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<h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Atemgasanalyse</span></h1>
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<div id="mw-content-text" class="mw-body-content mw-content-ltr" lang="de" dir="ltr"><div class="mw-content-ltr mw-parser-output" lang="de" dir="ltr"><p><b>Atemgasanalyse</b> ist die wissenschaftliche Untersuchung der menschlichen <a href="Atem" title="Atem">Atemluft</a>. Ziel ist es einerseits, Markersubstanzen zu identifizieren, die Rückschlüsse auf den klinischen Zustand eines Patienten erlauben, und andererseits <a href="Mathematisches_Modell" title="Mathematisches Modell">mathematische Modelle</a> zu entwickeln, die es erlauben, von Atemgaskonzentrationen auf die entsprechenden Blutkonzentrationen umzurechnen. Die gewonnenen Erkenntnisse können dann in <a href="Atemgastest" title="Atemgastest">Atemgastests</a> für die medizinische Diagnostik umgesetzt werden.
</p><p>Im Gegensatz zu Blutproben ist die Abnahme von Atemgasproben für den Patienten nicht-invasiv und kann auch beliebig oft wiederholt werden. Atemgasproben können in Echtzeit ausgewertet werden und ermöglichen daher auch eine kontinuierliche Beobachtung der Veränderung von Körpersubstanzen zum Beispiel am Ergometer, im Schlaflabor oder in der Intensivmedizin.
</p><p>Konnten früher nur Stoffe in hohen Konzentrationen wie z.&nbsp;B. <a href="Kohlenstoffdioxid" title="Kohlenstoffdioxid">Kohlenstoffdioxid</a> und <a href="Ethanol" title="Ethanol">Alkohol</a> identifiziert werden, ist es durch die Fortschritte der letzten Jahre in der Analysetechnik (<a href="Gaschromatographie_mit_Massenspektrometrie-Kopplung" title="Gaschromatographie mit Massenspektrometrie-Kopplung">GC-MS</a>, PTR-MS, SIFT-MS, <a href="Ionen-Mobilit%C3%A4ts-Spektrometer" title="Ionen-Mobilitäts-Spektrometer">IMS</a>, <a href="Elektronische_Nase" title="Elektronische Nase">chemische Sensoren</a>) möglich, ein einzelnes <a href="Molek%C3%BCl" title="Molekül">Molekül</a> in einer Billion Moleküle (<a href="Parts_per_million" title="Parts per million">ppt</a>) zu entdecken.
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<div class="mw-heading mw-heading2"><h2 id="Geschichte">Geschichte</h2></div>
<p>Die moderne Ära der Atemgasanalyse wurde vom <a href="Nobelpreis" title="Nobelpreis">Nobelpreisträger</a> <a href="Linus_Pauling" title="Linus Pauling">Linus Pauling</a> eingeleitet, der nachwies, dass die menschliche Atemluft über 200 <a href="Fl%C3%BCchtige_organische_Verbindungen" title="Flüchtige organische Verbindungen">flüchtige organische Verbindungen</a> (volatile organic compounds, VOCs) in picomolarer Konzentration enthält.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>
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<div class="mw-heading mw-heading2"><h2 id="Zusammenhang_Atemgas-/Blutkonzentrationen"><span id="Zusammenhang_Atemgas-.2FBlutkonzentrationen"></span>Zusammenhang Atemgas-/Blutkonzentrationen</h2></div>
<p>Ein einfaches Modell für den Zusammenhang zwischen Atemgas- und Blutkonzentrationen wurde von Farhi<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> angegeben:
</p>
<dl><dd><span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle C_{A}={\frac {C_{\bar {v}}}{\lambda _{\text{b:air}}+{\dot {V}}_{A}/{\dot {Q}}_{c}}}.}">
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<annotation encoding="application/x-tex">{\displaystyle C_{A}={\frac {C_{\bar {v}}}{\lambda _{\text{b:air}}+{\dot {V}}_{A}/{\dot {Q}}_{c}}}.}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/8c04155bd3097abeb58f688fdb5927cdb3373b5f.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -3.005ex; width:22.628ex; height:6.676ex;" alt="{\displaystyle C_{A}={\frac {C_{\bar {v}}}{\lambda _{\text{b:air}}+{\dot {V}}_{A}/{\dot {Q}}_{c}}}.}" loading="lazy"></span></dd></dl>
<p>Hierbei ist <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle C_{A}}">
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<annotation encoding="application/x-tex">{\displaystyle C_{A}}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/69c5f6fde0832b5aa24cc8d90aca913e132e9929.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.671ex; width:3.127ex; height:2.509ex;" alt="{\displaystyle C_{A}}" loading="lazy"></span> die alveolare Konzentration (dabei wird angenommen, dass sie mit der gemessenen übereinstimmt), <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle C_{\bar {v}}}">
