Dipstick and lateral-flow formats have dominated rapid diagnostics over the last three decades. These formats gained popularity in the consumer markets due to their compactness, portability and facile interpretation without external instrumentation. However, lack of quantitation in measurements has challenged the demand of existing assay formats in consumer markets. Recently, paper-based microfluidics has emerged as a multiplexable point-of-care platform which might transcend the capabilities of existing assays in resource-limited settings. However, paper-based microfluidics can enable fluid handling and quantitative analysis for potential applications in healthcare, veterinary medicine, environmental monitoring and food safety. Currently, in its early development stages, paper-based microfluidics is considered a low-cost, lightweight, and disposable technology. The aim of this review is to discuss: (1) fabrication of paper-based microfluidic devices, (2) functionalisation of microfluidic components to increase the capabilities and the performance, (3) introduction of existing detection techniques to the paper platform and (4) exploration of extracting quantitative readouts via handheld devices and camera phones. Additionally, this review includes challenges to scaling up, commercialisation and regulatory issues. The factors which limit paper-based microfluidic devices to become real world products and future directions are also identified.

Paper-based microfluidic point-of-care diagnostic devices

Advances in paper-based point-of-care diagnostics.

“Paper-based microfluidics” or “lab on paper,” as a burgeoning research field with its beginning in 2007, provides a novel system for fluid handling and fluid analysis for a variety of applications including health diagnostics, environmental monitoring as well as food quality testing. The reasons why paper becomes an attractive substrate for making microfluidic systems include: (1) it is a ubiquitous and extremely cheap cellulosic material; (2) it is compatible with many chemical/biochemical/medical applications; and (3) it transports liquids using capillary forces without the assistance of external forces. By building microfluidic channels on paper, liquid flow is confined within the channels, and therefore, liquid flow can be guided in a controlled manner. A variety of 2D and even 3D microfluidic channels have been created on paper, which are able to transport liquids in the predesigned pathways on paper. At the current stage of its development, paper-based microfluidic system is claimed to be low-cost, easy-to-use, disposable, and equipment-free, and therefore, is a rising technology particularly relevant to improving the healthcare and disease screening in the developing world, especially for those areas with no- or low-infrastructure and limited trained medical and health professionals. The research in paper-based microfluidics is experiencing a period of explosion; most published works have focused on: (1) inventing low-cost and simple fabrication techniques for paper-based microfluidic devices; and (2) exploring new applications of paper-based microfluidics by incorporating efficient detection methods. This paper aims to review both the fabrication techniques and applications of paper-based microfluidics reported to date. This paper also attempts to convey to the readers, from the authors’ point of view the current limitations of paper-based microfluidics which require further research, and a few perspective directions this new analytical system may take in its development.

A perspective on paper-based microfluidics: Current status and future trends

https://www.cell.com/trends/biotechnology/pdf/S0167-7799(15)00187-0.pdf

Emerging Technologies for Next-Generation Point-of-Care Testing

Paper-based sensors are a new alternative technology for fabricating simple, low-cost, portable and disposable analytical devices for many application areas including clinical diagnosis, food quality control and environmental monitoring. The unique properties of paper which allow passive liquid transport and compatibility with chemicals/biochemicals are the main advantages of using paper as a sensing platform. Depending on the main goal to be achieved in paper-based sensors, the fabrication methods and the analysis techniques can be tuned to fulfill the needs of the end-user. Current paper-based sensors are focused on microfluidic delivery of solution to the detection site whereas more advanced designs involve complex 3-D geometries based on the same microfluidic principles. Although paper-based sensors are very promising, they still suffer from certain limitations such as accuracy and sensitivity. However, it is anticipated that in the future, with advances in fabrication and analytical techniques, that there will be more new and innovative developments in paper-based sensors. These sensors could better meet the current objectives of a viable low-cost and portable device in addition to offering high sensitivity and selectivity, and multiple analyte discrimination. This paper is a review of recent advances in paper-based sensors and covers the following topics: existing fabrication techniques, analytical methods and application areas. Finally, the present challenges and future outlooks are discussed.

https://www.mdpi.com/1424-8220/12/9/11505/pdf

Recent Advances in Paper-Based Sensors

Paper based point-of-care testing disc for multiplex whole cell bacteria analysis

Chondrolaryngoplasty.

Facial Gender-Confirming Surgery

Preoperative analyses of the columellar-philtral and nasolabial angles (CPA and NLA) are important considerations for the rhinoplasty surgeon. This study aims to quantify and compare the degree of change in nasal tip rotation as measured by CPA and NLA over time following rhinoplasty and to identify surgical maneuvers or patient characteristics that may affect nasal tip rotation. Prospective analysis of CPA and NLA in 111 consecutive, consenting cosmetic, and/or functional rhinoplasty patients of the senior author over a 1-year time period was performed. Angles were analyzed before surgery, immediately after surgery, and at 1 week, 1 month, 6 months, and 1 year following surgery. Subgroup analyses based on surgical maneuvers and other covariates were performed. The greatest change to CPA and NLA in the upright position was 11.8 degrees (95% confidence interval [CI]: 9.8-13.7, p < 0.001) and 9.3 degrees (95% CI: 7.9-10.7, p < 0.001) of elevation 1 week after surgery, respectively. The mean CPA was not significantly different than preoperative measures 6 months after surgery; however, the NLA remained 4.94 degrees (95% CI: 2.1-8.4, p = 0.001) elevated. Females showed approximately 10 degrees more elevated CPA than males in pre- and postoperative time points; however, the NLA did not discriminate between sexes. Transfixion incisions appears to cause a significant decrease in postoperative NLA compared with patient who did not undergo transfixion incisions. Measurements for nasal tip rotation are variable and inconsistent throughout the literature. This study shows that rhinoplasty may have a greater effect on nasal tip rotation as measured by NLA and that the effects of NLA and CPA are independent, signifying that a standardized measurement for nasal tip rotation is warranted.

Change in Columellar-Philtral and Nasolabial Angles Over Time Following Rhinoplasty.

Microtia Reconstruction in Patients with Craniofacial Microsomia

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