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Hu Z, Hu L, Zhang C, Yin X, Zhang Y, Fang K, Wu B, Huang X. Simultaneous determination of total homocysteine, methionine, methylmalonic acid and 2-methylcitric acid in dried blood spots by ultra-performance liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1244:124253. [PMID: 39089063 DOI: 10.1016/j.jchromb.2024.124253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 07/10/2024] [Accepted: 07/20/2024] [Indexed: 08/03/2024]
Abstract
Homocysteine, methionine, methylmalonic acid and 2-methylcitric acid are clinically relevant markers in the methionine, propionate, and cobalamin metabolism. This study aimed to develop and validate an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for simultaneously determining total homocysteine, methionine, methylmalonic acid and 2-methylcitric acid in dried blood spots. Three 3.2 mm discs were punched from each calibrator, quality control, and sample dried blood spot into a 96-well U-plate. Each sample was spiked with internal standards and extracted. Then the supernatant was transferred to another 96-well U-plate. After nitrogen drying, the dried residues were reconstituted, centrifuged, and the resulting supernatant was transferred to another 96-well plate for analysis. The method was performed using UPLC-MS/MS within 3 min, validated according to guidance documents, and applied to 72 samples from confirmed patients with methionine, propionate, and cobalamin metabolism disorders. The UPLC-MS/MS method provided satisfactory separation of the four analytes. The R2 values were ≥ 0.9937 for all analytes. The recoveries ranged from 94.17 to 114.29 %, and the coefficients of variation for intraday and interday precision were 0.19 % to 5.23 % and 1.02 % to 6.89 %, respectively. No significant carry-over was detected for the four analytes, and most of confirmed samples exhibited biomarker patterns characteristic of the relevant disorders. A simple and fast UPLC-MS/MS method was successfully developed, validated, and applied to clinical samples for the simultaneous determination of total homocysteine, methionine, methylmalonic acid, and 2-methylcitric acid in dried blood spots.
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Affiliation(s)
- Zhenzhen Hu
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lingwei Hu
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chao Zhang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoshan Yin
- School of Health in Social Science, The University of Edinburg, United Kingdom
| | - Yu Zhang
- Zhejiang BiosanBiochemical Technologies Co., Ltd., Hangzhou, China
| | - Kexin Fang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Benqing Wu
- Department of Neonatology, Children's Medical Center, University of Chinese Academy of Science-Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Xinwen Huang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Liu Y, Ma X, Chen Z, He R, Zhang Y, Dong H, Ma Y, Wu T, Wang Q, Ding Y, Li X, Li D, Song J, Li M, Jin Y, Qin J, Yang Y. Dual rare genetic diseases in five pediatric patients: insights from next-generation diagnostic methods. Orphanet J Rare Dis 2024; 19:159. [PMID: 38610036 PMCID: PMC11015677 DOI: 10.1186/s13023-024-03148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Clinicians traditionally aim to identify a singular explanation for the clinical presentation of a patient; however, in some cases, the diagnosis may remain elusive or fail to comprehensively explain the clinical findings. In recent years, advancements in next-generation sequencing, including whole-exome sequencing, have led to the incidental identification of dual diagnoses in patients. Herein we present the cases of five pediatric patients diagnosed with dual rare genetic diseases. Their natural history and diagnostic process were explored, and lessons learned from utilizing next-generation diagnostic technologies have been reported. RESULTS Five pediatric cases (3 boys, 2 girls) with dual diagnoses were reported. The age at diagnosis was from 3 months to 10 years. The main clinical presentations were psychomotor retardation and increased muscular tension, some accompanied with liver dysfunction, abnormal appearance, precocious puberty, dorsiflexion restriction and varus of both feet, etc. After whole-exome sequencing, nine diseases were confirmed in these patients: Angelman syndrome and Krabbe disease in case 1, Citrin deficiency and Kabuki syndrome in case 2, Homocysteinemia type 2 and Copy number variant in case 3, Isolated methylmalonic acidemia and Niemann-Pick disease type B in case 4, Isolated methylmalonic acidemia and 21-hydroxylase deficiency in case 5. Fifteen gene mutations and 2 CNVs were identified. Four novel mutations were observed, including c.15292de1A in KMT2D, c.159_164inv and c.1427G > A in SLC25A13, and c.591 C > G in MTHFR. CONCLUSIONS Our findings underscore the importance of clinicians being vigilant about the significance of historical and physical examination. Comprehensive clinical experience is crucial for identifying atypical clinical features, particularly in cases involving dual rare genetic diseases.