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<annotation encoding="application/x-tex">{\displaystyle C_{\bar {v}}}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/51c97551384fa5f8354634a9603059ac749502b6.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.838ex; width:2.781ex; height:2.676ex;" alt="{\displaystyle C_{\bar {v}}}" loading="lazy"></span> die gemischt venöse Konzentration, und <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle \lambda _{\text{b:air}}}">
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<mrow class="MJX-TeXAtom-ORD">
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<mi>λ<!-- λ --></mi>
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<annotation encoding="application/x-tex">{\displaystyle \lambda _{\text{b:air}}}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/57fde47bbf3ac9b3bf507fc3a97187758760e9e4.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.671ex; width:4.883ex; height:2.509ex;" alt="{\displaystyle \lambda _{\text{b:air}}}" loading="lazy"></span> der Blut:Luft Partitionskoeffizient, und <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\dot {V}}_{A}/{\dot {Q}}_{c}}">
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<annotation encoding="application/x-tex">{\displaystyle {\dot {V}}_{A}/{\dot {Q}}_{c}}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/7450e1b4d27923f97635bb602c4016ab9913fc3a.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.838ex; width:7.197ex; height:3.343ex;" alt="{\displaystyle {\dot {V}}_{A}/{\dot {Q}}_{c}}" loading="lazy"></span> das Ventilations-Perfusions-Verhältnis (in Ruhe ca. 1).
</p><p>Multipliziert man zum Beispiel nach dieser Gleichung die durchschnittliche Acetonkonzentration von <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle 1\,\mathrm {\mu g/l} }">
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<annotation encoding="application/x-tex">{\displaystyle 1\,\mathrm {\mu g/l} }</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/7b9d8fc05c1da8df794865738d007975b273d5e8.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.838ex; width:5.923ex; height:2.843ex;" alt="{\displaystyle 1\,\mathrm {\mu g/l} }" loading="lazy"></span> in der end-tidalen Atemluft mit dem Partitionskoeffizienten <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle \lambda _{\text{b:air}}=340}">
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<annotation encoding="application/x-tex">{\displaystyle \lambda _{\text{b:air}}=340}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/a869c41e306a5fc0e4a52e55bdc5419577c3ff77.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.671ex; width:11.469ex; height:2.509ex;" alt="{\displaystyle \lambda _{\text{b:air}}=340}" loading="lazy"></span>, so erhält man um einen Faktor 3 abweichende Werte von den tatsächlich gemessenen arteriellen Blutwerten, die im Bereich von <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle \mathrm {1\,mg/l} }">
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<annotation encoding="application/x-tex">{\displaystyle \mathrm {1\,mg/l} }</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/257f6fb5aae8bdbb2db41c60c857c0594eb3ec5e.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.838ex; width:6.457ex; height:2.843ex;" alt="{\displaystyle \mathrm {1\,mg/l} }" loading="lazy"></span> liegen. Für Isopren mit einem Partitionskoeffizienten <span class="mwe-math-element mwe-math-element-inline"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle \lambda _{\text{b:air}}=0{,}95}">
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<annotation encoding="application/x-tex">{\displaystyle \lambda _{\text{b:air}}=0{,}95}</annotation>
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</math></span><img src="./_assets_/eb734a37dd21ce173a46342d1cc64c92/baf65045a0d6729964adf9e2242572bc93b6e79e.svg" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.671ex; width:12.115ex; height:2.509ex;" alt="{\displaystyle \lambda _{\text{b:air}}=0{,}95}" loading="lazy"></span> kann das Ventilations-Perfusions-Verhältnis in dieser Gleichung auch nicht mehr vernachlässigt werden.
