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A key issue in GCxGC-HRMS data analysis is how to approach large-sample studies in an efficient and comprehensive way. We have developed a semi-automated data-driven workflow from identification to suspect screening, which allows highly selective monitoring of each identified chemical in a large-sample dataset. The example dataset used to illustrate the potential of the approach consisted of human sweat samples from 40 participants, including field blanks (80 samples). These samples have been collected in a Horizon 2020 project to investigate the capacity of body odour to communicate emotion and influence social behaviour. We used dynamic headspace extraction, which allows comprehensive extraction with high preconcentration capability, and has to date only been used for a few biological applications. We found 325 sweat volatiles compared to 581 known skin volatiles, 107 of which matched perfectly with the literature, and 218 compounds (67%) novel sweat volatiles. Unlike partitioning-based extraction methods, the developed method detects semi-polar (log P < 2) nitrogen and oxygen-containing compounds. However, it is unable to detect certain acids due to the pH conditions of unmodified sweat samples. Using a single analytical method, our coverage of the boiling point and polarity space was comparable to the cumulative coverage of all the available 35 studies investigating skin volatiles with different analytical methods. We believe that our framework will open up the possibility of efficiently using GCxGC-HRMS for large-sample studies in a wide range of applications such as biological and environmental studies.

Heart failure (HF) is the main cause of mortality worldwide, particularly in the elderly. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the gold standard biomarker for HF diagnosis and therapy monitoring. It is determined in blood samples by the immunochemical methods generally adopted by most laboratories. Saliva analysis is a powerful tool for clinical applications, mainly due to its non-invasive and less risky sampling. This study describes a validated analytical procedure for NT-proBNP determination in saliva samples using a commercial Enzyme-Linked Immuno-Sorbent Assay. Linearity, matrix effect, sensitivity, recovery and assay-precision were evaluated. The analytical approach showed a linear behaviour of the signal throughout the concentrations tested, with a minimum detectable dose of 1 pg/mL, a satisfactory NT-proBNP recovery (95–110%), and acceptable precision (coefficient of variation ≤ 10%). Short-term (3 weeks) and long-term (5 months) stability of NT-proBNP in saliva samples under the storage conditions most frequently used in clinical laboratories (4, − 20, and − 80 °C) was also investigated and showed that the optimal storage conditions were at − 20 °C for up to 2.5 months. Finally, the method was tested for the determination of NT-proBNP in saliva samples collected from ten hospitalized acute HF patients. Preliminary results indicate a decrease in NT-proBNP in saliva from admission to discharge, thus suggesting that this procedure is an effective saliva-based point-of-care device for HF monitoring.

Despite the rapid evolution of industrial technologies in the last decades greatly improved many production processes, several industrial sectors still rely heavily on manual labour. Ship building is a possible example, as the fabrication of the hull is still mainly performed by human operators. Styrene, a largely used chemical in many production chains of the polymer industry, is the main component of the fiberglass used for the hulls. In the long term, exposure to styrene is known for its irritating effect, ototoxicity and suspected cancerogenic effects. In this work, we developed a radial colorimetric dosimeter based on nanostructured materials loaded with potassium permanganate and characterized to finely control the reaction kinetics over an eight hours work shift. Colorimetric dosimeters were successfully tested in a real case scenario by comparing their data with those obtained by sampling styrene with passive absorption tubes and analysing their content by thermal desorption/gas chromatography/mass spectrometry.

The key role of inflammation in COVID-19 induced many authors to study the cytokine storm, whereas the role of other inflammatory mediators such as oxylipins is still poorly understood. IMPRECOVID was a monocentric retrospective observational pilot study with COVID-19 related pneumonia patients (n = 52) admitted to Pisa University Hospital between March and April 2020. Our MS-based analytical platform permitted the simultaneous determination of sixty plasma oxylipins in a single run at ppt levels for a comprehensive characterisation of the inflammatory cascade in COVID-19 patients. The datasets containing oxylipin and cytokine plasma levels were analysed by principal component analysis (PCA), computation of Fisher's canonical variable, and a multivariate receiver operating characteristic (ROC) curve. Differently from cytokines, the panel of oxylipins clearly differentiated samples collected in COVID-19 wards (n = 43) and Intensive Care Units (ICUs) (n = 27), as shown by the PCA and the multivariate ROC curve with a resulting AUC equal to 0.92. ICU patients showed lower (down to two orders of magnitude) plasma concentrations of anti-inflammatory and pro-resolving lipid mediators, suggesting an impaired inflammation response as part of a prolonged and unsolvable pro-inflammatory status. In conclusion, our targeted oxylipidomics platform helped shedding new light in this field. Targeting the lipid mediator class switching is extremely important for a timely picture of a patient's ability to respond to the viral attack. A prediction model exploiting selected lipid mediators as biomarkers seems to have good chances to classify patients at risk of severe COVID-19.

