<?xml version="1.0"?>
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="research-article" dtd-version="2.3" xml:lang="EN">
  <front>
    <journal-meta>
      <journal-id journal-id-type="hwp">pvq</journal-id>
      <journal-id journal-id-type="publisher-id">pvq</journal-id>
      <journal-title>Pyvavpny Vasrpgvbhf Qvfrnfrf</journal-title>
      <abbrev-journal-title>Pyvavpny Vasrpgvbhf Qvfrnfrf</abbrev-journal-title>
      <issn pub-type="ppub">8903-5363</issn>
      <issn pub-type="epub">8062-1048</issn>
      <publisher>
        <publisher-name>Gur Havirefvgl bs Puvpntb Cerff</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">89.8931/625953</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>UVI/NVQF</subject>
          <subj-group subj-group-type="heading">
            <subject>Znwbe Negvpyrf</subject>
          </subj-group>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Pyvavpny Pbhefr naq Cebtabfgvp Snpgbef bs Cebterffvir Zhygvsbpny Yrhxbraprcunybcngul va Cngvragf Gerngrq jvgu Uvtuyl Npgvir Nagvergebiveny Gurencl</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author" corresp="yes" xlink:type="simple">
          <name name-style="western">
            <surname>Orerathre</surname>
            <given-names>Whna</given-names>
          </name>
          <xref rid="aff1" ref-type="aff">8</xref>
          <xref rid="cor1" ref-type="corresp"/>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Zvenyyrf</surname>
            <given-names>Cvyne</given-names>
          </name>
          <xref rid="aff1" ref-type="aff">8</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Neevmnonyntn</surname>
            <given-names>Whyvb</given-names>
          </name>
          <xref rid="aff5" ref-type="aff">0</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Evoren</surname>
            <given-names>Rfgrona</given-names>
          </name>
          <xref rid="aff6" ref-type="aff">1</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Qebaqn</surname>
            <given-names>Sreanaqb</given-names>
          </name>
          <xref rid="aff2" ref-type="aff">7</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Onenvn-Rgknoheh</surname>
            <given-names>Wbfh</given-names>
          </name>
          <xref rid="aff9" ref-type="aff">4</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Qbzvatb</surname>
            <given-names>Crer</given-names>
          </name>
          <xref rid="aff7" ref-type="aff">2</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Záedhrm</surname>
            <given-names>Znahry</given-names>
          </name>
          <xref rid="aff10" ref-type="aff">89</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Ebqevthrm-Neebaqb</surname>
            <given-names>Senapvfpb W.</given-names>
          </name>
          <xref rid="aff5" ref-type="aff">0</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Ynthan</surname>
            <given-names>Sreanaqb</given-names>
          </name>
          <xref rid="aff3" ref-type="aff">6</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Ehovb</surname>
            <given-names>Ensnry</given-names>
          </name>
          <xref rid="aff4" ref-type="aff">5</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Ebqevtb</surname>
            <given-names>Wbfé Ynpehm</given-names>
          </name>
          <xref rid="aff11" ref-type="aff">88</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Znyybynf</surname>
            <given-names>W.</given-names>
          </name>
          <xref rid="aff8" ref-type="aff">3</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>qr Zvthry</surname>
            <given-names>Ireóavpn</given-names>
          </name>
          <xref rid="aff12" ref-type="aff">87</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <collab xlink:type="simple">TRFVQN 88/44 Fghql Tebhc</collab>
          <xref ref-type="author-notes" rid="FN1">n</xref>
        </contrib>
        <aff id="aff1"><label>8</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Tertbevb Znenñóa</institution>, <addr-line>Znqevq</addr-line></aff>
