Startseite Medizin A cross-sectional study of biomarkers of exposure and effect in smokers and moist snuff consumers
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

A cross-sectional study of biomarkers of exposure and effect in smokers and moist snuff consumers

  • G.L. Prasad EMAIL logo , Bobbette A. Jones , Peter Chen und Evan O. Gregg
Veröffentlicht/Copyright: 23. Oktober 2015
Veröffentlichen auch Sie bei De Gruyter Brill
Manuskript einreichen Informationen für Autor*innen
Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 54 Heft 4

Abstract

Background: Cigarette smoking is a major risk factor for several chronic diseases. Epidemiological data indicate the use of smokeless tobacco (ST) is associated with significantly lower risk for smoking-related diseases compared to cigarettes. Several biomarkers of exposure (BioExp) and effect (BioEff) associated with smoking and use of moist snuff (ST) were evaluated.

Methods: A single site, cross-sectional clinical study enrolled three groups of generally healthy male smokers (SMK), moist snuff consumers (MSC), and non-tobacco consumers (NTC), and several BioExp and BioEff were evaluated.

Results: Blood and urinary BioExp, including total nicotine equivalents and tobacco-specific nitrosamines, were higher in MSC compared to SMK. Biomarkers of combustion-related toxicants and cadmium were elevated in SMK. Elevated levels of some BioEff associated with oxidative stress (urinary isoprostanes and leukotriene E4), inflammation (white blood cell count), platelet activation (thromboxane metabolites), and lipid metabolism (apolipoprotein B100 and oxidized low-density lipoprotein) were observed in SMK relative to NTC and MSC (all p<0.05). The non-smoking groups (MSC and NTC) showed similar levels of combustion-related BioExp and BioEff.

Conclusions: Higher levels of exposure to nicotine and some N′-nitrosamines may be observed in MSC, and SMK are exposed to higher levels of combustion-related toxicants. Changes in BioEff consistent with some aspects of inflammation, oxidative stress, and altered lipid metabolism were detected in SMK compared to the non-smoking groups. The biomarker data further improve our understanding of pathophysiological changes and the risk continuum associated with various tobacco products, and could be useful components of future assessments of tobacco products.

Keywords: biological effect; biomarkers; exposure; moist snuff; smoking
Corresponding author: G.L. Prasad, R.J. Reynolds Tobacco Company, P.O. Box 1487, Winston-Salem, NC 27102, USA, Phone: +1 336 741 7562, Fax: +1 336 741 2841, E-mail:

References

1. Perfetti TA, Rodgman A. The complexity of tobacco and tobacco smoke. Beitr Tabakforsch 2011;25:215–32.Suche in Google Scholar

2. Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC, editors. World Health Organization classification of tumours. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press, 2004.Suche in Google Scholar

3. U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the surgeon general. Atlanta, GA: Centers for Disease Control and Prevention. Office on Smoking and Health, 2010.Suche in Google Scholar

4. van der Vaart H, Postma DS, Timens W, Ten Hacken NH. Acute effects of cigarette smoke on inflammation and oxidative stress: a review. Thorax 2004;59:713–21.10.1136/thx.2003.012468Suche in Google Scholar

5. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest 2007;131:1557–66.10.1378/chest.06-2179Suche in Google Scholar

6. Borgerding MF, Bodnar JA, Curtin GM, Swauger JE. The chemical composition of smokeless tobacco: a survey of products sold in the United States in 2006 and 2007. Regul Toxicol Pharmacol 2012;64:367–87.10.1016/j.yrtph.2012.09.003Suche in Google Scholar

7. Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom. J Am Med Assoc 2000;284:706–12.10.1001/jama.284.6.706Suche in Google Scholar

8. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans: tobacco smoke and involuntary smoking. Lyon: IARC Press, 2004.Suche in Google Scholar

9. Zeller M, Hatsukami D, Strategic Dialogue on Tobacco Harm Reduction Group. The strategic dialogue on tobacco harm reduction: a vision and blueprint for action in the US. Tob Control 2009;18:324–32.10.1136/tc.2008.027318Suche in Google Scholar