The composition of exhaled breath derives from an intricate combination of normal and abnormal physiological processes that are modified by the consumption of food and beverages, circadian rhythms, bacterial infections, and genetics as well as exposure to xenobiotics. This complexity, which results wide intra- and inter-individual variability and is further influenced by sampling conditions, hinders the identification of specific biomarkers and makes it difficult to differentiate between pathological and nominally healthy subjects. The identification of a ‘normal’ breath composition and the relative influence of the aforementioned parameters would make breath analyses much faster for diagnostic applications. We thus compared, for the first time, the breath composition of age-matched volunteers following a vegan and a Mediterranean omnivorous diet in order to evaluate the impact of diet on breath composition. Mixed breath was collected from 38 nominally healthy volunteers who were asked to breathe into a 2 l handmade Nalophan bag. Exhalation flow rate and carbon dioxide values were monitored during breath sampling. An aliquot (100 ml) of breath was loaded into a sorbent tube (250 mg of Tenax GR, 60/80 mesh) before being analyzed by thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS). Breath profiling using TD-GC-MS analysis identified five compounds (methanol, 1-propanol, pentane, hexane, and hexanal), thus enabling differentiation between samples collected from the different group members. Principal component analysis showed a clear separation between groups, suggesting that breath analysis could be used to study the influence of dietary habits in the fields of nutrition and metabolism. Surprisingly, one Italian woman and her brother showed extremely low breath isoprene levels (about 5 pbv), despite their normal lipidic profile and respiratory data, such as flow rate and pCO2. Further investigations to reveal the reasons behind low isoprene levels in breath would help reveal the origin of isoprene in breath.

When working with humid gaseous samples, the amount of water vapour collected in a needle trap along with volatile analytes may vary from sample to sample and decrease during the storage. This has a major impact on desorption efficiency and recovery. We propose the addition of a labelled internal standards to nullify the effect of variable humidity on the analytical performance of needle trap micro-extraction combined with gas chromatography mass spectrometry. Triple-bed (Divinylbenzene/Carbopack X/Carboxen 1000) and single-bed (Tenax GR) needles were tested with standard gaseous mixtures prepared at different relative humidity levels (85%, 50% and 10%). The standard mixtures contained twenty-five analytes representative of breath and ambient air constituents, including hydrocarbons, ketones, aldehydes, aromatics, and sulphurs, in the concentration range 0.1-700 ppbv. The two needles showed different behaviours, as recovery was independent of humidity for single-beds, whereas a low recovery (10-20%) was observed when triple-beds trapped very volatile compounds at low humidity (e.g. pentane and ethanol, 10% relative humidity. Triple-beds showed an almost quantitative recovery (>90%) of all the analytes at 50% and 85% relative humidity. This big difference was probably due to the reduced action of water vapour pressure during the desorption step. The addition of 6 D-acetone and 8 D-toluene to the sorbent material before gas sampling and the normalization of raw data nullified this effect, thereby lowering the variations of analyte recovery at different humidity levels down to 20%. Internal standards were also exploited to limit within 10-20% alterations in peak areas of very volatile compounds during needle storage at room temperature. This variation may results from a loss of water vapour either retained from the sorbent material and/or condensed on triple-bed needle walls. After normalization, the inter- and intra-day precision were halved to 5% and 10% in the case of single-beds, respectively, and to 15% and 20% with three-beds. The addition of an internal standard to the sorbent helps to keep the overall analytical procedure under control and improves the reliability of needle trap micro-extraction for the analysis of volatile organic compounds at ultra-trace levels.

