-in particular, medical diagnosis and environmental monitoring. Different techniques can be used for biosensing, with amperometric devices taking the central role due to their widespread application in glucose monitoring. In fact, glucose biosensing takes an approximately 70% share of the biosensor market due to the need for diabetic patients to monitor their sugar levels several times a day, making it an appealing commercial market.In this review, we present the basic principles of electrochemical biosensor devices. A description of the different generations of glucose sensors is used to describe in some detail the operation of amperometric sensors and how the introduction of mediators can enhance the performance of the sensors. Electrochemical impedance spectroscopy is a technique being increasingly used in devices due to its ability to detect variations in resistance and capacitance upon binding events. Novel advances in electrochemical sensors, due to the use of nanomaterials such as carbon nanotubes and graphene, are presented as well as future directions that the field is taking.

Different Cytokine Production and Effector/Memory Dynamics of αβ+ or γδ+ T-Cell Subsets in the Peripheral Blood of Patients with Active Pulmonary Tuberculosis

Immunity to M.tuberculosis (MTB) infection consists of interactions between various T-cell subsets that control the infection and prevent further reactivation. We analysed the effector/memory T-cell dynamics and cytokines production in the peripheral blood of patients with pulmonary tuberculosis (TB). We observed that the frequency of CD4+ T-cell effectors was significantly increased during active TB, confirming a major role of this T-cell subset in TB immunity. Pre-terminally differentiated CD8+ T-lymphocytes were increased in the peripheral blood as well. In contrast, we observed a reduced number of effector mycobacteria-reactive γδ+ T-lymphocytes with a specific defects in reacting to mycobacterial nonpeptidic antigens, suggesting that this innate response is rapidly lost during TB infection. Nevertheless, the frequency of γδ+ T-cells effectors in TB patients was higher than the αβ+ T-cell response to peptide from MTB-ESAT-6 protein and quantitatively similar to PPD reactivity. Thus, αβ+and γδ+ T-cell differentiation and function are differently triggered by active TB infection.