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Moreover, the laboratory comparison with the San Francisco General Hospital met the Clinical and Laboratory Standards Institute (CLSI) guidelines

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Shammah used altered the tongue microbiome, with significant shifts in species composition, particularly enriching species with high acetaldehyde-production potential

Given that naturally occurring sucrose is typically present in processed tobacco in relatively small amounts, its substantial variability across chewing tobacco brands suggests that sucrose or sucrose-containing additives are used in product manufacturing, with the likely purpose of modifying its taste and potentially other characteristics