clinical toxicology

临床毒理学
  • 文章类型: Journal Article
    TUM的毒理学主要与KlinikumrechtsderIsar(MRI)的医学院有关。临床毒理学系成立于1963年。MaxVonClarmann,头,他的活动集中在中毒的治疗和分析方法的发展上,并建立了毒物信息中心。他的继任者,ThomasZielker和FlorianEyer,该部门进一步发展成为国际知名机构。1967年,MRI与药理学和毒理学研究所一起成为TUM医学院。导演MelchiorReiter,路德维希·马克西米利安大学药理学研究所(LMU),1970年,与导演GerhardLange一起在GesellschaftFürStrahlen-undUmweltforschung(GSF)发起了毒理学系的成立。研究重点是重金属的神经毒性作用以及持久性化学物质的代谢和肝毒性。在1973年兰格意外去世后,他于1975年由图宾根大学的赫尔穆特·格林继任。现在的毒理学研究所迅速发展和规范了体外试验方法,研究致癌物和诱变剂以及重金属毒性的机制。在GSF和德国主管中心组织了15个主要毒理学领域的培训课程。1987年,Greim成为TUM新成立的毒理学和环境卫生研究所的所长,随着研究和教学活动的扩大,特别是在TUM和LMU化学学院的毒理学,此后成为德国大学化学专业学生的必修课。
    Toxicology at the TUM is mainly associated with the Faculty of Medicine at the Klinikum rechts der Isar (MRI). The Department of Clinical Toxicology has been founded in 1963. Max von Clarmann, the head, focused his activities on the treatment of intoxications and the development of analytical methods and established a poison information center. His successors, Thomas Zielker and Florian Eyer, further developed this department to an internationally renown institution.In 1967, the MRI became the TUM faculty of medicine with its Institute of Pharmacology and Toxicology. The director Melchior Reiter, formerly Institute of Pharmacology of the Ludwig Maximilians University (LMU), in 1970 initiated the foundation of the Department of Toxicology at the Gesellschaft für Strahlen- und Umweltforschung (GSF) with the director Gerhard Lange. The research focused on the neurotoxic effects of heavy metals and the metabolism and hepatoxicity of persistent chemicals. After Lange\'s unexpected death in 1973, he was succeeded in 1975 by Helmut Greim from the University of Tübingen. The now Institute of Toxicology rapidly expanded developing and standardizing in vitro test methods, investigating the mechanism of carcinogens and mutagens and heavy metal toxicity. Training courses in the 15 major areas of toxicology have been organized at the GSF and competent centers in Germany. In 1987, Greim became the director of the newly founded Institute of Toxicology and Environmental Hygiene of the TUM, with expanded research and teaching activities, especially in toxicology at the faculties of Chemistry of the TUM and LMU, which thereafter became mandatory for students of chemistry at German universities.
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  • 文章类型: Journal Article
    蘑菇中毒在美国很常见。gyromitrin(乙醛N-甲基-N-甲酰腙)是一种临床上重要的霉菌毒素,主要与lorchel(即假羊肚菌)gyromitraesculenta有关。“真羊肚菌和假羊肚菌之间的相似性导致了Gyromitraspp的错误识别。可食用,并受到羊肚菌的追捧。,导致毒性。尽管有文献证据概述了有毒的后遗症,Gyromitraspp.蘑菇通常被食用和准备用于烹饪目的。经典的临床教学强调显著的神经毒性,包括癫痫发作,与摄入含有陀螺蛋白的蘑菇有关,源于陀螺mitrin的末端代谢产物单甲基肼。我们在2002年1月1日至2020年12月31日之间向密歇根毒物和药物信息中心报告的病例中,对与摄入已知或怀疑含有陀螺蛋白的蘑菇物种相关的临床毒性进行了纵向描述性审查。我们向我们中心报告的19年描述性病例系列含有陀螺蛋白的蘑菇摄入,表现出胃肠道体征和症状占优势,包括肝毒性.在118个确诊病例中,报告的摄入中有108例(91.5%)涉及Gyromitraesculenta。与症状摄入相关的最常见的临床表现(n=83)是上述胃肠道症状(n=62;74.7%)。神经系统症状较少(n=22,26.5%),而肝毒性发生在较少的患者中(n=14;16.9%)。有症状的患者,大多数患者接受对症和支持治疗(n=58;70%).共有7例患者(n=7;8.4%)使用了吡哆醇,具有肝毒性或神经毒性。医疗结果从次要到主要,没有死亡报告。患者介绍(即GI与神经毒性症状)摄入含陀螺mitrin的蘑菇后可能是高度可变和多因素的,由于摄入剂量的差异,地理分布,患者和蘑菇物种的遗传变异,和毒素组成的物种特异性差异。未来的研究需要在物种水平上鉴定摄入的含陀螺仪的蘑菇,并研究遗传多态性对临床毒物差异的贡献。