SummaryBackgroundThe key role of inflammation in the progression of COVID-19 was evident right from the beginning of the pandemic. Consequently, many authors studied the onset and evolution of the cytokine storm. In contrast, other inflammatory mediators such as oxylipins have received almost no attention.MethodsWe conducted a monocentric observational and retrospective study (IMPRE-COVID-19) with patients (aged ≥ 18 years) admitted to Pisa University Hospital with COVID-19 related pneumonia. SARS-CoV-2 infection was confirmed by polymerase chain reaction in a nasopharyngeal swab, while pneumonia was demonstrated by CT scan. Oxylipin plasma levels were analysed in a convenient sample of 52 patients randomly selected from those that had a complete set of cytokine values evaluated for clinical purposes. In 12 cases, plasma samples collected on different days were available at the BMS Multispecialistic Biobank of Pisa University Hospital and were analysed to understand the evolution of the oxylipin levels during hospitalization. The two datasets that included oxylipin and cytokine values were analysed by principal component analysis (PCA), computation of Fisher’s canonical variable, and a multivariate receiver operating characteristic (ROC) curve.FindingsBetween March and April 2020, 52 patients were enrolled of which 28 were hospitalised in COVID-19 wards, 20 in ICUs, and 4 who were initially hospitalised in the wards and who were then transferred to the ICUs due to deteriorating health conditions. Plasma samples collected on different days were available from 7 patients in the wards, 1 from an ICU, and 4 from patients who were hospitalised in both. The mean age of participants was 61 years (SD 16), 11 were females (21%), and 41 were males (79%), without significant differences between groups in terms of age and gender. PCA of oxylipin data led to a clear differentiation of samples collected in COVID-19 wards and ICUs. This differentiation had not been obtained with cytokine data. In addition, borderline samples were from patients hospitalised in COVID-19 wards that were about to be transferred to the ICUs, thus suggesting that differentiation is not a consequence of a different treatment, but somehow related to a diverse evolution of the pathology. Computation of Fisher’s canonical variable identified the original input variables that were the most effective in discriminating between the two classes. The combination of the two datasets did not improve the discrimination, thus suggesting that oxylipins are more informative than cytokines for this purpose. A multivariate class model built using the four lowest-order principal components as the input variables, and COVID-19 ward samples as the target class, produced a ROC curve with a resulting area under the curve (AUC) equal to 0·92 – which is much higher than most AUC outcomes obtained for individual oxylipins.InterpretationAfter analysing the metabolic pathways of the most informative oxylipins, we speculate that more severe COVID-19 is associated with a selective deficiency of pro-resolving oxylipins leading to ineffective resolutive mechanisms of inflammation, likely worsened by endothelial damage. We believe that our oxylipin data suggest the possibility to predict the evolution of COVID-19 in individual patients at an early stage.FundingInstitutional funds from the University of Pisa supported the study.

Matrix metalloproteinases (MMPs) are an important factor in cancer progression and metastasis, especially gelatinases MMP-2 and MMP-9. A simple methodology for their detection and monitoring is highly desirable. Molecular probes have been very widely and successfully applied to study the activity of MMPs in cellular processes in vitro. We thus synthesized a small compound library of MMP-2 and MMP-9 binding probes based on drug molecules and endowed with free amine groups for the functionalization of transducer surfaces. In this study, we combined experimental results obtained by a kinetic fluorogenic peptide substrate cleavage assay with molecular modeling studies in order to assess the ability of the probe to bind to their target enzymes. The synthesized biphenyl substituted lysine derivatives showed IC50-values in the low nanomolar concentration range against MMP-2 (ligands 3a-d: 3 nM to 8 µM, ligands 4a-d: 45 nM to 350 µM) and low micromolar range against MMP-9 (ligands 3a-d: 350 nM to 60 µM, ligands 4a-d: 5 µM to 600 µM), with a selectivity up to more than 160-fold for MMP-2. The experimental results correlated well with molecular modelling with FleXAID and X-score functions. We showed that in our compound series, the side chain remained far away from the S1′ cavity and the ligand for all the docked minima. Ligands 4a-d with their free amine group on the side chain may thus be bound to transducer surfaces for the fabrication of sensors, while retaining their activity against their target enzymes.