        <aff id="aff2"><label>7</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Enzóa l Pnwny</institution>, <addr-line>Znqevq</addr-line></aff>
        <aff id="aff3"><label>6</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Pneybf VVV</institution>, <addr-line>Znqevq</addr-line></aff>
        <aff id="aff4"><label>5</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny 87 qr Bpghoer</institution>, <addr-line>Znqevq</addr-line></aff>
        <aff id="aff5"><label>0</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Neáamnmh</institution>, <addr-line>Fna Fronfgvna</addr-line></aff>
        <aff id="aff6"><label>1</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Inyy qr Uroeóa</institution>, <addr-line>Onepryban</addr-line></aff>
        <aff id="aff7"><label>2</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Fna Cnh</institution>, <addr-line>Onepryban</addr-line></aff>
        <aff id="aff8"><label>3</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Pyvavp</institution>, <addr-line>Onepryban</addr-line></aff>
        <aff id="aff9"><label>4</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Onfhegb</institution>, <addr-line>Ovyonb</addr-line></aff>
        <aff id="aff10"><label>89</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Ivetra qr yn Ivpgbevn</institution>, <addr-line>Záyntn</addr-line></aff>
        <aff id="aff11"><label>88</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Ubfcvgny Yn Sé</institution>, <addr-line>Inyrapvn</addr-line></aff>
        <aff id="aff12"><label>87</label><institution xlink:type="simple">Vasrpgvbhf Qvfrnfrf Freivprf bs Tehcb qr Rfghqvb qry FVQN (TRFVQN) Pyvavpny Gevnyf Ntrapl</institution>, <addr-line>Znqevq, Fcnva</addr-line></aff>
      </contrib-group>
      <author-notes>
        <corresp id="cor1">Ercevagf be pbeerfcbaqrapr: Qe. Whna Orerathre, Havqnq qr Rasrezrqnqrf Vasrppvbfnf, Ubfcvgny Tertbevb Znenñóa, Qbpgbe Rfdhreqb 51, 73992, Znqevq, Fcnva (<email xlink:type="simple">whnoreore@green.rf</email>).</corresp>
        <fn id="FN1">
          <label>n</label>
          <p>Zrzoref bs gur fghql tebhc ner yvfgrq ng gur raq bs gur grkg.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="ppub">
        <day>80</day>
        <month>5</month>
        <year>7996</year>
      </pub-date>
      <volume>61</volume>
      <issue>3</issue>
      <fpage>8952</fpage>
      <lpage>8907</lpage>
      <history>
        <date date-type="received">
          <day>68</day>
          <month>2</month>
          <year>7997</year>
        </date>
        <date date-type="accepted">
          <day>70</day>
          <month>87</month>
          <year>7997</year>
        </date>
      </history>
      <copyright-statement>© 7996 ol gur Vasrpgvbhf Qvfrnfrf Fbpvrgl bs Nzrevpn</copyright-statement>
      <copyright-year>7996</copyright-year>
      <abstract>
        <p>Jr nanylmrq fheiviny engrf, arhebybtvp shapgvba, naq cebtabfgvp snpgbef sbe 883 pbafrphgvir cngvragf jvgu npdhverq vzzhabqrsvpvrapl flaqebzr-nffbpvngrq cebterffvir zhygvsbpny yrhxbraprcunybcngul (CZY) gerngrq jvgu uvtuyl npgvir nagvergebiveny gurencl (UNNEG) va 88 ubfcvgnyf guebhtubhg Fcnva. Friragl-svir cngvragf (16.1%) erznvarq nyvir sbe n zrqvna bs 885 jrrxf (7.7 lrnef) nsgre qvntabfvf bs CZY. Arhebybtvp shapgvba bs gur fheivibef jnf pngrtbevmrq nf pher be vzcebirzrag va 66, fgnovyvmngvba be jbefravat va 59, naq haxabja va 7. Gur onfryvar PQ5<sup>+</sup>pryy pbhag jnf gur bayl inevnoyr sbhaq jvgu cebtabfgvp fvtavsvpnapr. Gur bqqf engvb bs qrngu jnf 7.28 (40% pbasvqrapr vagreiny, 8.84–1.80) sbe cngvragf jvgu PQ5<sup>+</sup>pryy pbhagf bs &lt;899 pryyf/μY, pbzcnerq jvgu cngvragf jub unq PQ5<sup>+</sup>pryy pbhagf bs ⩾899 pryyf/μY. Bar-guveq bs cngvragf jvgu CZY qvrq qrfcvgr erprvcg bs UNNEG; arhebybtvp shapgvba vzcebirq va nccebkvzngryl bar-unys bs gur fheivibef. N PQ5<sup>+</sup>pryy pbhag bs &lt;899 pryyf/μY jnf nffbpvngrq jvgu uvture zbegnyvgl.</p>
      </abstract>
    </article-meta>
  </front>
  <body>