10. Gartner CE, Hall WD, Vos T, Bertram MY, Wallace AL, Lim SS. Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study. Lancet 2007;369:2010–4.10.1016/S0140-6736(07)60677-1Suche in Google Scholar

11. Hatsukami DK, Joseph AM, Lesage M, Jensen J, Murphy SE, Pentel PR, et al. Developing the science base for reducing tobacco harm. Nicotine Tob Res 2007;9 Suppl 4:S537–53.10.1080/14622200701679040Suche in Google Scholar

12. Lee PN, Hamling J. Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. BMC Med 2009;7:36.10.1186/1741-7015-7-36Suche in Google Scholar

13. Luo J, Ye W, Zendehdel K, Adami J, Adami H-O, Boffetta P, et al. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet 2007;369:2015–20.10.1016/S0140-6736(07)60678-3Suche in Google Scholar

14. Rodu B. Snus and the risk of cancer of the mouth, lung, and pancreas. Lancet 2007;370:1207–8.10.1016/S0140-6736(07)61533-5Suche in Google Scholar

15. Royal College of Physicians. Harm reduction in nicotine addiction: helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians, 2007.Suche in Google Scholar

16. Britton J, Edwards R. Tobacco smoking, harm reduction, and nicotine product regulation. Lancet 2008;371:441–5.10.1016/S0140-6736(07)61482-2Suche in Google Scholar

17. Henley SJ, Thun MJ, Connell C, Calle EE. Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States). Cancer Causes Control 2005;16:347–58.10.1007/s10552-004-5519-6Suche in Google Scholar PubMed

18. Piano MR, Benowitz NL, Fitzgerald GA, Corbridge S, Heath J, Hahn E, et al. Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation 2010;122:1520–44.10.1161/CIR.0b013e3181f432c3Suche in Google Scholar PubMed

19. Life Sciences Research Office. Scientific methods to evaluate potential reduces-risk tobacco products. Bethesda, MD: Life Sciences Research Office, 2007.Suche in Google Scholar

20. Feng S, Roethig HJ, Liang Q, Kinser R, Jin Y, Scherer G, et al. Evaluation of urinary 1-hydroxypyrene, S-phenylmercapturic acid, trans,trans-muconic acid, 3-methyladenine, 3-ethyladenine, 8-hydroxy-2′-deoxyguanosine and thioethers as biomarkers of exposure to cigarette smoke. Biomarkers 2006;11:28–52.10.1080/13547500500399730Suche in Google Scholar PubMed

21. Lowe FJ, Gregg EO, McEwan M. Evaluation of biomarkers of exposure and potential harm in smokers, former smokers and never-smokers. Clin Chem Lab Med 2009;47:311–20.10.1515/CCLM.2009.069Suche in Google Scholar PubMed

22. Sarkar M, Liu J, Koval T, Wang J, Feng S, Serafin R, et al. Evaluation of biomarkers of exposure in adult cigarette smokers using Marlboro snus. Nicotine Tob Res 2010;12:105–16.10.1093/ntr/ntp183Suche in Google Scholar PubMed

23. Hecht SS, Yuan JM, Hatsukami D. Applying tobacco carcinogen and toxicant biomarkers in product regulation and cancer prevention. Chem Res Toxicol 2010;23:1001–8.10.1021/tx100056mSuche in Google Scholar PubMed PubMed Central

24. Calapai G, Caputi AP, Mannucci C, Russo GA, Gregg E, Puntoni R, et al. Cardiovascular biomarkers in groups of established smokers after a decade of smoking. Basic Clin Pharmacol Toxicol 2009;104:322–8.10.1111/j.1742-7843.2008.00361.xSuche in Google Scholar PubMed

25. Zedler BK, Kinser R, Oey J, Nelson B, Roethig HJ, Walk RA, et al. Biomarkers of exposure and potential harm in adult smokers of 3–7 mg tar yield (Federal Trade Commission) cigarettes and in adult non-smokers. Biomarkers 2006;11:201–20.10.1080/13547500600576260Suche in Google Scholar PubMed