The rapid and selective identification in the clinical setting of pathogenic bacteria causing healthcare associated infections (HAIs) and in particular blood stream infections (BSIs) is a major challenge, as the number of people affected worldwide and the associated mortality are on the rise. In fact, traditional laboratory techniques such culture and polymerase chain reaction (PCR)-based methodologies are often associated to long turnaround times, which justify the pressing need for the development of rapid, specific and portable point of care devices. The recently discovered clustered regularly interspaced short palindromic repeat loci (CRISPR) and the new class of programmable endonuclease enzymes called CRISPR associated proteins (Cas) have revolutionised molecular diagnostics. The use of Cas proteins in optical and electrochemical biosensing devices has significantly improved the detection of nucleic acids in clinical samples. In this study, a CRISPR/Cas12a system was coupled with electrochemical impedance spectroscopy (EIS) measurements to develop a label-free biosensing assay for the detection of Escherichia coli and Staphylococcus aureus, two bacterial species commonly associated to BSI infections. The programmable Cas12a endonuclease activity, induced by a specific guide RNA (gRNA), and the triggered collateral activity were assessed in in vitro restriction analyses, and evaluated thanks to impedance measurements using a modified gold electrode. The Cas12a/gRNA system was able to specifically recognize amplicons from different clinical isolates of E. coli and S. aureus with a limit of detection of 3 nM and a short turnaround time approximately of 1.5 h. To the best of our knowledge, this is the first biosensing device based on CRISPR/Cas12a label free impedance assay.

Notwithstanding its relatively recent discovery, graphene has gone through many evolution steps and inspired a multitude of applications in many fields, from electronics to life science. The recent advancements in graphene production and patterning, and the inclusion of two-dimensional (2D) graphenic materials in three-dimensional (3D) superstructures, further extended the number of potential applications. In this Review, we focus on laser-induced graphene (LIG), an intriguing 3D porous graphenic material produced by direct laser scribing of carbonaceous precursors, and on its applications in chemical sensors and biosensors. LIG can be shaped in different 3D forms with a high surface-to-volume ratio, which is a valuable characteristic for sensors that typically rely on phenomena occurring at surfaces and interfaces. Herein, an overview of LIG, including synthesis from various precursors, structure, and characteristic properties, is first provided. The discussion focuses especially on transport and surface properties, and on how these can be controlled by tuning the laser processing. Progresses and trends in LIG-based chemical sensors are then reviewed, discussing the various transduction mechanisms and different LIG functionalization procedures for chemical sensing. A comparative evaluation of sensors performance is then provided. Finally, sensors for glucose detection are reviewed in more detail, since they represent the vast majority of LIG-based chemical sensors.

Although its first definition dates back to more than a century ago, pH and its measurement are still studied for improving the performance of current sensors in everyday analysis. The gold standard is the glass electrode, but its intrinsic fragility and need of frequent calibration are pushing the research field towards alternative sensitive devices and materials. In this review, we describe the most recent optical, electrochemical, and transistor-based sensors to provide an overview on the status of the scientific efforts towards pH sensing.

Breath analysis is an alternative approach for disease diagnosis and for monitoring therapy. The lack of standardized procedures for collecting and analysing breath samples currently limits its use in clinical practice. In order to overcome this limitation, the ‘Peppermint Consortium’ was established within the breath community to carry out breath wash-out experiments and define reference values for a panel of compounds contained in the peppermint oil capsule. Here, we present a needle trap micro-extraction technique coupled with gas chromatography and tandem mass spectrometry for a rapid and accurate determination of alpha-pinene, beta-pinene, limonene, eucalyptol, menthofuran, menthone, menthol and menthyl acetate in mixed breath samples. Detection limits between 1 and 20 pptv were observed when 25 ml of a humidified standard gas mixture were loaded into a needle trap device at a flow rate of 10 ml min−1. Inter- and intra-day precisions were lower than 15%, thus confirming the reliability of the assay. Our procedure was used to analyse breath samples taken from a nominally healthy volunteer who was invited to swallow a 200 mg capsule of peppermint oil. Six samples were collected at various times within 6 h of ingestion. Analyte concentrations were not affected by the sampling mode (i.e. mixed vs. end-tidal fraction), whereas respiratory rate and exhalation flow rate values slightly influenced the concentration of the target compounds in breath samples.