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Affiliation(s)
- Yupeng Liu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Xue Ma
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhehui Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ruxuan He
- Department of Respiration, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yao Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hui Dong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yanyan Ma
- Department of Pediatrics, Qinghai University Affiliated Hospital, Xining, China
| | - Tongfei Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qiao Wang
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yuan Ding
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiyuan Li
- Department of Precise Medicine, General Hospital of Tianjin Medical University, Tianjin, China
| | - Dongxiao Li
- Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jinqing Song
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Mengqiu Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Udhani R, Kothari C, Sarvaiya J. A Comprehensive Study: Traditional and Cutting-Edge Analytical Techniques for the Biomarker Based Detection of the Micronutrients & POC Sensing Directions for Next-Generation Diagnostic. Crit Rev Anal Chem 2023:1-20. [PMID: 36720848 DOI: 10.1080/10408347.2023.2169823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Micronutrient deficiency is wide spread and highly affects morbidity, mortality, and well-being of human beings. Micronutrient deficiency gradually manifests into diseases, which effects pathophysiology directly or indirectly. There is an imprecision in the diagnosis of micronutrient deficiency because of two causes; the selection of the standard biomarker and the diagnostic technique used. In appropriate diagnosis could increase the severity of the disorder. Instead of a single a combination of biomarkers can give more stringent results for micronutrient testing. Several traditional analytical techniques are used for diagnosis but HPLC, ELISA & LCMS/MS are most sensitive and reliable methods used by CLSIA-certified labs. However, these techniques require well-equipped, centralized laboratory facilities. The diagnostic era moves toward the Point of Care Testing (POCT), a boon in emerging diagnostics, breaking all paradigms of traditional analytical techniques. POCT led us toward the development of biosensors, which encompasses many techniques like paper-based sensors, microfluidic chip, wearable devices, and smartphone-assisted diagnostics, which become more popular diagnostic tools. This outlook summarizes the micronutrients like vitamins A, B5, B6, B7, B9, B12 C, D, and E and Minerals like iron, calcium, zinc, magnesium, and sodium; along with its biomarkers, analytical techniques, and point of care innovation in micronutrients.
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Affiliation(s)
- Raveena Udhani
- Department of Pharmaceutical Analysis, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Charmy Kothari
- Department of Pharmaceutical Analysis, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Jayrajsinh Sarvaiya
- School of Engineering and Technology, National Forensic Science University, Gandhinagar, Gujarat, India
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Rappold BA. Review of the Use of Liquid Chromatography-Tandem Mass Spectrometry in Clinical Laboratories: Part II-Operations. Ann Lab Med 2022; 42:531-557. [PMID: 35470272 PMCID: PMC9057814 DOI: 10.3343/alm.2022.42.5.531] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/08/2022] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is increasingly utilized in clinical laboratories because it has advantages in terms of specificity and sensitivity over other analytical technologies. These advantages come with additional responsibilities and challenges given that many assays and platforms are not provided to laboratories as a single kit or device. The skills, staff, and assays used in LC-MS/MS are internally developed by the laboratory, with relatively few exceptions. Hence, a laboratory that deploys LC-MS/MS assays must be conscientious of the practices and procedures adopted to overcome the challenges associated with the technology. This review discusses the post-development landscape of LC-MS/MS assays, including validation, quality assurance, operations, and troubleshooting. The content knowledge of LC-MS/MS users is quite broad and deep and spans multiple scientific fields, including biology, clinical chemistry, chromatography, engineering, and MS. However, there are no formal academic programs or specific literature to train laboratory staff on the fundamentals of LC-MS/MS beyond the reports on method development. Therefore, depending on their experience level, some readers may be familiar with aspects of the laboratory practices described herein, while others may be not. This review endeavors to assemble aspects of LC-MS/MS operations in the clinical laboratory to provide a framework for the thoughtful development and execution of LC-MS/MS applications.