26. Liu J, Liang Q, Frost-Pineda K, Muhammad-Kah R, Rimmer L, Roethig H, et al. Relationship between biomarkers of cigarette smoke exposure and biomarkers of inflammation, oxidative stress, and platelet activation in adult cigarette smokers. Cancer Epidemiol Biomarkers Prev 2011;20:1760–9.10.1158/1055-9965.EPI-10-0987Suche in Google Scholar PubMed

27. Frost-Pineda K, Liang Q, Liu J, Rimmer L, Jin Y, Feng S, et al. Biomarkers of potential harm among adult smokers and non-smokers in the total exposure study. Nicotine Tob Res 2011;13:182–93.10.1093/ntr/ntq235Suche in Google Scholar PubMed

28. Faux SP, Tai T, Thorne D, Xu Y, Breheny D, Gaca M. The role of oxidative stress in the biological responses of lung epithelial cells to cigarette smoke. Biomarkers 2009;14 Suppl 1:90–6.10.1080/13547500902965047Suche in Google Scholar PubMed

29. Lowe FJ, Luettich K, Gregg EO. Lung cancer biomarkers for the assessment of modified risk tobacco products: an oxidative stress perspective. Biomarkers 2013;18:183–95.10.3109/1354750X.2013.777116Suche in Google Scholar PubMed PubMed Central

30. Campbell LR, Brown BG, Jones BA, Marano KM, Borgerding MF. Study of cardiovascular disease biomarkers among tobacco consumers, Part 1: biomarkers of exposure. Inhal Toxicol 2015;27:149–56.10.3109/08958378.2015.1013228Suche in Google Scholar PubMed PubMed Central

31. Marano KM, Kathman SJ, Jones BA, Nordskog BK, Brown BG, Borgerding MF. Study of cardiovascular disease biomarkers among tobacco consumers. Part 3: evaluation and comparison with the US National Health and Nutrition Examination Survey. Inhal Toxicol 2015;27:167–73.10.3109/08958378.2015.1009196Suche in Google Scholar PubMed PubMed Central

32. Nordskog BK, Brown BG, Marano KM, Campell LR, Jones BA, Borgerding MF. Study of cardiovascular disease biomarkers among tobacco consumers, Part 2: biomarkers of biological effect. Inhal Toxicol 2015;27:157–66.10.3109/08958378.2015.1013227Suche in Google Scholar PubMed PubMed Central

33. Lee JW, Devanarayan V, Barrett YC, Weiner R, Allinson J, Fountain S, et al. Fit-for-purpose method development and validation for successful biomarker measurement. Pharm Res 2006;23:312–28.10.1007/s11095-005-9045-3Suche in Google Scholar PubMed

34. Gregg EO, Minet E, McEwan M. Urinary biomarkers of smokers’ exposure to tobacco smoke constituents in tobacco products assessment: a fit for purpose approach. Biomarkers 2013;18:467–86.10.3109/1354750X.2013.821523Suche in Google Scholar PubMed PubMed Central

35. Reilly M, Delanty N, Lawson JA, FitzGerald GA. Modulation of oxidant stress in vivo in chronic cigarette smokers. Circulation 1996;94:19–25.10.1161/01.CIR.94.1.19Suche in Google Scholar PubMed

36. Kuusimaki L, Peltonen Y, Mutanen P, Peltonen K, Savela K. Urinary hydroxy-metabolites of naphthalene, phenanthrene and pyrene as markers of exposure to diesel exhaust. Int Arch Occup Environ Health 2004;77:23–30.10.1007/s00420-003-0477-ySuche in Google Scholar PubMed

37. Scherer G. Biomonitoring of inhaled complex mixtures – ambient air, diesel exhaust and cigarette smoke. Exp Toxicol Pathol 2005;57:75–110.10.1016/j.etp.2005.05.007Suche in Google Scholar PubMed

38. Naufal ZS, Marano KM, Kathman SJ, Wilson CL. Differential exposure biomarker levels among cigarette smokers and smokeless tobacco consumers in the National Health and Nutrition Examination Survey 1999–2008. Biomarkers 2011;16:222–35.10.3109/1354750X.2010.546013Suche in Google Scholar PubMed