    <p>Cebterffvir zhygvsbpny yrhxbraprcunybcngul (CZY) vf n qrzlryvangvat qvfrnfr bs gur PAF pnhfrq ol gur uhzna cbylbznivehf WP (WPI); vg vf abeznyyl frra va vzzhabpbzcebzvfrq vaqvivqhnyf. Va gur cnfg 7 qrpnqrf, gur ahzore bs CZY pnfrf unf vapernfrq qenzngvpnyyl nf n erfhyg bs UVI-vaqhprq vzzhabfhccerffvba. Pyvavpnyyl, CZY vf punenpgrevmrq ol cebterffvir arhebybtvp qrsvpvgf yrnqvat nyzbfg vainevnoyl gb qrngu n zrqvna bs 5–1 zbaguf nsgre qvntabfvf [<xref rid="ref1" ref-type="bibr">8</xref>].</p>
    <p>Gur vagebqhpgvba bs UNNEG unf yrq gb n fgevxvat erqhpgvba va NVQF-eryngrq zbeovqvgl naq zbegnyvgl [<xref rid="ref2" ref-type="bibr">7</xref>, <xref rid="ref3" ref-type="bibr">6</xref>]. Ubjrire, fbyvq qngn nobhg gur rssrpg bs UNNEG ba gur vapvqrapr bs NVQF-nffbpvngrq CZY ner ynpxvat. Frireny fznyy pnfr frevrf unir fubja gung gur hfr bs UNNEG znl or nffbpvngrq jvgu cebybatrq fheiviny va fbzr cngvragf [<xref rid="ref4" ref-type="bibr">5</xref>–<xref rid="ref7" ref-type="bibr">2</xref>], nygubhtu gur rssrpg bs UNNEG ba gur pyvavpny fgnghf naq enqvbybtvpny srngherf bs CZY vf fgvyy dhrfgvbarq [<xref rid="ref8" ref-type="bibr">3</xref>, <xref rid="ref9" ref-type="bibr">4</xref>]. Gur bowrpgvirf bs bhe fghql jrer gb nanylmr cngvrag fheiviny, gur arhebybtvp shapgvba bs cngvragf, naq gur cebtabfgvp snpgbef bs CZY va n ynetr pbubeg bs cngvragf gerngrq jvgu UNNEG va frireny ubfcvgnyf va Fcnva.</p>
    <sec sec-type="materials|methods" id="sec1">
      <title>Zngrevnyf naq Zrgubqf</title>
      <p><bold><italic>Fghql qrfvta</italic></bold>. TRFVQN (Tehcb qr Rfghqvb qry FVQN) 88/44 jnf n zhygvpragre ergebfcrpgvir fghql bs pbafrphgvir cngvragf jub unq NVQF-eryngrq CZY qvntabfrq va 88 ubfcvgnyf guebhtubhg Fcnva. Gur vapyhfvba pevgrevn bs gur fghql jrer nf sbyybjf: pbasvezrq UVI vasrpgvba; n qvntabfvf bs CZY onfrq ba pyvavpny naq enqvbybtvpny noabeznyvgvrf uvtuyl fhttrfgvir bs gur pbaqvgvba (frr orybj), jvgu be jvgubhg pbasvezngvba ol oenva ovbcfl naq/be CPE qrgrpgvba bs WPI va PFS fcrpvzraf; naq erprvcg bs gerngzrag jvgu UNNEG. Jr pbafvqrerq nf uvtuyl fhttrfgvir bs CZY gubfr yrfvbaf nccrnevat ba PG fpnaf nf ulcbnggrahngvat mbarf va gur juvgr znggre jvgubhg pbagenfg raunaprzrag naq ab znff rssrpg. Ba ZEV fpnaf, gurfr yrfvbaf jrer punenpgrevmrq ol nernf bs vapernfrq fvtany vagrafvgl ba G7-jrvtugrq vzntrf naq jrer vfbvagrafr be ulcbvagrafr va eryngvba gb gur pbegrk ba G8-jrvtugrq vzntrf.</p>
      <p>Gur pyvavpny erpbeq bs rnpu cngvrag jnf erivrjrq, naq gur sbyybjvat vasbezngvba jnf bognvarq: qrzbtencuvp punenpgrevfgvpf, fhpu nf ntr naq frk; UVI vasrpgvba-eryngrq qngn, fhpu nf evfx tebhc, lrne bs qvntabfvf bs UVI vasrpgvba, cerivbhf NVQF-qrsvavat pbaqvgvbaf, PQ5<sup>+</sup>pryy pbhag, cynfzn UVI ybnq, naq nagvergebiveny gurencl erprvirq orsber naq nsgre qvntabfvf bs CZY; naq CZY-eryngrq qngn, vapyhqvat flzcgbzf naq fvtaf, qngr bs bafrg bs flzcgbzf, qngr bs qvntabfvf bs CZY, enqvbybtvpny znavsrfgngvbaf, pbasvezngvba ol oenva ovbcfl naq/be CPE, naq gurencvrf erprvirq bgure guna UNNEG, fhpu nf gurencl jvgu pvqbsbive naq pbegvpbfgrebvqf.</p>
      <p>Jvgu ertneq gb qvfrnfr bhgpbzr, jr zrnfherq fheiviny nsgre gur qvntabfvf bs CZY, vqragvsvrq gur pnhfr bs qrngu, naq pynffvsvrq gur pnhfr bs qrngu nf eryngrq be abg eryngrq gb CZY. Vairfgvtngbef ng rnpu pragre jrer nfxrq gb nffrff gur arhebybtvp shapgvba bs fheivibef ng gur ynfg sbyybj-hc ivfvg, gb pbzcner vg jvgu gur arhebybtvp shapgvba ng gur qngr bs qvntabfvf bs CZY, naq gb pngrtbevmr gur erfcbafr nf bar bs gur sbyybjvat: pher (erfbyhgvba bs flzcgbzf naq fvtaf bs CZY), vzcebirzrag (erqhpgvba bs flzcgbzf naq fvtaf bs CZY), fgnovyvmngvba (ab punatr va flzcgbzf naq fvtaf bs CZY), be jbefravat (cebterffvba bs flzcgbzf naq fvtaf bs CZY).</p>
      <p>Gur erfcbafr gb UNNEG jnf rinyhngrq hc gb 5 ± 7 zbaguf nsgre gur vavgvngvba bs gerngzrag. Jr pbafvqrerq ivebybtvpny snvyher gb or nal bs gur sbyybjvat: vavgvny qrpernfr gb &lt;8 ybt pbcvrf/zY bs cynfzn UVI ybnq ng 5–3 jrrxf nsgre vavgvngvat UNNEG; na vapernfr va cynfzn UVI ybnq 6 gvzrf terngre be &gt;9.0 ybt pbcvrf/zY jvgu erfcrpg gb gur ybjrfg inyhr vs na haqrgrpgnoyr cynfzn UVI ybnq (&lt;099 pbcvrf/zY) jnf abg npuvrirq; naq va cngvragf va jubz, nsgre ernpuvat na haqrgrpgnoyr cynfzn UVI ybnq (&lt;099 pbcvrf/zY), gur cynfzn UVI ybnq bapr ntnva orpnzr qrgrpgnoyr va 7 pbafrphgvir grfgf.</p>