    Mushroom poisonings are common in the United States. Gyromitrin (acetaldehyde N-methyl-N-formylhydrazone) is a clinically significant mycotoxin primarily associated with the lorchel (i.e. the false morel) Gyromitra esculenta. Resemblance between \'true and false morels\' has resulted in misidentification of Gyromitra spp. as edible and sought after Morchella spp., resulting in toxicity. Despite literature evidence outlining toxic sequalae, Gyromitra spp. mushrooms are commonly consumed and prepared for culinary purposes. Classic clinical teachings emphasize significant neurotoxicity, including seizures, associated with ingestion of gyromitrin-containing mushrooms, stemming from gyromitrin\'s terminal metabolite monomethylhydrazine. We performed a longitudinal descriptive review of the clinical toxicity associated with ingestion of mushroom species known or suspected to contain gyromitrin in cases reported to the Michigan Poison & Drug Information Center between January 1, 2002, to December 31, 2020. Our 19-year descriptive case series of gyromitrin-containing mushroom ingestions reported to our Center demonstrated a preponderance of gastrointestinal signs and symptoms, including hepatotoxicity. Of 118 identified cases, 108 (91.5%) of the reported ingestions involved Gyromitra esculenta. The most frequent clinical findings associated with symptomatic ingestions (n = 83) were the aforementioned gastrointestinal symptoms (n = 62; 74.7%). Neurological symptoms were less frequent (n = 22, 26.5%) while hepatotoxicity occurred in fewer patients (n = 14; 16.9%). Of symptomatic patients, most were treated with symptomatic and supportive care (n = 58; 70%). Pyridoxine was used in a total of seven patients (n = 7; 8.4%) with either hepatotoxicity or neurotoxicity. Medical outcomes ranged from minor to major, with no reported deaths. Patient presentations (i.e. GI vs. neurotoxic symptoms) following ingestion of gyromitrin-containing mushrooms may be highly variable and multifactorial, owing to differences in dose ingested, geographical distribution, genetic variability of both patient and mushroom species, and species-specific differences in toxin composition. Future research warrants species-level identification of ingested gyromitrin-containing mushrooms and investigating the contribution of genetic polymorphisms to differences in clinical toxidromes.
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  • 文章类型: Journal Article
    背景:emamectin苯甲酸酯(EMB-一种大环内酯类杀虫剂,如阿维菌素)的作用机制涉及昆虫中谷氨酸门控氯化物通道和GABA受体的破坏,导致瘫痪和死亡。EMB过量会破坏血脑屏障,导致严重中毒和意识改变。
    目的:回顾患者的EMB中毒表现并重新评估临床表现。
    方法:这项回顾性研究回顾了(2008年8月31日至2023年8月31日)医科大学医院的记录。我们分析了症状,患者特征,生命体征,格拉斯哥昏迷量表评分,实验室发现,和结果。
    结果:10例患者(男性:6例,女性:4例,中位年龄=64.5岁)发生EMB中毒。常见症状包括喉咙痛,肠胃不适,呼吸困难,意识改变;两名患者出现喉部腐蚀损伤。管理涉及活性炭管理,洗胃,和重症监护室入院。
    结论:喉咙痛和腐蚀性损伤是EMB中毒的独特表现,值得警惕。腐蚀损伤的潜在机制包括EMB的皮肤和眼睛刺激作用,其溶剂可能会产生腐蚀作用。
    结论:EMB中毒表现为多种症状,包括喉咙痛,胃肠道症状,中枢神经系统抑郁症,和潜在的吸入性肺炎。识别和及时管理EMB中毒对于提高患者预后和减少并发症至关重要。
    BACKGROUND: The mechanism of emamectin benzoate (EMB-a macrocyclic lactone insecticide like abamectin) action involves the disruption of glutamate-gated chloride channels and GABA receptors in insects, leading to paralysis and death. EMB overdose can breach the blood-brain barrier, resulting in severe poisoning and altered consciousness.