</p><p>Weiterentwicklungen dieses Modells sind daher ein aktuelles Forschungsgebiet.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="Siehe_auch">Siehe auch</h2></div>
<ul><li><a href="Wasserstoffatemtest" title="Wasserstoffatemtest">Wasserstoffatemtest</a></li></ul>
<div class="mw-heading mw-heading2"><h2 id="Einzelnachweise">Einzelnachweise</h2></div>
<ol class="references">
<li id="cite_note-1"><span class="mw-cite-backlink"><a href="#cite_ref-1">↑</a></span> <span class="reference-text">Linus Pauling, Arthur B. Robinson, Roy Teranish, Paul Cary: <cite style="font-style:italic">Quantitative Analysis of Urine Vapor and Breath by Gas-Liquid Partition Chromatography</cite>. In: <cite style="font-style:italic">Proc Natl Acad Sci U S A</cite>. <span style="white-space:nowrap">Band<span style="display:inline-block;width:.2em">&nbsp;</span>68</span>, <span style="white-space:nowrap">Nr.<span style="display:inline-block;width:.2em">&nbsp;</span>10</span>, 1971, <span style="white-space:nowrap">S.<span style="display:inline-block;width:.2em">&nbsp;</span>2374–2376</span>, <a href="Digital_Object_Identifier" title="Digital Object Identifier">doi</a>:<span class="uri-handle" style="white-space:nowrap"><a rel="nofollow" class="external text" href="https://doi.org/10.1073/pnas.68.10.2374">10.1073/pnas.68.10.2374</a></span>.<span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rfr_id=info:sid/de.wikipedia.org:Atemgasanalyse&amp;rft.atitle=Quantitative+Analysis+of+Urine+Vapor+and+Breath+by+Gas-Liquid+Partition+Chromatography&amp;rft.au=Linus+Pauling%2C+Arthur+B.+Robinson%2C+Roy+Teranish%2C+...&amp;rft.date=1971&amp;rft.doi=10.1073%2Fpnas.68.10.2374&amp;rft.genre=journal&amp;rft.issue=10&amp;rft.jtitle=Proc+Natl+Acad+Sci+U+S+A&amp;rft.pages=2374-2376&amp;rft.volume=68" style="display:none">&nbsp;</span></span>
</li>
<li id="cite_note-2"><span class="mw-cite-backlink"><a href="#cite_ref-2">↑</a></span> <span class="reference-text">Anil S. Modak: <cite style="font-style:italic">Single time point diagnostic breath tests: a review</cite>. In: <cite style="font-style:italic">Journal of Breath Research</cite>. <span style="white-space:nowrap">Band<span style="display:inline-block;width:.2em">&nbsp;</span>4</span>, <span style="white-space:nowrap">Nr.<span style="display:inline-block;width:.2em">&nbsp;</span>1</span>, 2010, <span style="white-space:nowrap">S.<span style="display:inline-block;width:.2em">&nbsp;</span>017002</span>, <a href="Digital_Object_Identifier" title="Digital Object Identifier">doi</a>:<span class="uri-handle" style="white-space:nowrap"><a rel="nofollow" class="external text" href="https://doi.org/10.1088/1752-7155%2F4%2F1%2F017002">10.1088/1752-7155/4/1/017002</a></span>.<span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rfr_id=info:sid/de.wikipedia.org:Atemgasanalyse&amp;rft.atitle=Single+time+point+diagnostic+breath+tests%3A+a+review&amp;rft.au=Anil+S.+Modak&amp;rft.date=2010&amp;rft.doi=10.1088%2F1752-7155%2F4%2F1%2F017002&amp;rft.genre=journal&amp;rft.issue=1&amp;rft.jtitle=Journal+of+Breath+Research&amp;rft.pages=017002&amp;rft.volume=4" style="display:none">&nbsp;</span></span>
</li>
<li id="cite_note-3"><span class="mw-cite-backlink"><a href="#cite_ref-3">↑</a></span> <span class="reference-text">Leon E. Farhi: <cite style="font-style:italic">Elimination of inert gas by the lung</cite>. In: <cite style="font-style:italic">Respiration Physiology</cite>. <span style="white-space:nowrap">Band<span style="display:inline-block;width:.2em">&nbsp;</span>3</span>, <span style="white-space:nowrap">Nr.<span style="display:inline-block;width:.2em">&nbsp;</span>1</span>, Juli 1967, <span style="white-space:nowrap">S.<span style="display:inline-block;width:.2em">&nbsp;</span>1–11</span>, <a href="Digital_Object_Identifier" title="Digital Object Identifier">doi</a>:<span class="uri-handle" style="white-space:nowrap"><a rel="nofollow" class="external text" href="https://doi.org/10.1016/0034-5687%2867%2990018-7">10.1016/0034-5687(67)90018-7</a></span>.<span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rfr_id=info:sid/de.wikipedia.org:Atemgasanalyse&amp;rft.atitle=Elimination+of+inert+gas+by+the+lung&amp;rft.au=Leon+E.+Farhi&amp;rft.date=1967-07&amp;rft.doi=10.1016%2F0034-5687%2867%2990018-7&amp;rft.genre=journal&amp;rft.issue=1&amp;rft.jtitle=Respiration+Physiology&amp;rft.pages=1-11&amp;rft.volume=3" style="display:none">&nbsp;</span></span>