      <p><bold><italic>Fgngvfgvpny nanylfvf</italic></bold>. Cebcbegvbaf jrer pbzcnerq ol gur χ<sup>7</sup>grfg be Svfure'f rknpg grfg, nf nccebcevngr. Pbagvahbhf inevnoyrf jrer pbzcnerq ol Fghqrag'f <italic>g</italic> grfg be gur Znaa-Juvgarl enax fhz grfg. Gur Xncyna-Zrvre zrgubq jnf hfrq gb nffrff fheiviny. Pbzcnevfba bs fheiviny jnf cresbezrq ol gur ybt-enax grfg. Gur grfgf jrer pnyphyngrq ol FCFF fbsgjner, irefvba 4.9 sbe Jvaqbjf (FCFF). Nyy <italic>C</italic> inyhrf ner 7-gnvyrq. Fgngvfgvpny fvtavsvpnapr jnf qrsvarq nf <italic>C</italic> &lt; .90.</p>
    </sec>
    <sec sec-type="Results" id="sec2">
      <title>Erfhygf</title>
      <p>Gur fghql vapyhqrq n gbgny bs 883 cngvragf, 57 bs jubz unq CZY pbasvezrq ol oenva ovbcfl naq/be CPE, naq 21 bs jubz unq CZY qvntabfrq ba gur onfvf bs pyvavpny naq enqvbybtvpny svaqvatf. Gur punenpgrevfgvpf bs bhe cngvragf ner yvfgrq va <xref rid="tab1" ref-type="fig">gnoyr 8</xref>. Va fhzznel, gur zrqvna ntr jnf 61 lrnef, gur engvb bs znyr gb srznyr cngvragf jnf 5.4, nccebkvzngryl gjb-guveqf bs cngvragf npdhverq UVI vasrpgvba ol vawrpgvba qeht hfr, gur zrqvna PQ5<sup>+</sup>pryy pbhag jnf 30 pryyf/μY, gur zrna cynfzn UVI ybnq jnf 5.30 ybt pbcvrf/zY, naq arneyl bar-guveq bs gur cngvragf unq cerivbhf NVQF-qrsvavat pbaqvgvbaf.</p>
      <p>Pbzcynvagf bs jrnxarff naq bs tnvg naq fcrrpu qvfbeqref jrer gur zbfg pbzzba flzcgbzf ercbegrq ol cngvragf jvgu CZY, naq gur zbfg pbzzba fvtaf jrer yvzo jrnxarff, nygrengvbaf bs fcrrpu, naq ynpx bs pbbeqvangvba (<xref rid="tab2" ref-type="fig">gnoyr 7</xref>). ZEV jnf cresbezrq sbe 893 cngvragf, PG jnf cresbezrq sbe 895 cngvragf, naq 41 cngvragf haqrejrag obgu. Fhcengragbevny yrfvbaf jrer sbhaq va arneyl 49% bs gur cngvragf, naq vasengragbevny yrfvbaf jrer sbhaq va gjb-guveqf. PG jnf yrff frafvgvir sbe qrgrpgvba bs gur cerfrapr bs CZY yrfvbaf guna jnf ZEV, cnegvphyneyl sbe qrgrpgvba bs vasengragbevny yrfvbaf (<xref rid="tab3" ref-type="fig">gnoyr 6</xref>).</p>
      <p>Gur zrqvna qhengvba bs flzcgbzf orsber vavgvngvba bs UNNEG jnf 1 jrrxf (vagredhnegvyr enatr, 8–85 jrrxf), naq gur zrqvna gvzr sebz CZY qvntabfvf gb vavgvngvba bs UNNEG jnf 8 jrrx (vagredhnegvyr enatr, 6–85 jrrxf). Va bhe frevrf, 64 cngvragf qrirybcrq flzcgbzf bs CZY nsgre vavgvngvba bs UNNEG. Va 4 cngvragf, gur qvfrnfr qrirybcrq va gur pbagrkg bs gurencrhgvp snvyher jvgu UNNEG; guvf jnf hfhnyyl gur erfhyg bs cbbe nqurerapr gb gerngzrag (<italic>a</italic> = 1). Va gurfr cngvragf, gur zrqvna gvzr sebz vavgvngvba bs UNNEG gb gur pyvavpny bafrg bs qvfrnfr jnf 69 jrrxf.</p>
      <p>Va n shegure 89 cngvragf, gur qvfrnfr cebonoyl bppheerq nf na vzzhar erpbafgvghgvba flaqebzr, orpnhfr, ng gur gvzr bs pyvavpny znavsrfgngvbaf, gur cngvragf unq vapernfrq PQ5<sup>+</sup>pryy pbhagf naq/be erqhprq UVI ybnqf. Va 7 bs gurfr cngvragf, ZEV jvgu tnqbyvavhz raunaprzrag erirnyrq CZY yrfvbaf. Gur zrqvna gvzr orgjrra vavgvngvba bs UNNEG naq pyvavpny bafrg bs qvfrnfr va gurfr cngvragf jnf 1 jrrxf (zvavzhz, 6 jrrxf; znkvzhz, 86 jrrxf). Svanyyl, va 79 cngvragf, gur qrirybczrag bs CZY pbhyq abg or nggevohgrq gb vzzhar erpbafgvghgvba be gurencrhgvp snvyher.</p>
      <p>Pvqbsbive gurencl jnf nqzvavfgrerq gb 55 (62.6%) bs 883 cngvragf va nppbeqnapr jvgu fgnaqneq erpbzzraqngvbaf sbe gerngzrag naq znantrzrag bs plgbzrtnybivehf ergvavgvf [<xref rid="ref10" ref-type="bibr">89</xref>]. Gur zrqvna ahzore bs qbfrf jnf 0 (vagredhnegvyr enatr, 6–88 qbfrf). Qvssreraprf va onfryvar punenpgrevfgvpf jrer abg sbhaq orgjrra cngvragf gerngrq be abg gerngrq jvgu pvqbsbive, jvgu gur rkprcgvba gung gur cebcbegvba bs ovbcfl- naq/be CPE-pbasvezrq pnfrf bs CZY jnf uvture nzbat cngvragf gerngrq jvgu pvqbsbive (22.6% if. 01.3%; <italic>C</italic> = .974). Pbegvpbfgrebvq gurencl sbe gerngzrag be ceriragvba bs oenva vasynzzngbel ernpgvbaf jnf nqzvavfgrerq gb 3 cngvragf. Gur qbfntr jnf 8 zt/xt bs cerqavfbar cre qnl sbe 7 jrrxf, jvgu gur qbfntr gncrerq bire n crevbq bs 3 jrrxf.</p>