39. Nestor TB, Gentry JS, Peele DM, Riddick MG, Conner BT, Edwards ME. Role of oxides of nitrogen in tobacco-specific nitrosamine formation in flue-cured tobacco. Beitr Tabakforsch 2003;20:467–75.10.2478/cttr-2013-0762Suche in Google Scholar

40. Stephens WE, Calder A, Newton J. Source and health implications of high toxic metal concentrations in illicit tobacco products. Environ Sci Technol 2005;39:479–88.10.1021/es049038sSuche in Google Scholar PubMed

41. Marano KM, Naufal ZS, Kathman SJ, Bodnar JA, Borgerding MF, Garner CD, et al. Cadmium exposure and tobacco consumption: biomarkers and risk assessment. Regul Toxicol Pharmacol 2012;64:243–52.10.1016/j.yrtph.2012.07.008Suche in Google Scholar PubMed

42. Marano KM, Naufal ZS, Kathman SJ, Bodnar JA, Borgerding MF, Wilson CL. Arsenic exposure and tobacco consumption: biomarkers and risk assessment. Regul Toxicol Pharmacol 2012;64:225–32.10.1016/j.yrtph.2012.07.007Suche in Google Scholar PubMed

43. Jarup L, Akesson A. Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol 2009;238:201–8.10.1016/j.taap.2009.04.020Suche in Google Scholar PubMed

44. U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress: A report of the surgeon general. Atlanta, GA: U.S. DHHS, Centers for Disease Control and Prevention, Office on Smoking and Health, 2014.Suche in Google Scholar

45. Montuschi P, Collins JV, Ciabattoni G, Lazzeri N, Corradi M, Kharitonov SA, et al. Exhaled 8-isoprostane as an in vivo biomarker of lung oxidative stress in patients with COPD and healthy smokers. Am J Respir Crit Care Med 2000;162:1175–7.10.1164/ajrccm.162.3.2001063Suche in Google Scholar PubMed

46. Suzuki J, Ogawa M, Watanabe R, Takayama K, Hirata Y, Nagai R, et al. Roles of prostaglandin E2 in cardiovascular diseases. Int Heart J 2011;52:266–9.10.1536/ihj.52.266Suche in Google Scholar PubMed

47. Gomez I, Foudi N, Longrois D, Norel X. The role of prostaglandin E2 in human vascular inflammation. Prostaglandins Leukot Essent Fatty Acids 2013;89:55–63.10.1016/j.plefa.2013.04.004Suche in Google Scholar PubMed

48. Milne GL, Yin H, Hardy KD, Davies SS, Roberts LJ, 2nd. Isoprostane generation and function. Chem Rev 2011;111:5973–96.10.1021/cr200160hSuche in Google Scholar PubMed PubMed Central

49. Bozyk PD, Moore BB. Prostaglandin E2 and the pathogenesis of pulmonary fibrosis. Am J Respir Cell Mol Biol 2011;45:445–52.10.1165/rcmb.2011-0025RTSuche in Google Scholar PubMed PubMed Central

50. Dallongeville J, Marecaux N, Richard F, Bonte D, Zylberberg G, Fantino M, et al. Cigarette smoking is associated with differences in nutritional habits and related to lipoprotein alterations independently of food and alcohol intake. Eur J Clin Nutr 1996;50:647–54.Suche in Google Scholar

51. Prasad GL, Jones BA, Schmidt E, Chen P, Kennedy AD. Global metabolomic profiles reveal differences in oxidative stress and inflammation pathways in smokers and moist snuff consumers. J Metabolomics 2015;1:2. DOI: 10.7243/2059-0008-1-2.10.7243/2059-0008-1-2Suche in Google Scholar

Supplemental Material:

The online version of this article (DOI: 10.1515/cclm-2015-0594) offers supplementary material, available to authorized users.