    OBJECTIVE: Review EMB poisoning presentations in patients and reevaluate clinical manifestations.
    METHODS: This retrospective study reviewed (August 31, 2008-August 31, 2023) medical university hospital records. We analyzed symptoms, patient characteristics, vital signs, Glasgow Coma Scale scores, laboratory findings, and outcomes.
    RESULTS: Ten patients (males: 6, females: 4, median age = 64.5 years) experienced EMB poisoning. Common symptoms included sore throat, gastrointestinal distress, dyspnea, and altered consciousness; two patients showed laryngeal corrosive injuries. Management involved activated charcoal administration, gastric lavage, and intensive care unit admission.
    CONCLUSIONS: Sore throat and corrosive injuries were distinctive presentations of EMB poisoning, warranting vigilance. Potential mechanisms of corrosive injury include skin and eye irritation effects of EMB, the solvents of which might exert corrosive action.
    CONCLUSIONS: EMB poisoning manifests as diverse symptoms, including sore throat, gastrointestinal symptoms, central nervous system depression, and potential aspiration pneumonia. Recognizing and promptly managing EMB poisoning are crucial for enhancing patient outcomes and minimizing complications.
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  • 文章类型: Journal Article
    为医学生做好毒理学突发事件管理的适当准备,我们开发了基于模拟的急性临床毒理学医学教育(SBME)培训。我们的目的是报告可行性,这次培训的评估和经验教训。自2019年以来,每年约有180名五年级医学生被邀请参加SBME培训。培训包括互动讲座和两个SBME站。对于每个站,一组学生必须对醉酒患者进行初步评估和管理.培训结束后,学生完成了一份关于他们对临床毒理学的经验和信心的问卷。总的来说,绝大多数学生都认为培训提供了乐趣,互动和刺激的方式来教授临床毒理学。此外,他们对自己在这方面的技能更有信心。我们的初步研究表明,SBME培训得到了很好的评估,并且在更长的时间内是可行的。
    To prepare medical students appropriately for the management of toxicological emergencies, we have developed a simulation-based medical education (SBME) training in acute clinical toxicology. Our aim is to report on the feasibility, evaluation and lessons learned of this training. Since 2019, each year approximately 180 fifth-year medical students are invited to participate in the SBME training. The training consists of an interactive lecture and two SBME stations. For each station, a team of students had to perform the primary assessment and management of an intoxicated patient. After the training, the students completed a questionnaire about their experiences and confidence in clinical toxicology. Overall, the vast majority of students agreed that the training provided a fun, interactive and stimulating way to teach about clinical toxicology. Additionally, they felt more confident regarding their skills in this area. Our pilot study shows that SBME training was well-evaluated and feasible over a longer period.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    磷化铝(AlP),被称为“米片”,“被广泛用作有效的农药。然而,AlP中毒是许多国家常见的死亡原因,比如伊朗。不幸的是,到目前为止,尚无针对AlP毒性的特定解毒剂。AlP在暴露于湿气或酸时释放磷化氢气体。膦是一种有效的线粒体毒素,可以显着抑制细胞能量代谢。AlP中毒是一种需要即时有效干预的紧急情况。二羟基丙酮(DHA)是一种简单的糖,用于多种药理和美容目的。以前,我们发现,在各种体外和体内实验模型中,DHA可以显著防止氰化物和磷化氢等毒性物质引起的线粒体损伤。
    对住院患者(n=111)进行了资格标准评估。在这些患者中,由于数据不完整(n=11)和怀疑AlP以外的中毒(n=24),排除了n=35例。同时,n=76例确诊的AlP中毒病例纳入研究。未接受DHA的AlP中毒患者(n=18)作为对照组。患者(n=58)接受至少一剂DHA(500毫升5%DHA溶液w/v,i.v.)作为AlP中毒的常规治疗之外的辅助治疗。动脉血气(ABG),血液pH值,碳酸氢盐水平,监测其他生命体征和生化指标。此外,对未给予DHA的DHA治疗和AlP中毒患者的死亡率和住院时间进行了评估.在DHA治疗之前(在住院时)和之后评估几种生物标志物。在这项研究中,对AlP中毒患者的常规测试是电解质(K和Na)的测量,WBC,红细胞,血红蛋白,INR,碳酸盐(HCO3),血液pH值,PaCO2、PaO2和SGPT,SGOT,BUN,Cr.