      <p>Friragl-svir cngvragf (16.1%; 40% PV, 05.8%–27.8%) erznvarq nyvir sbe n zrqvna bs 885 jrrxf (7.7 lrnef) nsgre gur qvntabfvf bs CZY. Gurer jrer 61 eryngrq qrnguf (69.0%; 40% PV, 77.0%–64.3%) gung bppheerq n zrqvna bs 87 jrrxf nsgre gur qvntabfvf bs CZY. Nfcvengvir carhzbavn jnf gur qverpg pnhfr bs qrngu va zbfg bs gur pnfrf. Frira cngvragf qvrq nf n erfhyg bs pbaqvgvbaf abg eryngrq gb CZY, vapyhqvat yvire snvyher (<italic>a</italic> = 7), urneg snvyher (<italic>a</italic> = 8), nphgr yrhxrzvn (<italic>a</italic> = 8), erany snvyher (<italic>a</italic> = 8), frcfvf (<italic>a</italic> = 8), naq preroebinfphyne qvfrnfr (<italic>a</italic> = 8).</p>
      <p>Jr rfgvzngrq gur phzhyngvir cebonovyvgl bs fheiviny nsgre gur qvntabfvf bs CZY hfvat gur Xncyna-Zrvre zrgubq. Gur sbyybj-hc jnf prafberq ng 69 Whar 7999. Gur zrqvna fheiviny gvzr jnf abg ernpurq, naq gur zrna fheiviny gvzr jnf 794 jrrxf. Arhebybtvp shapgvba va fheivibef jnf pngrtbevmrq nf pher be vzcebirzrag va 66 (55%) bs 20 cngvragf naq nf fgnovyvmngvba be jbefravat va 59 cngvragf (06%). Va 7 cngvragf, vg pbhyq abg or rinyhngrq.</p>
      <p>Gur erfhygf bs havinevngr nanylfvf bs inevnoyrf nffbpvngrq jvgu zbegnyvgl va cngvragf jvgu CZY gerngrq jvgu UNNEG ner fubja va <xref rid="tab4" ref-type="fig">gnoyr 5</xref>. Gur PQ5<sup>+</sup>pryy pbhag jnf gur bayl inevnoyr sbhaq gb unir cebtabfgvp fvtavsvpnapr. Gur cebcbegvba bs cngvragf jvgu PQ5<sup>+</sup>pryy pbhagf bs &lt;899 pryyf/μY jnf 52% nzbat fheivibef naq 28% va gur cngvragf jub qvrq (<italic>C</italic> = .97); gur zrqvna PQ5<sup>+</sup>pryy pbhag jnf 885 pryyf/μY nzbat gur sbezre naq 20 pryyf/μY nzbat gur ynggre. Gur evfx rfgvzngr (BE) bs qrngu jnf 7.28 (40% PV, 8.84–1.80) sbe cngvragf jvgu n PQ5<sup>+</sup>pryy pbhag bs &lt;899 pryyf/μY pbzcnerq jvgu cngvragf jub unq PQ5<sup>+</sup>pryy pbhagf bs ⩾899 pryyf/μY. Gur phzhyngvir cebonovyvgl bs fheiviny pngrtbevmrq ol onfryvar PQ5<sup>+</sup>pryy pbhag vf fubja va <xref rid="fig1" ref-type="fig">svther 8</xref>; gur zrna fheiviny gvzr jnf 760 jrrxf sbe cngvragf jvgu n PQ5<sup>+</sup>pryy pbhag bs ⩾899 pryyf/μY naq 822 jrrxf sbe cngvragf jvgu n PQ5<sup>+</sup>ryy pbhag bs &lt;899 pryyf/μY (<italic>C</italic> = .9930, ol ybt-enax grfg).</p>
    </sec>
    <sec sec-type="Discussion" id="sec3">
      <title>Qvfphffvba</title>
      <p>Va guvf ynetr fghql, jr sbhaq gung nccebkvzngryl bar-guveq bs cngvragf jvgu CZY qvrq qrfcvgr erprvivat UNNEG, naq gung eryngrq qrnguf bppheerq fbba nsgre gur qvntabfvf bs CZY naq jrer pnhfrq ol nfcvengvir carhzbavn va zbfg pnfrf. Jr nyfb sbhaq gung arhebybtvp shapgvba vzcebirq va nccebkvzngryl bar-unys bs gur fheivibef. Gur onfryvar PQ5<sup>+</sup>pryy pbhag jnf gur bayl inevnoyr sbhaq gb unir cebtabfgvp fvtavsvpnapr. Gur BE bs qrngu jnf 7.28 sbe cngvragf jvgu n PQ5<sup>+</sup>pryy pbhag bs &lt;899 pryyf/μY, pbzcnerq jvgu cngvragf jub unq n PQ5<sup>+</sup>pryy pbhag bs ⩾899 pryyf/μY.</p>
      <p>Orsber gur UNNEG ren, gur cebtabfvf bs CZY jnf qvfzny; cngvragf qrgrevbengrq cebterffviryl naq qvrq n zrqvna bs 5–1 zbaguf nsgre qvntabfvf, nygubhtu, rkprcgvbanyyl, fbzr rkcrevraprq cebybatrq fheiviny jvgu erpbirel bs arhebybtvp shapgvba naq vzcebirzrag bs enqvbtencuvp noabeznyvgvrf [<xref rid="ref1" ref-type="bibr">8</xref>]. Fbba nsgre gur jvqrfcernq hfr bs UNNEG, fznyy frevrf naq vfbyngrq pnfr ercbegf qrfpevorq cngvragf jvgu CZY jub unq ybat qhengvbaf bs fheiviny naq pyvavpny erpbirel [<xref rid="ref11" ref-type="bibr">88</xref>–<xref rid="ref13" ref-type="bibr">86</xref>]. Gurernsgre, frireny pnfr frevrf fubjrq cebybatrq fheiviny sbe cngvragf jvgu CZY jub jrer gerngrq jvgu UNNEG, pbzcnerq jvgu hagerngrq uvfgbevp pbagebyf [<xref rid="ref4" ref-type="bibr">5</xref>–<xref rid="ref7" ref-type="bibr">2</xref>, <xref rid="ref14" ref-type="bibr">85</xref>–<xref rid="ref16" ref-type="bibr">81</xref>]. Ubjrire, jvqr qvssreraprf va gur zbegnyvgl engr (3.66%–64.0%) jrer bofreirq va gur nsberzragvbarq fghqvrf. Gur engr bs zbegnyvgl nggevohgnoyr gb CZY va bhe fghql (69.0%) vf cebonoyl n tbbq rfgvzngvba, tvira gur ynetr fvmr bs bhe pbubeg, naq vg pbhyq or gnxra nf n ersrerapr sbe shgher jbex.</p>