</li>
<li id="cite_note-4"><span class="mw-cite-backlink"><a href="#cite_ref-4">↑</a></span> <span class="reference-text">Julian King, Helin Koc, <a href="Karl_Unterkofler" title="Karl Unterkofler">Karl Unterkofler</a>, Pawel Mochalski, Alexander Kupferthaler, <a href="Gerald_Teschl" title="Gerald Teschl">Gerald Teschl</a>, <a href="Susanne_Teschl" title="Susanne Teschl">Susanne Teschl</a>, Hartmann Hinterhuber, <a href="Anton_Amann_(Chemiker)" title="Anton Amann (Chemiker)">Anton Amann</a>: <cite style="font-style:italic">Physiological modeling of isoprene dynamics in exhaled breath</cite>. In: <cite style="font-style:italic">Journal of Theoretical Biology</cite>. <span style="white-space:nowrap">Band<span style="display:inline-block;width:.2em">&nbsp;</span>267</span>, <span style="white-space:nowrap">Nr.<span style="display:inline-block;width:.2em">&nbsp;</span>4</span>, 21.&nbsp;November 2010, <span style="white-space:nowrap">S.<span style="display:inline-block;width:.2em">&nbsp;</span>626–637</span>, <a href="Digital_Object_Identifier" title="Digital Object Identifier">doi</a>:<span class="uri-handle" style="white-space:nowrap"><a rel="nofollow" class="external text" href="https://doi.org/10.1016/j.jtbi.2010.09.028">10.1016/j.jtbi.2010.09.028</a></span>.<span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rfr_id=info:sid/de.wikipedia.org:Atemgasanalyse&amp;rft.atitle=Physiological+modeling+of+isoprene+dynamics+in+exhaled+breath&amp;rft.au=Julian+King%2C+Helin+Koc%2C+Karl+Unterkofler%2C+...&amp;rft.date=2010-11-21&amp;rft.doi=10.1016%2Fj.jtbi.2010.09.028&amp;rft.genre=journal&amp;rft.issue=4&amp;rft.jtitle=Journal+of+Theoretical+Biology&amp;rft.pages=626-637&amp;rft.volume=267" style="display:none">&nbsp;</span></span>
</li>
<li id="cite_note-5"><span class="mw-cite-backlink"><a href="#cite_ref-5">↑</a></span> <span class="reference-text">Julian King, Karl Unterkofler, Gerald Teschl, Susanne Teschl, Helin Koc, Hartmann Hinterhuber, Anton Amann: <cite style="font-style:italic">A mathematical model for breath gas analysis of volatile organic compounds with special emphasis on acetone</cite>. In: <cite style="font-style:italic">Journal of Mathematical Biology</cite>. <span style="white-space:nowrap">Band<span style="display:inline-block;width:.2em">&nbsp;</span>63</span>, 2011, <span style="white-space:nowrap">S.<span style="display:inline-block;width:.2em">&nbsp;</span>959–999</span>, <a href="Digital_Object_Identifier" title="Digital Object Identifier">doi</a>:<span class="uri-handle" style="white-space:nowrap"><a rel="nofollow" class="external text" href="https://doi.org/10.1007/s00285-010-0398-9">10.1007/s00285-010-0398-9</a></span>.<span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&amp;rfr_id=info:sid/de.wikipedia.org:Atemgasanalyse&amp;rft.atitle=A+mathematical+model+for+breath+gas+analysis+of+volatile+organic+compounds+with+special+emphasis+on+acetone&amp;rft.au=Julian+King%2C+Karl+Unterkofler%2C+Gerald+Teschl%2C+...&amp;rft.btitle=Journal+of+Mathematical+Biology&amp;rft.date=2011&amp;rft.doi=10.1007%2Fs00285-010-0398-9&amp;rft.genre=book&amp;rft.pages=959-999&amp;rft.volume=63" style="display:none">&nbsp;</span></span>
</li>
</ol>
<div class="mw-heading mw-heading2"><h2 id="Weblinks">Weblinks</h2></div>
<ul><li><a rel="nofollow" class="external text" href="https://www.uibk.ac.at/en/breath-research/"><i>Atemgasanalyse</i> am Institut für Atemgasanalytik der UNI Innsbruck</a></li>
<li><a rel="nofollow" class="external text" href="http://www.gesundheit.de/medizin/untersuchungen/hno-und-atmung/atemgasanalyse-ueber-die-atemluft-lassen-sich-krankheiten-diagnostizieren"><i>Atemgasanalyse: Über die Atemluft lassen sich Krankheiten diagnostizieren</i> auf gesundheit.de</a></li>
<li><a rel="nofollow" class="external text" href="http://www.clinicum.at/dynasite.cfm?dsmid=62972&amp;dspaid=476596"><i>Atemgasanalyse: Atem statt Blut</i> auf CliniCum.at</a></li>
<li><a rel="nofollow" class="external text" href="http://www.breath-analysis.net/"><i>Breath-Analysis Data Mining Project</i></a></li></ul>
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