COVID-19 is a highly transmissible respiratory illness that has rapidly spread all over the world causing more than 115 million cases and 2.5 million deaths. Most epidemiological projections estimate that the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus causing the infection will circulate in the next few years and raise enormous economic and social issues. COVID-19 has a dramatic impact on health care systems and patient management, and is delaying or stopping breath research activities due to the risk of infection to the operators following contact with patients, potentially infected samples or contaminated equipment. In this scenario, we investigated whether virus inactivation procedures, based on a thermal treatment (60 °C for 1 h) or storage of tubes at room temperature for 72 h, could be used to allow the routine breath analysis workflow to carry on with an optimal level of safety during the pandemic. Tests were carried out using dry and humid gaseous samples containing about 100 representative chemicals found in exhaled breath and ambient air. Samples were collected in commercially available sorbent tubes, i.e. Tenax GR and a combination of Tenax TA, Carbograph 1TD and Carboxen 1003. Our results showed that all compounds were stable at room temperature up to 72 h and that sample humidity was the key factor affecting the stability of the compounds upon thermal treatment. Tenax GR-based sorbent tubes were less impacted by the thermal treatment, showing variations in the range 20%–30% for most target analytes. A significant loss of aldehydes and sulphur compounds was observed using carbon molecular sieve-based tubes. In this case, a dry purge step before inactivation at 60 °C significantly reduced the loss of the target analytes, whose variations were comparable to the method variability. Finally, a breath analysis workflow including a SARS-CoV-2 inactivation treatment is proposed.

Lymphocytes (B, T and natural killer cells) and immunoglobulins are essential for the adaptive immune response against external pathogens. Flow cytometry and enzyme-linked immunosorbent (ELISA) kits are the gold standards to detect immunoglobulins, B cells and T cells, whereas the impedance measurement is the most used technique for natural killer cells. For point-of-care, fast and low-cost devices, biosensors could be suitable for the reliable, stable and reproducible detection of immunoglobulins and lymphocytes. In the literature, such biosensors are commonly fabricated using antibodies, aptamers, proteins and nanomaterials, whereas electrochemical, optical and piezoelectric techniques are used for detection. This review describes how these measurement techniques and transducers can be used to fabricate biosensors for detecting lymphocytes and the total content of immunoglobulins. The various methods and configurations are reported, along with the advantages and current limitations.

Biomarkers of oxidative stress are generally measured in blood and its derivatives. However, the invasiveness of blood collection makes the monitoring of such chemicals during exercise not feasible. Saliva analysis is an interesting approach in sport medicine because the collection procedure is easy-to-use and does not require specially-trained personnel. These features guarantee the collection of multiple samples from the same subject in a short span of time, thus allowing the monitoring of the subject before, during and after physical tests, training or competitions. The aim of this work was to evaluate the possibility of following the changes in the concentration of some oxidative stress markers in saliva samples taken over time by athletes under exercise. To this purpose, ketones (i.e. acetone, 2-butanone and 2-pentanone), aldehydes (i.e. propanal, butanal, and hexanal), α,β-unsaturated aldehydes (i.e. acrolein and methacrolein) and di-carbonyls (i.e. glyoxal and methylglyoxal) were derivatized with 2,4-dinitrophenylhydrazine, and determined by ultra-high performance liquid chromatography coupled to diode array detector. Prostaglandin E

Heart failure (HF) is a cardiovascular disease affecting about 26 million people worldwide costing about $100 billons per year. HF activates several compensatory mechanisms and neurohormonal systems, so we hypothesized that the concomitant monitoring of a panel of potential biomarkers related to such conditions might help predicting HF evolution. Saliva analysis by point-of-care devices is expected to become an innovative and powerful monitoring approach since the chemical composition of saliva mirrors that of blood. The aims of this study were (i) to develop an innovative procedure combining MEPS with UHPLC-MS/MS for the simultaneous determination of 8-isoprostaglandin F2α and cortisol in saliva and (ii) to monitor lactate, uric acid, TNF-α, cortisol, α-amylase and 8-isoprostaglandin F2α concentrations in stimulated saliva samples collected from 44 HF patients during their hospitalisation due to acute HF. Limit of detection of 10 pg/mL, satisfactory recovery (95–110%), and good intra- and inter-day precisions (RSD ≤ 10%) were obtained for 8-isoprostaglandin F2α and cortisol. Salivary lactate and 8-isoprostaglandin F2α were strongly correlated with NT-proBNP. Most patients (about 70%) showed a significant decrease (a factor of 3 at least) of both lactate and 8-isoprostaglandin F2α levels at discharge, suggesting a relationship between salivary levels and improved clinical conditions during hospitalization.