    患者入院时,血液pH值显著下降(酸中毒),血PaO2和HCO3水平是AlP中毒的标志。发现与基于医院常规AlP中毒方案(无DHA)治疗的患者相比,DHA显着减轻了AlP中毒的生物标志物,并大大提高了患者的生存率(DHA治疗组为65.52%,对照组为33.34%)。在本研究中,DHA治疗的患者没有明显的不良反应。
    这些数据表明,肠胃外DHA是一种新型有效的抗AlP中毒解毒剂,除常规支持治疗外,还可用作佐剂。
    IR.SUMS.REC.1394.102。
    UNASSIGNED: Aluminum phosphide (AlP), known as \"rice tablet,\" is widely used as an effective pesticide. However, AlP poisoning is a common cause of mortality in many countries, such as Iran. Unfortunately, there is no specific antidote for AlP toxicity to date. AlP releases phosphine gas when it is exposed to moisture or acid. Phosphine is a potent mitochondrial toxin that could significantly inhibit cellular energy metabolism. AlP poisoning is an emergency condition that needs instant and effective intervention. Dihydroxyacetone (DHA) is a simple saccharide used for several pharmacological as well as cosmetic purposes. Previously, we found that DHA could significantly prevent mitochondrial impairment induced by toxic agents such as cyanide and phosphine in various in vitro and in vivo experimental models.
    UNASSIGNED: Hospitalized patients (n = 111) were evaluated for eligibility criteria. Among these patients, n = 35 cases were excluded due to incomplete data (n = 11) and suspicion of poisoning with poisons other than AlP (n = 24). Meanwhile, n = 76 cases with confirmed AlP poisoning were included in the study. AlP-poisoned patients who did not receive DHA (n = 18) were used as the control group.Patients (n = 58) received at least one dose of DHA (500 ml of 5 % DHA solution w/v, i.v.) as an adjuvant therapy in addition to the routine treatment of AlP poisoning. Arterial blood gas (ABG), blood pH, bicarbonate levels, and other vital signs and biochemical measurements were monitored. Moreover, the mortality rate and hospitalization time were evaluated in DHA-treated and AlP-poisoned patients without DHA administration. Several biomarkers were assessed before (upon hospitalization) and after DHA treatment. The routine tests for AlP-poisoned patients in this study were the measurement of electrolytes (K+ and Na+), WBC, RBC, hemoglobin, INR, carbonate (HCO3), blood pH, PaCO2, and PaO2 and SGPT, SGOT, BUN, Cr.
    UNASSIGNED: Upon patients\' admission, significant decreases in blood pH (acidosis), blood PaO2, and HCO3 levels were the hallmarks of AlP poisoning. It was found that DHA significantly alleviated biomarkers of AlP poisoning and tremendously enhanced patients\' survival rate (65.52 % in DHA-treated vs 33.34 % in the control group) compared to patients treated based on hospital routine AlP poisoning protocols (no DHA). No significant adverse effects were evident in DHA-treated patients in the current study.
    UNASSIGNED: These data suggest that parenteral DHA is a novel and effective antidote against AlP poisoning to be used as an adjuvant in addition to routine supportive treatment.
    UNASSIGNED: IR.SUMS.REC.1394.102.
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  • 文章类型: Journal Article
    液相色谱-高分辨率质谱(LC-HR-MS)已成为临床毒理学中化合物筛选的强大分析技术。为了评估LC-HR-MS3在检测有毒天然产物方面的潜力,构建了包含MS2和MS3质谱的85种天然产物(79种生物碱)的光谱库,并将其用于鉴定天然产物。使用LC-HR-MS3方法分析样品,并将产生的数据与光谱库匹配以鉴定天然产物。
    为了测试LC-HR-MS3方法在不同样品基质中的性能,将85种天然产物标准品分为三组,以分离结构异构体,并避免由多种分析物共洗脱引起的离子抑制作用。将分组的分析物掺入无药物的血清和无药物的尿液中以产生设计的临床样品。
    获得了尿液和血清样品中85种天然产物的化合物鉴定结果。在10个不同的分析物浓度下比较使用MS2和MS3质谱和仅使用MS2质谱的匹配分数。两种类型的数据分析为大多数分析物提供了相同的鉴定结果(血清中的96%,92%在尿液中),然而,对于剩余的分析物,MS2-MS3树数据分析在较低浓度下具有更好的识别性能。
    这项研究表明,与LC-HR-MS(MS2)相比,LC-HR-MS3可以提高在血清和尿液样本中测试的一小组有毒天然产物的鉴定性能。
    UNASSIGNED: Liquid chromatography-high-resolution mass spectrometry (LC-HR-MS) has emerged as a powerful analytical technology for compound screening in clinical toxicology. To evaluate the potential of LC-HR-MS3 in detecting toxic natural products, a spectral library of 85 natural products (79 alkaloids) that contains both MS2 and MS3 mass spectra was constructed and used to identify the natural products. Samples were analyzed using an LC-HR-MS3 method and the generated data were matched to the spectral library to identify the natural products.