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Affiliation(s)
- Brian A. Rappold
- Laboratory Corporation of America Holdings, Research Triangle Park, NC, USA
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Ruiz-Núñez B, Tarasse R, Vogelaar EF, Janneke Dijck-Brouwer DA, Muskiet FAJ. Higher Prevalence of "Low T3 Syndrome" in Patients With Chronic Fatigue Syndrome: A Case-Control Study. Front Endocrinol (Lausanne) 2018; 9:97. [PMID: 29615976 PMCID: PMC5869352 DOI: 10.3389/fendo.2018.00097] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/27/2018] [Indexed: 12/23/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is a heterogeneous disease with unknown cause(s). CFS symptoms resemble a hypothyroid state, possibly secondary to chronic (low-grade) (metabolic) inflammation. We studied 98 CFS patients (21-69 years, 21 males) and 99 age- and sex-matched controls (19-65 years, 23 males). We measured parameters of thyroid function, (metabolic) inflammation, gut wall integrity and nutrients influencing thyroid function and/or inflammation. Most remarkably, CFS patients exhibited similar thyrotropin, but lower free triiodothyronine (FT3) (difference of medians 0.1%), total thyroxine (TT4) (11.9%), total triiodothyronine (TT3) (12.5%), %TT3 (4.7%), sum activity of deiodinases (14.4%), secretory capacity of the thyroid gland (14.9%), 24-h urinary iodine (27.6%), and higher % reverse T3 (rT3) (13.3%). FT3 below the reference range, consistent with the "low T3 syndrome," was found in 16/98 CFS patients vs. 7/99 controls (OR 2.56; 95% confidence interval = 1.00-6.54). Most observations persisted in two sensitivity analyses with more stringent cutoff values for body mass index, high-sensitive C-reactive protein (hsCRP), and WBC. We found possible evidence of (chronic) low-grade metabolic inflammation (ferritin and HDL-C). FT3, TT3, TT4, and rT3 correlated positively with hsCRP in CFS patients and all subjects. TT3 and TT4 were positively related to hsCRP in controls. Low circulating T3 and the apparent shift from T3 to rT3 may reflect more severely depressed tissue T3 levels. The present findings might be in line with recent metabolomic studies pointing at a hypometabolic state. They resemble a mild form of "non-thyroidal illness syndrome" and "low T3 syndrome" experienced by a subgroup of hypothyroid patients receiving T4 monotherapy. Our study needs confirmation and extension by others. If confirmed, trials with, e.g., T3 and iodide supplements might be indicated.
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Affiliation(s)
- Begoña Ruiz-Núñez
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
- Healthy Institute, Madrid, Spain
- *Correspondence: Begoña Ruiz-Núñez,
| | - Rabab Tarasse
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - D. A. Janneke Dijck-Brouwer
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Frits A. J. Muskiet
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Tang DQ, Zou L, Yin XX, Ong CN. HILIC-MS for metabolomics: An attractive and complementary approach to RPLC-MS. MASS SPECTROMETRY REVIEWS 2016; 35:574-600. [PMID: 25284160 DOI: 10.1002/mas.21445] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/28/2014] [Indexed: 05/14/2023]
Abstract
Hydrophilic interaction chromatography (HILIC) is an emerging separation mode of liquid chromatography (LC). Using highly hydrophilic stationary phases capable of retaining polar/ionic metabolites, and accompany with high organic content mobile phase that offer readily compatibility with mass spectrometry (MS) has made HILIC an attractive complementary tool to the widely used reverse-phase (RP) chromatographic separations in metabolomic studies. The combination of HILIC and RPLC coupled with an MS detector expands the number of detected analytes and provides more comprehensive metabolite coverage than use of only RP chromatography. This review describes the recent applications of HILIC-MS/MS in metabolomic studies, ranging from amino acids, lipids, nucleotides, organic acids, pharmaceuticals, and metabolites of specific nature. The biological systems investigated include microbials, cultured cell line, plants, herbal medicine, urine, and serum as well as tissues from animals and humans. Owing to its unique capability to measure more-polar biomolecules, the HILIC separation technique would no doubt enhance the comprehensiveness of metabolite detection, and add significant value for metabolomic investigations. © 2014 Wiley Periodicals, Inc. Mass Spec Rev 35:574-600, 2016.