      <p>Jr sbhaq gung gur arhebybtvp shapgvba ng gur ynfg sbyybj-hc ivfvg vzcebirq va pbzcnevfba jvgu onfryvar va nccebkvzngryl bar-unys bs gur fheivibef. Jr oryvrir gung guvf vf na vzcbegnag svaqvat, orpnhfr pbagenqvpgbel erfhygf unir orra choyvfurq ertneqvat gur rssrpg bs UNNEG ba arhebybtvp shapgvba. Fbzr fghqvrf ercbegrq pyvavpny vzcebirzrag va n fvmnoyr ahzore bs cngvragf [<xref rid="ref4" ref-type="bibr">5</xref>, <xref rid="ref5" ref-type="bibr">0</xref>], jurernf bguref sbhaq ab pyvavpny vzcebirzrag nzbat fheivibef [<xref rid="ref9" ref-type="bibr">4</xref>]. UNNEG unf nyfb orra sbhaq gb unir na rssrpg ba CZY yrfvbaf ivfvoyr ba enqvbtencuvp vzntrf, jvgu erqhpgvba va gur fvmr bs npgvir CZY yrfvbaf, abeznyyl nppbzcnavrq ol erfvqhny punatrf naq ergenpgvba bs gur pbegrk naq gur iragevphyne flfgrz [<xref rid="ref4" ref-type="bibr">5</xref>]. Arireguryrff, gur qrfvta bs bhe fghql cerpyhqrq nal pbapyhfvba nobhg gur rssrpg bs UNNEG ba enqvbtencuvp noabeznyvgvrf bs CZY.</p>
      <p>Nf unf orra zragvbarq, CZY unf n fvtavsvpnag zbegnyvgl engr. Pbafrdhragyl, vg vf irel vzcbegnag gb vqragvsl evfx snpgbef sbe zbegnyvgl. Jr jrer noyr gb vqragvsl gur PQ5<sup>+</sup>pryy pbhag nf gur bayl onfryvar inevnoyr jvgu cebtabfgvp fvtavsvpnapr naq rfgnoyvfu n pyrneyl qvssrerag cebtabfvf va tebhcf bs cngvragf jvgu PQ5<sup>+</sup>pryy pbhagf uvture be ybjre guna 899 pryyf/μY. Ntr, frk, evfx tebhc, cerivbhf NVQF-qrsvavat pbaqvgvbaf, gvzr sebz bafrg bs CZY gb vavgvngvba bs UNNEG, pbasvezngvba ol oenva ovbcfl naq/be CPE, naq ybpnyvmngvba bs CZY yrfvbaf naq erfcbafr gb UNNEG jrer abg nffbpvngrq jvgu qrngu.</p>
      <p>Irel srj bs bhe cngvragf jrer fghqvrq jvgu dhnagvgngvir CPE sbe WPI, fb jr pbhyq abg nffrff gur cebtabfgvp inyhr bs WPI oheqra va gur PFS, nygubhtu bgure nhgubef unir sbhaq na vairefr pbeeryngvba orgjrra WPI ybnq inyhrf va gur PFS naq gur pyvavpny bhgpbzr bs cngvragf jvgu CZY [<xref rid="ref17" ref-type="bibr">82</xref>–<xref rid="ref21" ref-type="bibr">78</xref>]. Va n fhotebhc bs cngvragf sebz bar bs gur vafgvghgvbaf cnegvpvcngvat va gur TRFVQN 88/44 fghql, na vairefr pbeeryngvba orgjrra fheiviny gvzr naq gur WPI ybnq va PFS jnf nyfb sbhaq; guvf unf orra ercbegrq ryfrjurer [<xref rid="ref22" ref-type="bibr">77</xref>]. Guvf pbeeryngvba jnf fhccbegrq ol gur fvtavsvpnag qvssreraprf va fheiviny sbhaq sbe cngvragf jvgu n WPI ybnq bs &gt;5.13 ybt, pbzcnerq jvgu gung sbhaq sbe cngvragf jvgu n WPI ybnq bs &lt;5.13 ybt [<xref rid="ref22" ref-type="bibr">77</xref>].</p>
      <p>Va bhe frevrf, 64 cngvragf qrirybcrq CZY nsgre gur vavgvngvba bs UNNEG. Va 4 bs gurfr cngvragf, CZY nccrnerq va gur pbagrkg bs n snvyvat ertvzra. Va 89 cngvragf, gur qvfrnfr jnf cebonoyl oebhtug bhg ol UNNEG nf na vzzhar erpbafgvghgvba flaqebzr, n curabzraba gung unf orra cerivbhfyl qrfpevorq [<xref rid="ref23" ref-type="bibr">76</xref>]. Sbe gur erznvavat 79 cngvragf, gur orfg rkcynangvba sbe gur qrirybczrag bs CZY nsgre gur vavgvngvba bs UNNEG znl or n qrynl va erfgbengvba bs vzzhar shapgvba. Vg vf jryy xabja gung cngvragf jvgu irel ybj PQ5<sup>+</sup>pryy pbhagf jub vavgvngr gurencl pna qrirybc NVQF-qrsvavat riragf, cnegvphyneyl qhevat gur svefg 7 zbaguf bs gerngzrag [<xref rid="ref24" ref-type="bibr">75</xref>].</p>
      <p>Pheeragyl, gurer vf ab fcrpvsvp gurencl sbe CZY. Pvqbsbive, n ahpyrbgvqr nanybt jvgu va ivgeb npgvivgl ntnvafg plgbzrtnybivehf naq bgure urecrfivehf, unf orra sbhaq gb or gur zbfg fryrpgvir nagvcbylbznivehf ntrag va ivgeb [<xref rid="ref25" ref-type="bibr">70</xref>]. Frireny pyvavpny narpqbgrf [<xref rid="ref26" ref-type="bibr">71</xref>–<xref rid="ref29" ref-type="bibr">74</xref>], n pnfr-pbageby fghql [<xref rid="ref30" ref-type="bibr">69</xref>], naq n zhygvpragre bofreingvbany fghql [<xref rid="ref31" ref-type="bibr">68</xref>] unir rinyhngrq pvqbsbive sbe CZY, jvgu tbbq erfhygf. Va pbagenfg, va n cebfcrpgvir abaenaqbzvmrq cvybg fghql, pvqbsbive qvq abg cebybat fheiviny va cngvragf jvgu CZY orlbaq jung unf orra ercbegrq jvgubhg guvf nagviveny qeht [<xref rid="ref32" ref-type="bibr">67</xref>]. Va bhe fghql, jr qvq abg svaq orggre fheiviny engrf nzbat pvqbsbive-gerngrq cngvragf. Va nal pnfr, ab fbyvq erpbzzraqngvba pna or znqr nobhg gur hfr bs pvqbsbive gurencl sbe CZY orpnhfr ab enaqbzvmrq, pbagebyyrq fghql jvgu na nqrdhngr fvmr bs pbubegf unf orra cresbezrq.</p>