    UNASSIGNED: To test the performance of the LC-HR-MS3 method in different sample matrices, the 85 natural product standards were divided into three groups to separate structural isomers and avoid ion suppression effects caused by co-elution of multiple analytes. The grouped analytes were spiked into drug-free serum and drug-free urine to produce contrived clinical samples.
    UNASSIGNED: The compound identification results of the 85 natural products in urine and serum samples were obtained. The match scores using both MS2 and MS3 mass spectra and those using only MS2 mass spectra were compared at 10 different analyte concentrations. The two types of data analysis provided identical identification results for the majority of the analytes (96% in serum, 92% in urine), whereas, for the remaining analytes, the MS2-MS3 tree data analysis had better performance in identifying them at lower concentrations.
    UNASSIGNED: This study shows that in comparison to LC-HR-MS (MS2), LC-HR-MS3 can increase the performance in identification of a small group of the toxic natural products tested in serum and urine specimens.
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  • 文章类型: Journal Article
    目的:本文旨在探索在临床药理学中采用大型语言模型(LLM)-一种人工智能(AI)的可能性,重点关注其在生物武器开发中可能的误用。此外,伦理考虑,立法,并分析了潜在的风险降低措施。
    方法:对现有文献的全面回顾调查了人工智能和LLM在生物武器创作中的潜在误用。搜索内容包括来自PubMed,Scopus,以及使用特定协议识别的WebofScience核心集合。为了探索监管景观,经合组织。使用了AI平台。
    结果:他回顾了AI和LLM的双重用途漏洞,专注于生物武器的发展。随后,一个案例研究用于说明AI操纵导致有害物质合成的潜力。现有法规不足以解决与AI和LLM相关的道德问题。提出了缓解措施,包括技术解决方案(可解释的人工智能),通过合作努力建立道德准则,并实施政策变更,以建立全面的监管框架。
    结论:将AI和LLM整合到临床药理学中提供了宝贵的机会,同时也引入了重要的道德和安全考虑。解决人工智能的双重用途需要强有力的法规,以及采用基于技术解决方案和遵循透明度原则的道德价值观的战略方法,问责制,和安全。此外,强调了人工智能在制定针对新型有害物质的对策方面的潜在作用。通过采取积极主动的方法,可以充分利用AI和LLM的潜在优势,同时将相关风险降至最低。
    This paper aims to explore the possibility of employing large language models (LLMs) - a type of artificial intelligence (AI) - in clinical pharmacology, with a focus on its possible misuse in bioweapon development. Additionally, ethical considerations, legislation and potential risk reduction measures are analysed. The existing literature is reviewed to investigate the potential misuse of AI and LLMs in bioweapon creation. The search includes articles from PubMed, Scopus and Web of Science Core Collection that were identified using a specific protocol. To explore the regulatory landscape, the OECD.ai platform was used. The review highlights the dual-use vulnerability of AI and LLMs, with a focus on bioweapon development. Subsequently, a case study is used to illustrate the potential of AI manipulation resulting in harmful substance synthesis. Existing regulations inadequately address the ethical concerns tied to AI and LLMs. Mitigation measures are proposed, including technical solutions (explainable AI), establishing ethical guidelines through collaborative efforts, and implementing policy changes to create a comprehensive regulatory framework. The integration of AI and LLMs into clinical pharmacology presents invaluable opportunities, while also introducing significant ethical and safety considerations. Addressing the dual-use nature of AI requires robust regulations, as well as adopting a strategic approach grounded in technical solutions and ethical values following the principles of transparency, accountability and safety. Additionally, AI\'s potential role in developing countermeasures against novel hazardous substances is underscored. By adopting a proactive approach, the potential benefits of AI and LLMs can be fully harnessed while minimizing the associated risks.