Exhaled air and breath condensate contain a large number of health biomarkers, such as volatile and semi-volatile organic compounds, proteins and lipids. Nowadays, the collection of breath samples is carried out by commercial or lab-made sampling systems that collect only one type of sample (e.g. gaseous or condensate phase), thus limiting the diagnostic capability of breath tests. This work presents a portable prototype optimized for the simultaneous collection of gaseous exhaled breath and exhaled breath condensate within five minutes. The system is fully portable and has a total weight of about 1 Kg. An illustrative determination of ethanol, isoprene, acetone, isopropyl alcohol, 1-propanol, 2-butanone, 2-pentanone, toluene and xylenes in breath, and cortisol and 8-iso-prostaglandin F 2α in breath condensate is discussed.

International audience; Biomarkers of oxidative stress are generally measured in blood and its derivatives. However, the invasiveness of blood collection makes the monitoring of such chemicals during exercise not feasible. Saliva analysis is an interesting approach in sport medicine because the collection procedure is easy-to-use and does not require specially-trained personnel. These features guarantee the collection of multiple samples from the same subject in a short span of time, thus allowing the monitoring of the subject before, during and after physical tests, training or competitions. The aim of this work was to evaluate the possibility of following the changes in the concentration of some oxidative stress markers in saliva samples taken over time by athletes under exercise. To this purpose, ketones (i.e. acetone, 2-butanone and 2-pentanone), aldehydes (i.e. propanal, butanal, and hexanal), α,β-unsaturated aldehydes (i.e. acrolein and methacrolein) and di-carbonyls (i.e. glyoxal and methylglyoxal) were derivatized with 2,4-dinitrophenylhydrazine, and determined by ultra-high performance liquid chromatography coupled to diode array detector. Prostaglandin E2, F2/E2-isoprostanes, F2-dihomo-isoprostanes, F4-neuroprostanes, and F2-dihomo-isofuranes were also determined by a reliable analytical procedure that combines micro-extraction by packed sorbent and ultra-high performance liquid chromatography-electrospray ionization tandem mass spectrometry. Overall the validation process showed that the methods have limits of detection in the range of units of ppb for carbonyls and tens to hundreds of ppt for isoprostanes and prostanoids, very good quantitative recoveries (90–110%) and intra- and inter-day precision lower than 15%. The proof of applicability of the proposed analytical approach was investigated by monitoring the selected markers of oxidative stress in ten swimmers performing a VO2max cycle ergo meter test. The results highlighted a clear increase of salivary by-products of oxidative stress during exercise, whereas a sharp decrease, approaching baseline values, of these compounds was observed in the recovery phase. This study opens up a new approach in the evaluation of oxidative stress and its relation to aerobic activity.

Environmental pollution associated to plastic debris is gaining increasing relevance not only as a threat to ecosystems but also for its possible harmful effects on biota and human health. The release of toxic volatile organic compounds (VOCs) is a potential hazard associated with the environmental weathering of plastic debris. Artificial aging of reference polymers (polystyrene, polypropylene, polyethylene terephthalate, high and low density polyethylene) was performed in a Solar Box at 40 °C and 750 W/m2. The volatile degradation products were determined before and after 1, 2, 3 and 4 weeks of aging using a validated analytical procedure combining headspace (HS) with needle trap microextraction (NTME) and gas chromatography/mass spectrometry (GC–MS). A progressive increase in VOCs was observed during artificial photo-degradation, whose chemical profile resulted polymer-dependent and included carbonyls, lactones, esters, acids, alcohols, ethers, aromatics. The amount of extractable fraction in polar solvents generally showed a similar trend. The same analytical procedure was used to determine VOCs released from plastic debris collected at a marine beach. All samples released harmful compounds (e.g. acrolein, benzene, propanal, methyl vinyl ketone, and methyl propenyl ketone), supporting the initial hypothesis that microplastics represent an unrecognized source of environmental pollution.

A reliable method for the determination of carbonyl compounds in exhaled breath based on on-sorbent derivatization coupled with thermal desorption and gas chromatography-tandem mass spectrometry is described. The analytical performances were optimized for a mixture of C2-C9 aldehydes and C3-C9 ketones, particularly interesting for clinical applications, by using an internal standard and applying a 2(3) full factorial design. A volume of sample (250 ml) was loaded at 50 ml min(-1) into a Tenax GR sorbent tube containing 130 nmol of O-(2,3,4,5,6-pentafluorobenzyl) hydroxylamine hydrochloride. All compounds showed a limit of detection lower than 200 pptv. The yield of the derivatization procedure was normalized by adding to the sample a known amount of D-6-acetone as an internal standard. This allowed halving the relative standard deviation to 10% and 15% for the mono-and di-carbonyl compounds, respectively, thus improving reliability. The optimized method was applied to the determination of carbonyl compounds in 12 breath samples collected from four patients suffering from heart failure during hospitalization.