Received: 2015-6-24
Accepted: 2015-8-26
Published Online: 2015-10-23
Published in Print: 2016-4-1

©2016 by De Gruyter

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Macroprolactin: searching for a needle in a haystack?
  4. Review
  5. Laboratory medicine in the new healthcare environment
  6. Opinion Paper
  7. Developing GRADE outcome-based recommendations about diagnostic tests: a key role in laboratory medicine policies
  8. EFLM Survey
  9. Accreditation process in European countries – an EFLM survey
  10. Genetics and Molecular Diagnostics
  11. HB Puerta del Sol [HBA1:c.148A>C], HB Valdecilla [HBA2:c.3G>T], HB Gran Vía [HBA2:c.98T>G], HB Macarena [HBA2:c.358C>T] and HB El Retiro [HBA2:c.364_366dupGTG]: description of five new hemoglobinopathies
  12. General Clinical Chemistry and Laboratory Medicine
  13. A candidate reference method using ICP-MS for sweat chloride quantification
  14. Quantification of hemoglobin A1c by off-line HPLC separation and liquid chromatography-tandem mass spectrometry: a modification of the IFCC reference measurement procedure
  15. Comparison between B·R·A·H·M·S PCT direct, a new sensitive point-of-care testing device for rapid quantification of procalcitonin in emergency department patients and established reference methods – a prospective multinational trial
  16. Evaluation of a hand-held blood gas analyzer for rapid determination of blood gases, electrolytes and metabolites in intensive care setting
  17. Use of a faecal immunochemical test for haemoglobin can aid in the investigation of patients with lower abdominal symptoms
  18. A possible cause of the variable detectability of macroprolactin by different immunoassay systems
  19. A multicenter comparison of whole blood vitamin B6 assays
  20. Analytical and clinical performance of the new Fujirebio 25-OH vitamin D assay, a comparison with liquid chromatography-tandem mass spectrometry (LC-MS/MS) and three other automated assays
  21. Development and validation of a 2nd tier test for identification of purine nucleoside phosphorylase deficiency patients during expanded newborn screening by liquid chromatography-tandem mass spectrometry
  22. A cross-sectional study of biomarkers of exposure and effect in smokers and moist snuff consumers
  23. Reference Values and Biological Variations
  24. Pediatric reference value distributions and covariate-stratified reference intervals for 29 endocrine and special chemistry biomarkers on the Beckman Coulter Immunoassay Systems: a CALIPER study of healthy community children
  25. Development of reference intervals for serum alkaline phosphatase among adults in Southern China traced to the new IFCC reference measurement procedure
  26. Birth season predicts the values of red blood cell distribution width (RDW) in adulthood
  27. Cardiovascular Diseases
  28. Cardiovascular risk stratification in hemodialysis patients in the era of highly sensitive troponins: should we choose between hs-troponin I and hs-troponin T?
  29. A standardised FACS assay based on native, receptor transfected cells for the clinical diagnosis and monitoring of β1-adrenergic receptor autoantibodies in human heart disease
  30. Infectious Diseases
  31. The diagnostic value of serum fucosylated fetuin A in hepatitis B virus-related liver diseases
  32. Letters to the Editor
  33. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia
  34. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a reply
  35. STORE (Sample Tracking: Organization, Refrigeration and Expansion): a project in a clinical laboratory perspective
  36. Control materials for immunochromatographic strip used for α-thalassemia screening
  37. Comparison of a 10- vs. 15-min centrifugation time for chemical and immunochemical assays and impact on turnaround time in a hospital laboratory
  38. Pre-analytical phase in cryoglobulin (CRG) detection: an alternative method for sample transport
  39. The efficacy of an internet-based e-learning system using the CellaVision Competency Software for continuing professional development
  40. Clinical examinations after the Fukushima disaster: a case report of Soma General Hospital
  41. Non-fasting plasma glucose concentration in blood donors
  42. Analytical evaluation of a second generation assay for chromogranin A; a dual-site study
  43. UBE3A, c.1347_1348delGA: a mutation in question
https://doi.org/10.1515/cclm-2015-0594
Schlagwörter für diesen Artikel
biological effect; biomarkers; exposure; moist snuff; smoking