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  • 文章类型: Journal Article
    连字符质谱(MS)已发展成为一种非常强大的高灵敏度和特异性的分析技术。它用于分析经典和替代矩阵中非常广泛的分析物。本文将主要基于PubMed(1990年至2023年4月)中索引的综述文章,提供有关连字MS在临床毒理学中的最新应用的概述。
    关于矩阵的概述,样品制备,分析系统,给出了检测模式以及验证和质量控制。此外,讨论了选定的应用程序。
    更广泛地使用连字MS技术,特别是在系统毒理学分析和滥用药物测试中,将有助于克服基于免疫测定的筛查策略的局限性。这目前受到高仪器成本的阻碍,人员资格要求,和不太有利的周转时间,可以通过更友好的用户来克服,理想的全自动MS仪器。这将有助于在更多的实验室中提供基于连字符MS的分析,并将分析扩展到大量有机药物,毒物和/或代谢物。即使是最新的新型精神活性物质(NPS)也可以通过高分辨率MS方法进行推定鉴定,他们可能的存在被传达给治疗医生,稍后确认。
    UNASSIGNED: Hyphenated mass spectrometry (MS) has evolved into a very powerful analytical technique of high sensitivity and specificity. It is used to analyze a very wide spectrum of analytes in classical and alternative matrices. The presented paper will provide an overview of the current state-of-the-art of hyphenated MS applications in clinical toxicology primarily based on review articles indexed in PubMed (1990 to April 2023).
    UNASSIGNED: A general overview of matrices, sample preparation, analytical systems, detection modes, and validation and quality control is given. Moreover, selected applications are discussed.
    UNASSIGNED: A more widespread use of hyphenated MS techniques, especially in systematic toxicological analysis and drugs of abuse testing, would help overcome limitations of immunoassay-based screening strategies. This is currently hampered by high instrument cost, qualification requirements for personnel, and less favorable turnaround times, which could be overcome by more user-friendly, ideally fully automated MS instruments. This would help making hyphenated MS-based analysis available in more laboratories and expanding analysis to a large number of organic drugs, poisons, and/or metabolites. Even the most recent novel psychoactive substances (NPS) could be presumptively identified by high-resolution MS methods, their likely presence be communicated to treating physicians, and be confirmed later on.
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  • 文章类型: Journal Article
    需要提供快速和,可能,中毒情况下的现场分析结果促使研究人员快速开发,敏感,以及适用于非专业实验室和需要点(PON)的具有成本效益的方法和分析设备。近年来,纸基微流控分析装置(μPAD)技术得到了快速发展,低成本替代传统的快速检测有害化合物。事实上,μPAD已被开发用于检测有毒分子(砷,氰化物,乙醇,和亚硝酸盐),毒品,和滥用药物(苯二氮卓类药物,卡西诺酮,可卡因,芬太尼,氯胺酮,MDMA,吗啡,合成大麻素,四氢大麻酚,和赛拉嗪),以及用于毒品犯罪的精神活性物质(氟硝西泮,γ-羟基丁酸(GHB),氯胺酮,安乃近,咪达唑仑,和东pol碱)。本报告严格评估了纸质设备的最新发展,特别是在检测方法中,以及这些新的分析工具是如何在法医和临床毒理学中进行测试的,还包括对它们应用的未来观点,例如多传感纸质设备,微流控纸基分离,和可穿戴的纸质传感器。
    The need for providing rapid and, possibly, on-the-spot analytical results in the case of intoxication has prompted researchers to develop rapid, sensitive, and cost-effective methods and analytical devices suitable for use in nonspecialized laboratories and at the point of need (PON). In recent years, the technology of paper-based microfluidic analytical devices (μPADs) has undergone rapid development and now provides a feasible, low-cost alternative to traditional rapid tests for detecting harmful compounds. In fact, µPADs have been developed to detect toxic molecules (arsenic, cyanide, ethanol, and nitrite), drugs, and drugs of abuse (benzodiazepines, cathinones, cocaine, fentanyl, ketamine, MDMA, morphine, synthetic cannabinoids, tetrahydrocannabinol, and xylazine), and also psychoactive substances used for drug-facilitated crimes (flunitrazepam, gamma-hydroxybutyric acid (GHB), ketamine, metamizole, midazolam, and scopolamine). The present report critically evaluates the recent developments in paper-based devices, particularly in detection methods, and how these new analytical tools have been tested in forensic and clinical toxicology, also including future perspectives on their application, such as multisensing paper-based devices, microfluidic paper-based separation, and wearable paper-based sensors.
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