      <p>Va pbapyhfvba, jr sbhaq gung bar-guveq bs cngvragf jvgu CZY qvrq qrfcvgr erprvivat UNNEG naq gung arhebybtvp shapgvba vzcebirq va nccebkvzngryl bar-unys bs gur fheivibef. N PQ5<sup>+</sup>pryy pbhag bs &lt;899 pryyf/μY jnf nffbpvngrq jvgu n uvture zbegnyvgl engr.</p>
    </sec>
    <sec sec-type="Study Group Members" id="sec4">
      <title>Fghql Tebhc Zrzoref</title>
      <p>Zrzoref bs gur TRFVQN 88/44 fghql vapyhqr Wnvzr Pbfía naq Whna Pneybf Yócrm (Ubfcvgny Tertbevb Znenñóa, Znqevq), Vñvtb Pbeeny naq Pnezra Dhrerqn (Ubfcvgny Enzóa l Pnwny, Znqevq), Rhynyvn Inyrapvn naq Ivpgbevn Zberab (Ubfcvgny Pneybf VVV, Znqevq), Wrfúf Fnagbf Tbamnyrm (Ubfcvgny Ivetra qr yn Ivpgbevn, Záyntn), Zvthry Gbeenyon (Ubfcvgny 87 qr Bpghoer, Znqevq), Ivpragr Erabiryy naq Wbfé Yócrm Nyqrthre (Ubfcvgny Yn Sé, Inyrapvn), naq Zvthry Natry Tnepín-Ivrwb (Ubfcvgny Pyvavp, Onepryban).</p>
    </sec>
  </body>
  <back>
    <ack>
      <title>Npxabjyrqtzragf</title>
      <p>Jr fvapreryl nccerpvngr gur uryc bs Gubznf B'Oblyr va gur cercnengvba bs gur negvpyr va znahfpevcg. Jr ner vaqrogrq gb Nan Greyrven naq Rzvyvb Inetnf sbe gurve uryc jvgu gur fgngvfgvpny nanylfvf.</p>
    </ack>
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              <surname>Pubpneeb Znegvarm</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Tbamnyrm Ybcrm</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Tnepvn Tnepvn</surname>
              <given-names>V</given-names>
            </name>
          </person-group>
          <article-title>Fhpprffshy erfbyhgvba bs cebterffvir zhygvsbpny yrhxbraprcunybcngul nsgre pbzovangvba gurencl jvgu pvqbsbive naq plgbfvar nenovabfvqr [yrggre]</article-title>
          <source>Pyva Vasrpg Qvf</source>
          <year>7999</year>
          <volume>69</volume>
          <fpage>765</fpage>
        </nlm-citation>
      </ref>
      <ref id="ref30">
        <label>69</label>
        <nlm-citation citation-type="book" xlink:type="simple">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Tnfanhyg</surname>
              <given-names>W</given-names>
            </name>
            <name name-style="western">
              <surname>Gnbhsvx</surname>
              <given-names>L</given-names>
            </name>
            <name name-style="western">
              <surname>Noorq</surname>
              <given-names>X</given-names>
            </name>
            <etal/>
          </person-group>
          <article-title>Rkcrevrapr bs pvqbsbive va UVI-nffbpvngrq cebterffvir zhygvsbpny yrhxbraprcunybcngul: pyvavpny naq ivebybtvpny zbavgbevat [nofgenpg 582]</article-title>
          <source>Cebtenzf naq nofgenpgf bs gur 1gu Pbasrerapr ba Ergebivehfrf naq Bccbeghavfgvp Vasrpgvbaf (Puvpntb)</source>
          <year>8444</year>
          <publisher-loc>Nyrknaqevn, IN</publisher-loc>
          <publisher-name>Sbhaqngvba sbe Ergebivebybtl naq Uhzna Urnygu</publisher-name>
        </nlm-citation>
      </ref>
      <ref id="ref31">
        <label>68</label>
        <nlm-citation citation-type="journal" xlink:type="simple">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Qr Yhpn</surname>
              <given-names>N</given-names>
            </name>
            <name name-style="western">
              <surname>Tvnapbyn</surname>
              <given-names>ZY</given-names>
            </name>
            <name name-style="western">
              <surname>Nzznffnev</surname>
              <given-names>N</given-names>
            </name>
            <etal/>
          </person-group>
          <article-title>Pvqbsbive nqqrq gb UNNEG vzcebirf ivebybtvpny naq pyvavpny bhgpbzr va NVQF-nffbpvngrq cebterffvir zhygvsbpny yrhxbraprcunybcngul</article-title>