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Affiliation(s)
- Dao-Quan Tang
- Department of Pharmaceutical Analysis, Xuzhou Medical College, Xuzhou, 221044, China
- Jiangsu Key Lab for the study of New Drug and Clinical Pharmacy, Xuzhou Medical College, Yunlong, China
- NUS Environmental Research Inst., National University of Singapore, 5 A Engineering Srive 1, Singapore, 117411, Singapore
| | - Ll Zou
- Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Singapore, 117597, Singapore
| | - Xiao-Xing Yin
- Jiangsu Key Lab for the study of New Drug and Clinical Pharmacy, Xuzhou Medical College, Yunlong, China
| | - Choon Nam Ong
- NUS Environmental Research Inst., National University of Singapore, 5 A Engineering Srive 1, Singapore, 117411, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Singapore, 117597, Singapore
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Lo SY, Gordon C, Sadilkova K, Jack RM, Dickerson JA. Quantifying MMA by SLE LC-MS/MS: Unexpected challenges in assay development. Clin Biochem 2016; 49:967-72. [PMID: 27208560 DOI: 10.1016/j.clinbiochem.2016.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Analysis of serum/plasma methylmalonic acid (MMA) is important for the diagnosis and management of methylmalonic acidemia in pediatric populations. This work focuses on developing and validating a liquid chromatography tandem mass spectrometry (LC-MS/MS) method to monitor methylmalonic acidemia using a simple method preparation. DESIGN AND METHODS MMA and stable isotope labeled d3-MMA was extracted using supported liquid extraction (SLE). Assay imprecision, bias, linearity, recovery and carryover were determined. The relationship between MMA and propionyl acylcarnitine (C3-acylcarnitine) was also evaluated using historical paired results from 51 unique individuals. RESULTS Baseline separation between MMA and succinic acid was completed in 7min. The assay was linear from 0.1 to 500μM. The intra-day and inter-day imprecision CV ranged from 4.1 to 13.2% (0.3 to 526μM) and 5.0 to 15.7% (0.3 to 233μM), respectively. Recovery ranged from 93 to 125%. The correlation with a national reference laboratory LC-MS/MS assay showed a Deming regression of 1.026 and intercept of -1.335. Carryover was determined to be <0.04%. Patient-specific correlation was observed between MMA and C3-acylcarnitine. CONCLUSION This report describes the first LC-MS/MS method using SLE for MMA extraction. In addition, we illustrate the challenges encountered during this method development that should be assessed and resolved by any laboratory implementing a SLE LC-MS/MS assay designed to quantify analytes across several orders of magnitude.
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Affiliation(s)
- Sheng-Ying Lo
- Department of Laboratory Medicine, Chemistry Division, University of Washington, Seattle, WA, United States
| | - Cindy Gordon
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States
| | - Katerina Sadilkova
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States
| | - Rhona M Jack
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States
| | - Jane A Dickerson
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States.
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Obeid R, Geisel J, Herrmann W. Comparison of two methods for measuring methylmalonic acid as a marker for vitamin B12 deficiency. ACTA ACUST UNITED AC 2015. [PMID: 29540015 DOI: 10.1515/dx-2014-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Methylmalonic acid (MMA) is a functional marker of vitamin B12 status and a valuable diagnostic tool. The gas chromatography mass spectrometry (GCMS) MMA assay has been used for decades in clinical studies. METHODS In this study, we compared a newly developed liquid chromatography tandem mass spectrometry assay for MMA (ClinMass® Complete Kit) with the GCMS method and further measured other relevant vitamin B12 markers (homocysteine, total B12 and holotranscobalamin) to validate the new liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) method. For this purpose, 138 samples that were sent to our routine laboratory total B12 assay were used. RESULTS The GCMS and LC-MS/MS assays showed a strong correlation (r=0.92, p<0.001) particularly at low holoTC levels (deficiency is more probable). Forty six cases had MMA>300 nmol/L with both methods. Only five subjects showed MMA GCMS>300 nmol/L, but MMA LC-MS/MS≤300 nmol/L. However, the LC-MS/MS method showed a slightly better correlation with other B12 markers (holoTC, total B12). In addition, the LC-MS/MS method offers several advantages over the GCMS method, such as saving time and costs, precision, flexibility and popularity in modern labs. CONCLUSIONS The new LC-MS/MS assay for MMA showed an excellent correlation to the GCMS method. The two methods showed similar agreements with other vitamin B12 markers.
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Affiliation(s)
- Rima Obeid
- 1Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg/Saar, Germany2Aarhus Institute of Advanced Studies, University of Aarhus, 8000 Aarhus C, Denmark
| | - Jürgen Geisel
- 1Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg/Saar, Germany
| | - Wolfgang Herrmann
- 1Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg/Saar, Germany
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Leung KSY, Fong BMW. LC–MS/MS in the routine clinical laboratory: has its time come? Anal Bioanal Chem 2013; 406:2289-301. [DOI: 10.1007/s00216-013-7542-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/18/2013] [Accepted: 11/28/2013] [Indexed: 11/30/2022]
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