Point-of-care detection of cytokines in cytokine storm management and beyond: Significance and challenges

Cytokines are signaling molecules between cells in immune system. Cytokine storm, due to the sudden acute increase in levels of pro-inflammatory circulating cytokines, can result in disease severity and major-organ damage. Thus, there is urgent need to develop rapid, sensitive, and specific methods for monitoring of cytokines in biology and medicine. Undoubtedly, point-of-care testing (POCT) will provide clinical significance in disease early diagnosis, management, and prevention. This review aims to summarize and discuss the latest technologies for detection of cytokines with a focus on POCT. The overview of diseases resulting from imbalanced cytokine levels, such as COVID-19, sepsis and other cytokine release syndromes are presented. The clinical cut-off levels of cytokine as biomarkers for different diseases are summarized. The challenges and perspectives on the development of cytokine POCT devices are also proposed and discussed. Cytokine POCT devices are expected to be the ongoing spotlight of disease management and prevention during COVID-19 pandemic and also the post COVID-19 pandemic era.

Design and Development of Transient Sensing Devices for Healthcare Applications

With the ever-growing requirements in the healthcare sector aimed at personalized diagnostics and treatment, continuous and real-time monitoring of relevant parameters is gaining significant traction. In many applications, health status monitoring may be carried out by dedicated wearable or implantable sensing devices only within a defined period and followed by sensor removal without additional risks for the patient. At the same time, disposal of the increasing number of conventional portable electronic devices with short life cycles raises serious environmental concerns due to the dangerous accumulation of electronic and chemical waste. An attractive solution to address these complex and contradictory demands is offered by biodegradable sensing devices. Such devices may be able to perform required tests within a programmed period and then disappear by safe resorption in the body or harmless degradation in the environment. This work critically assesses the design and development concepts related to biodegradable and bioresorbable sensors for healthcare applications. Different aspects are comprehensively addressed, from fundamental material properties and sensing principles to application-tailored designs, fabrication techniques, and device implementations. The emerging approaches spanning the last 5 years are emphasized and a broad insight into the most important challenges and future perspectives of biodegradable sensors in healthcare are provided.

Volumetric, Microfluidic Plasmonic RT-PCR

Decentralized molecular detection of pathogens remains an important goal for public health. Although polymerase chain reaction (PCR) remains the gold-standard molecular detection method, thermocycling using Peltier heaters presents challenges in decentralized settings. Recent work has demonstrated plasmonic PCR, where nanomaterials on a surface or nanoparticles in solution heat upon stimulation by light, as a promising method for rapid thermocycling. Heating of a solution via nanoparticles suspended in solution has been demonstrated in PCR tubes, but not on microfluidic chips. We developed a volumetric, microfluidic plasmonic reverse transcription (RT)-PCR method. A microfluidic chip is fabricated with an integrated thermocouple to measure internal temperature, feeding into a proportional-integral-derivative (PID) algorithm that modulates an infrared LED for closed-loop control. Gold nanorods are dispersed in solution with RT-PCR reagents. We created an instrument for plasmonic RT-PCR using an infrared LED for heating, fan for cooling, and fluorometer for end-point fluorescence detection. Rapid thermocycling and amplification of SARS-CoV-2 within 16 min (5 min for RT, 45 cycles in 11 min) is achieved. This paper demonstrates volumetric, plasmonic PCR in a microfluidic chip, using an integrated thermocouple for closed-loop control. This work points to the promise of using microfluidics and nanomaterials to achieve rapid, compact detection of pathogens in decentralized settings.

Emerging Technologies for Timely Point-of-Care Diagnostics of Skin Cancer

Skin cancer is a global health crisis and a leading cause of morbidity and mortality worldwide. A leading factor of malignancy remains the UV radiation, driving various biomolecular changes. With shifting population behaviors, deficiency in screening programs and reliance on self-presentation, climate change and the ageing world populace, global incidents have been surging alarmingly. There is an urgent need for new technologies to achieve timely intervention through rapid and accurate diagnostics of skin cancer. Raman spectroscopy has been emerging as a highly promising analytical technology for diagnostic applications, poised to outpace the current costly, invasive and slow procedures, frequently hindered by varying sensitivity, specificity and lack of portability. Herein, complex and intricate progress are overviewed and consolidated across medical and engineering disciplines with a focus on the latest advances in the traditional and emerging skin cancer diagnostics. Methods detecting structural and chemical responses are categorized along with emerging chemo-biophysical sensing techniques. Particular attention is drawn to Raman spectroscopy, as a non-invasive, rapid and accurate sensing of molecular fingerprints in dermatological matrix with an additional focus on artificial intelligence, as a decision support tool collectively, laying the platform toward development and rapid translation of point-of-care diagnostic technologies for skin cancer to real-world applications.