The aim of this study was to investigate the relationship between warfarin dosage, international normalized ratio, plasma and oral fluid concentrations of warfarin, and its metabolites, namely RR/SS- and RS/SR-warfarin alcohols. Nine patients on long-term warfarin therapy (4 with stable and 5 with unstable international normalized ratio values) were longitudinally monitored for over two months by recording warfarin dosage and measuring international normalized ratio, warfarin and warfarin alcohols concentrations in oral fluid and in plasma. At equivalent dose (20–30 mg week− 1), the international normalized ratio was in the range 2.0–2.5 and 1.5–3.1 for stable and unstable patients, respectively. Moreover, stable patients showed nearly double total and unbound plasma warfarin concentration, and nearly triple oral fluid warfarin concentrations compared to unstable patients. Correlations between warfarin dosage and total plasma concentration of warfarin (r = 0.65, p < 0.01) or RS/SR-warfarin alcohols (r = 0.66, p < 0.01), as well as between stimulated oral fluid and total plasma concentrations of warfarin (r = 0.72, p < 0.01) and RS/SR-warfarin alcohols (r = 0.95, p < 0.01) suggest that the relative changes of the oral fluid concentrations of these species may provide clinically useful information for monitoring individual patients. Follow-up data revealed that even in the absence of changes of warfarin dose, the oscillations of plasma and oral fluid of WAR and RS/SR-warfarin alcohols parallel oscillations of international normalized ratio. Due to the long delay of its biological action, monitoring the plasma concentration of warfarin might help to predict variations of international normalized ratio and prevent the risk of thrombotic or haemorrhagic events. The information collected suggests that non-invasive monitoring of warfarin in oral fluid might represent a suitable tool for this purpose

This study was aimed at evaluating the influence of sampling procedure on the determination of uric acid and lactate in oral fluid. Samples of non-stimulated and stimulated oral fluid were collected from 22 healthy volunteers. Different frequencies of stimulation were obtained by moving a polyester swab within the mouth at 50, 100 and 150 min − 1 . Three oral fluid samples were consecutively collected from a subgroup of 5 volunteers at a constant stimulation (70 min − 1 ) and at a self-selected pace to evaluate reproducibility. The urate concentration in oral fluid decreased with the increase of the stimulation and oral fluid flow rate (r = − 0.98, p = 0.01). Also, the lactate concentration was much (p = 0.03, two tailed) lower in samples collected under a mild stimulation (50 min − 1 ) than in samples collected without stimulation. Nevertheless, it progressively increased at higher stimulations (100 and 150 min − 1 ). A transfer process mediated by membrane carriers (i.e. urate transporter and organic anion transporters) was hypothesized to explain these results. Finally, a reduced variability (relative standard deviation below 10%) of the urate concentration was obtained when oral fluid was sampled at constant stimulation (70 min − 1 ), but it increased remarkably (20–50%) in case of sampling at self-selected pace. Nevertheless, expressing the salivary excretion of urate as a function of time (μg min − 1 ), the variability of sampling procedure at self-selected pace was lower than 15%.

This work presents a reliable analytical procedure combining micro-extraction by packed sorbent (MEPS) and ultra-high performance liquid chromatography-electrospray ionization tandem mass spectrometry to determine 8-iso prostaglandin F2α, 8-iso prostaglandin E2 and prostaglandin E2 in dried blood spots (DBSs). To reach this goal, we optimized a fast semi-automated MEPS procedure for the clean-up and pre-concentration of the analytes extracted from a single DBS (50 μL) by a 70:30 v/v methanol:water mixture. Limits of detection of about 20 pg mL−1, satisfactory recoveries (90–110%) and very good intra- and inter-day precisions (RSD ≤10%) were obtained for all the analytes. The innovative addition of internal standards on the filter paper before DBS sampling allowed to compensate changes in the amount of analyte during storage. Since prostanoids and isoprostanoids are biomarkers involved in the pathogenesis and progression of many diseases (e.g. ductal patency, diabetic nephropathy, and acute lung injury), our analytical method offers interesting diagnostic and prognostic opportunities in the medical field. The present method is currently used for the analysis of such biomarkers in DBSs from preterm newborns collected in the clinical setting.