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Macroprolactin: searching for a needle in a haystack?
  4. Review
  5. Laboratory medicine in the new healthcare environment
  6. Opinion Paper
  7. Developing GRADE outcome-based recommendations about diagnostic tests: a key role in laboratory medicine policies
  8. EFLM Survey
  9. Accreditation process in European countries – an EFLM survey
  10. Genetics and Molecular Diagnostics
  11. HB Puerta del Sol [HBA1:c.148A>C], HB Valdecilla [HBA2:c.3G>T], HB Gran Vía [HBA2:c.98T>G], HB Macarena [HBA2:c.358C>T] and HB El Retiro [HBA2:c.364_366dupGTG]: description of five new hemoglobinopathies
  12. General Clinical Chemistry and Laboratory Medicine
  13. A candidate reference method using ICP-MS for sweat chloride quantification
  14. Quantification of hemoglobin A1c by off-line HPLC separation and liquid chromatography-tandem mass spectrometry: a modification of the IFCC reference measurement procedure
  15. Comparison between B·R·A·H·M·S PCT direct, a new sensitive point-of-care testing device for rapid quantification of procalcitonin in emergency department patients and established reference methods – a prospective multinational trial
  16. Evaluation of a hand-held blood gas analyzer for rapid determination of blood gases, electrolytes and metabolites in intensive care setting
  17. Use of a faecal immunochemical test for haemoglobin can aid in the investigation of patients with lower abdominal symptoms
  18. A possible cause of the variable detectability of macroprolactin by different immunoassay systems
  19. A multicenter comparison of whole blood vitamin B6 assays
  20. Analytical and clinical performance of the new Fujirebio 25-OH vitamin D assay, a comparison with liquid chromatography-tandem mass spectrometry (LC-MS/MS) and three other automated assays
  21. Development and validation of a 2nd tier test for identification of purine nucleoside phosphorylase deficiency patients during expanded newborn screening by liquid chromatography-tandem mass spectrometry
  22. A cross-sectional study of biomarkers of exposure and effect in smokers and moist snuff consumers
  23. Reference Values and Biological Variations
  24. Pediatric reference value distributions and covariate-stratified reference intervals for 29 endocrine and special chemistry biomarkers on the Beckman Coulter Immunoassay Systems: a CALIPER study of healthy community children
  25. Development of reference intervals for serum alkaline phosphatase among adults in Southern China traced to the new IFCC reference measurement procedure
  26. Birth season predicts the values of red blood cell distribution width (RDW) in adulthood
  27. Cardiovascular Diseases
  28. Cardiovascular risk stratification in hemodialysis patients in the era of highly sensitive troponins: should we choose between hs-troponin I and hs-troponin T?
  29. A standardised FACS assay based on native, receptor transfected cells for the clinical diagnosis and monitoring of β1-adrenergic receptor autoantibodies in human heart disease
  30. Infectious Diseases
  31. The diagnostic value of serum fucosylated fetuin A in hepatitis B virus-related liver diseases
  32. Letters to the Editor
  33. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia
  34. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a reply
  35. STORE (Sample Tracking: Organization, Refrigeration and Expansion): a project in a clinical laboratory perspective
  36. Control materials for immunochromatographic strip used for α-thalassemia screening
  37. Comparison of a 10- vs. 15-min centrifugation time for chemical and immunochemical assays and impact on turnaround time in a hospital laboratory
  38. Pre-analytical phase in cryoglobulin (CRG) detection: an alternative method for sample transport
  39. The efficacy of an internet-based e-learning system using the CellaVision Competency Software for continuing professional development
  40. Clinical examinations after the Fukushima disaster: a case report of Soma General Hospital
  41. Non-fasting plasma glucose concentration in blood donors
  42. Analytical evaluation of a second generation assay for chromogranin A; a dual-site study
  43. UBE3A, c.1347_1348delGA: a mutation in question
Jetzt anmelden und 20% sparen
Institutioneller Zugang
Wie funktioniert Authentifizierung?
Haben Sie eine Idee, wie wir unsere Website verbessern können?
Bitte schreiben Sie uns.
© 2025 De Gruyter Brill
Heruntergeladen am 10.12.2025 von https://www.degruyterbrill.com/document/doi/10.1515/cclm-2015-0594/pdf
Button zum nach oben scrollen