Dried Blood Matrix as a New Material for the Detection of DNA Viruses

The gold standard for diagnosing viruses such as the Hepatitis B Virus has remained largely unchanged, relying on conventional methods involving extraction, purification, and polymerase chain reaction (PCR). This approach is hindered by limited availability, as it is time-consuming and requires highly trained personnel. Moreover, it suffers from low recovery rates of the nucleic acid molecules for samples with low copy numbers. To address the challenges of complex instrumentation and low recovery rate of DNA, a drying process coupled with thermal treatment of whole blood is employed, resulting in the creation of a dried blood matrix characterized by a porous structure with a high surface-to-volume ratio where it also inactivates the amplification inhibitors present in whole blood. Drawing on insights from Brunauer-Emmett-Teller (BET)- Barrett-Joyner-Halenda (BJH) analysis, scanning electron microscopy (SEM), and fluorescence recovery after photobleaching (FRAP), detection assay is devised for HBV, as a demonstration, from whole blood with high recovery of DNA and simplified instrumentation achieving a limit of detection (LOD) of 10 IU mL-1. This assay can be completed in <1.5 h using a simple heater, can be applied to other DNA viruses, and is expected to be suitable for point-of-care, especially in low-resource settings.

Enhanced Laser-Induced Graphene Microfluidic Integrated Sensors (LIGMIS) for On-Site Biomedical and Environmental Monitoring

The convergence of microfluidic and electrochemical biosensor technologies offers significant potential for rapid, in-field diagnostics in biomedical and environmental applications. Traditional systems face challenges in cost, scalability, and operational complexity, especially in remote settings. Addressing these issues, laser-induced graphene microfluidic integrated sensors (LIGMIS) are presented as an innovative platform that integrates microfluidics and electrochemical sensors both comprised of laser-induced graphene. This study advances the LIGMIS concept by resolving issues of uneven fluid transport, increased hydrophobicity during storage, and sensor biofunctionalization challenges. Key innovations include Y-shaped reservoirs for consistent fluid flow, hydrophilic polyethyleneimine coatings to maintain wettability, and separable microfluidic and electrochemical components enabling isolated electrode nanoparticle metallization and biofunctionalization. Multiplexed electrochemical detection of the neonicotinoid imidacloprid and nitrate ions in environmental water samples yields detection limits of 707 nm and 10-5.4 m with wide sensing ranges of 5-100 µm and 10-5-10-1 m, respectively. Similarly, uric acid and calcium ions are detected in saliva, demonstrating detection limits of 217 nm and 10-5.3 m with sensing ranges of 10-50 µm, and 10-5-10-2.5 m, respectively. Overall, this biosensing demonstrates the capability of the LIGMIS platform for multiplexed detection in biologically complex solutions, with applications in environmental water quality monitoring and oral cancer screening.

Pilot implementation of an electronic diagnostic support tool (AiD-DST) designed to identify the cause(s) of delirium

OBJECTIVE(S)

The identification of cause(s) of delirium remains a clinical challenge within medicine. Our group have previously successfully developed and tested the Aetiology in Delirium-Decision Support Tool (AiD-DST). The AiD-DST is designed to help medical professionals close the gap on the detection of cause(s) of delirium. Here, we report on use of AiD-DST in the real-world setting.

METHODS

A real-world implementation study of the AiD-DST within a general medical ward of a metropolitan hospital was conducted over a 10-week period. A mixed method evaluation was performed based upon the RE-AIM Framework that incorporates reach, effectiveness, adoption, implementation and maintenance of an intervention.

RESULTS

Reach: fifty-three out of 87 (61%) eligible doctors consented to participation in the study.

EFFECTIVENESS

A mean of 4.3 diagnoses were generated per patient with no difference in frequency when compared with historical control (z = 1.36; p = .17). Average usability score was 5.86 (SD = 1.15) on a 7-point scale, with 93% of respondents being satisfied with the AiD-DST. Free text feedback comprised themes of accessibility, ergonomics, diagnostic accuracy and applicability of AiD-DST to related conditions.

IMPLEMENTATION

Instrument completion rate was 98% (n = 49/50), with a median completion time of 90 s. Maintenance: Sixty-seven % of uses of AiD-DST occurred in the second half of the study (p = .3). Following the initiation period there was an increase in use (r = .79; p = 02).

CONCLUSION

Proof of principle was demonstrated for local implementation of a diagnostic support tool (AiD-DST).

Electrochemical Paper-Based Microfluidics: Harnessing Capillary Flow for Advanced Diagnostics

Electrochemical paper-based microfluidics has attracted much attention due to the promise of transforming point-of-care diagnostics by facilitating quantitative analysis with low-cost and portable analyzers. Such devices harness capillary flow to transport samples and reagents, enabling bioassays to be executed passively. Despite exciting demonstrations of capillary-driven electrochemical tests, conventional methods for fabricating electrodes on paper impede capillary flow, limit fluidic pathways, and constrain accessible device architectures. This account reviews recent developments in paper-based electroanalytical devices and offers perspective by revisiting key milestones in lateral flow tests and paper-based microfluidics engineering. The study highlights the benefits associated with electrochemical sensing and discusses how the detection modality can be leveraged to unlock novel functionalities. Particular focus is given to electrofluidic platforms that embed electrodes into paper for enhanced biosensing applications. Together, these innovations pave the way for diagnostic technologies that offer portability, quantitative analysis, and seamless integration with digital healthcare, all without compromising the simplicity of commercially available rapid diagnostic tests.