A method for the simultaneous determination of warfarin and its active metabolites (warfarin alcohols) in dried blood spots samples was developed and validated. The procedure consisted of the collection of blood sample spots on Whatman 903 filter paper and the liquid extraction of the analytes by a 3:1 v/v methanol/acetonitrile mixture from 6 mm diameter disks punched out from dried blood spots. Extracted samples were analyzed by ultra-high performance liquid chromatography coupled to electrospray positive ionization and tandem mass spectrometry. Chromatographic separation was carried out in isocratic condition at 25 °C on a Poroshell 120 EC-C18 reversed phase column with a mobile phase consisting of 65% water containing 0.1% (v/v) formic acid and 35% acetonitrile containing 0.1% (v/v) formic acid at a flow rate of 0.5 mL min − 1 . The method did not show any detectable interference or matrix effect. The limits of detection were 0.007, 0.006 and 0.004 ng/mL for RR/SS-warfarin alcohols, RS/SR-warfarin alcohols and warfarin, respectively. Warfarin and warfarin alcohols recovery from dried blood spots sample was almost quantitative (range 96–103%). The intra- and inter-day precision (expressed as relative standard deviation) was always below 10%. Time stability studies highlighted that the concentrations of warfarin and both diastereoisomers of warfarin alcohols in a pooled blood sample were stable for at least 1 month at − 20 °C and after 4 cycles of thaw–freeze. Moreover, warfarin, RR/SS- and RS/SR-warfarin alcohols concentrations in the dried blood spots were stable for at least 7 days at 25 °C. Hematocrit value had a minor influence on the analytical result compared to blood drop volume. The method was successfully applied to the analysis of 15 blood samples from patients undergoing warfarin therapy and demonstrated its suitability as an alternative for warfarin and warfarin alcohols measurement in plasma. Good correlations between concentrations in plasma and dried blood spots were demonstrated for all three analytes, with correlation coefficients r ≥ 0.95. Warfarin concentration in dried blood spot correlated well with warfarin dosage (r = 0.70, p These preliminary results highlighted that the developed method can provide useful information for the therapeutic drug monitoring of warfarin and its active metabolites, although further studies in a larger clinical trial are needed.

This work presents a computerized system to monitor mouth pressure, tidal volume, exhaled airflow, respiration rate and end-tidal partial pressure of CO 2 during breath collection. The system was used to investigate the effect of different respiratory rates on the volatile organic compounds (VOCs) concentrations in exhaled breath. For this purpose, VOCs with well-defined biochemical pathways and different chemical and physical properties were selected as biomarkers related to metabolism (acetone and isopropyl alcohol), cholesterol synthesis (isoprene) and intestinal microflora activity (ethanol). Mixed breath was collected from a nominally healthy volunteer in resting conditions by filling a Nalophan bag. The subject followed a regimented breathing pattern at different respiratory rates (10, 30 and 50 breaths per minute). Results highlight that ventilation pattern strongly influences the concentration of the selected compounds. The proposed system allows exhaled breath to be collected also in patients showing dyspnea such as in case of chronic heart failure, asthma and pulmonary diseases.

The analytical performances of needle trap micro-extraction (NTME) coupled with gas chromatography-tandem mass spectrometry were evaluated by analyzing a mixture of twenty-two representative breath volatile organic compounds (VOCs) belonging to different chemical classes (i.e. hydrocarbons, ketones, aldehydes, aromatics and sulfurs). NTME is an emerging technique that guarantees detection limits in the pptv range by pre-concentrating low volumes of sample, and it is particularly suitable for breath analysis. For most VOCs, detection limits between 20 and 500 pptv were obtained by pre-concentrating 25 ml of a humidified standard gas mixture at a flow rate of 15 ml min-1. For all compounds, inter- and intra-day precisions were always below 15%, confirming the reliability of the method. The procedure was successfully applied to the analysis of exhaled breath samples collected from forty heart failure (HF) patients during their stay in the University Hospital of Pisa. The majority of patients (about 80%) showed a significant decrease of breath acetone levels (a factor of 3 or higher) at discharge compared to admission (acute phase) in correspondence to the improved clinical conditions during hospitalization, thus making this compound eligible as a biomarker of HF exacerbation.