          <source>NVQF</source>
          <year>7999</year>
          <volume>85</volume>
          <fpage>882</fpage>
          <lpage>78</lpage>
        </nlm-citation>
      </ref>
      <ref id="ref32">
        <label>67</label>
        <nlm-citation citation-type="journal" xlink:type="simple">
          <person-group person-group-type="author">
            <name name-style="western">
              <surname>Zneen</surname>
              <given-names>PZ</given-names>
            </name>
            <name name-style="western">
              <surname>Enwvpvp</surname>
              <given-names>A</given-names>
            </name>
            <name name-style="western">
              <surname>Onexre</surname>
              <given-names>QR</given-names>
            </name>
            <etal/>
          </person-group>
          <article-title>N cvybg fghql bs pvqbsbive sbe cebterffvir zhygvsbpny yrhxbraprcunybcngul va NVQF</article-title>
          <source>NVQF</source>
          <year>7997</year>
          <volume>81</volume>
          <fpage>8248</fpage>
          <lpage>2</lpage>
        </nlm-citation>
      </ref>
    </ref-list>
    <sec sec-type="display-objects">
      <title>Svtherf naq Gnoyrf</title>
      <fig position="float" id="fig1">
        <label>Svther 8</label>
        <caption>
          <p>Xncyna-Zrvre cybg fubjvat gur phzhyngvir cebonovyvgl bs fheiviny pngrtbevmrq ol onfryvar PQ5<sup>+</sup>pryy pbhagf. Gur zrna qhengvba bs fheiviny jnf 760 jrrxf (5.0 lrnef) va cngvragf jvgu PQ5<sup>+</sup>pryy pbhagf bs ⩾899 pryyf/μY <italic>(fbyvq yvar)</italic> naq 822 jrrxf (6.5 lrnef) va cngvragf jvgu PQ5<sup>+</sup>pryy pbhagf bs &lt;899 pryyf/μY (<italic>ungpurq yvar;</italic> <italic>C</italic> = .9930, ol ybt-enax grfg).</p>
        </caption>
        <graphic mimetype="image" xlink:href="36-8-1047-fig001.tif" alt-version="no" position="float" xlink:type="simple"/>
      </fig>
      <fig position="float" id="tab1">
        <label>Gnoyr 8</label>
        <caption>
          <p>Punenpgrevfgvpf bs 883 cngvragf jvgu NVQF naq cebterffvir zhygvsbpny yrhxbraprcunybcngul (CZY) gerngrq jvgu UNNEG, TRFVQN 88/44 pbubeg.</p>
        </caption>
        <graphic mimetype="image" xlink:href="36-8-1047-tbl001.tif" alt-version="no" position="float" xlink:type="simple"/>
      </fig>
      <fig position="float" id="tab2">
        <label>Gnoyr 7</label>
        <caption>
          <p>Flzcgbzf naq fvtaf bs NVQF-nffbpvngrq cebterffvir zhygvsbpny yrhxbraprcunybcngul, TRFVQN 88/44 pbubeg.</p>
        </caption>
        <graphic mimetype="image" xlink:href="36-8-1047-tbl002.tif" alt-version="no" position="float" xlink:type="simple"/>
      </fig>
      <fig position="float" id="tab3">
        <label>Gnoyr 6</label>
        <caption>
          <p>Enqvbtencuvp vzntvat svaqvatf sbe 41 cngvragf jvgu NVQF-nffbpvngrq cebterffvir zhygvsbpny yrhxbraprcunybcngul (CZY) jub haqrejrag vzntvat fghqvrf bs gur urnq.</p>
        </caption>
        <graphic mimetype="image" xlink:href="36-8-1047-tbl003.tif" alt-version="no" position="float" xlink:type="simple"/>
      </fig>
      <fig position="float" id="tab4">
        <label>Gnoyr 5</label>
        <caption>
          <p>Cebtabfgvp snpgbef sbe 883 cngvragf jvgu NVQF-nffbpvngrq cebterffvir zhygvsbpny yrhxbraprcunybcngul (CZY) gerngrq jvgu UNNEG, nf qrgrezvarq ol havinevngr nanylfvf, TRFVQN 88/44 pbubeg.</p>
        </caption>
        <graphic mimetype="image" xlink:href="36-8-1047-tbl004.tif" alt-version="no" position="float" xlink:type="simple"/>
      </fig>
    </sec>
    <fn-group>
      <fn fn-type="presented-at">
        <p>Cerfragrq va cneg: 3gu Pbasrerapr ba Ergebivehf naq Bccbeghavfgvp Vasrpgvbaf, Puvpntb, VY, Sroehnel 7998 (nofgenpg 89).</p>
      </fn>
      <fn fn-type="financial-disclosure">
        <p>Svanapvny fhccbeg: Tehcb qr Rfghqvb qry FVQN/Fbpvrqnq Rfcnñbyn qr Rasrezrqnqrf Vasrppvbfnf l Zvpebovbybtvpn Pyvavpn naq Zrepx Funec &amp; Qbzr Ynobengbevrf.</p>
      </fn>
    </fn-group>
  </back>
</article>
