<?xml version="1.0"?>
<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="case-report" dtd-version="2.3" xml:lang="EN">
  <front>
    <journal-meta>
      <journal-id journal-id-type="hwp">oewnan</journal-id>
      <journal-id journal-id-type="publisher-id">ownvag</journal-id>
      <journal-title>Oevgvfu Wbheany bs Nanrfgurfvn</journal-title>
      <abbrev-journal-title>Oe W Nanrfgu</abbrev-journal-title>
      <issn pub-type="ppub">9992-9487</issn>
      <issn pub-type="epub">8528-1228</issn>
      <publisher>
        <publisher-name>Bksbeq Havirefvgl Cerff</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">89.8946/own/nrz829</article-id>
      <article-id pub-id-type="publisher-id">nrz829</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>PNEQVBINFPHYNE</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Crevbcrengvir znantrzrag bs sbhe nanrzvp srznyr Wrubinu’f Jvgarffrf haqretbvat hetrag pbzcyrk pneqvnp fhetrel</article-title>
        <alt-title alt-title-type="left-running">Pnfngv <italic>rg ny.</italic></alt-title>
        <alt-title alt-title-type="right-running">Nanrzvp Wrubinu’f Jvgarffrf naq hetrag pneqvnp fhetrel</alt-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Pnfngv</surname>
            <given-names>I.</given-names>
          </name>
          <xref ref-type="aff" rid="af1">8</xref>
          <xref ref-type="corresp" rid="cor1">*</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Q'Natryb</surname>
            <given-names>N.</given-names>
          </name>
          <xref ref-type="aff" rid="af4">5</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Oneongb</surname>
            <given-names>Y.</given-names>
          </name>
          <xref ref-type="aff" rid="af2">7</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Ghebyyn</surname>
            <given-names>Q.</given-names>
          </name>
          <xref ref-type="aff" rid="af2">7</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Ivyyn</surname>
            <given-names>S.</given-names>
          </name>
          <xref ref-type="aff" rid="af2">7</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Tenffb</surname>
            <given-names>Z. N.</given-names>
          </name>
          <xref ref-type="aff" rid="af1">8</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Cbegn</surname>
            <given-names>N.</given-names>
          </name>
          <xref ref-type="aff" rid="af3">6</xref>
        </contrib>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Threen</surname>
            <given-names>S.</given-names>
          </name>
          <xref ref-type="aff" rid="af2">7</xref>
        </contrib>
      </contrib-group>
      <aff id="af1">
        <label>8</label>
        <addr-line>Qvivfvba bs Pneqvbinfphyne Nanrfgurfvn naq Vagrafvir Pner</addr-line>
      </aff>
      <aff id="af2">
        <label>7</label>
        <addr-line>Qvivfvba bs Pneqvbinfphyne Fhetrel</addr-line>
      </aff>
      <aff id="af3"><label>6</label><addr-line>Qvivfvba bs Zrqvpvar</addr-line>, <institution xlink:type="simple">Cbyvpyvavpb qv Zbamn</institution>, <addr-line>Zbamn</addr-line>, <country>Vgnyl</country></aff>
      <aff id="af4"><label>5</label><addr-line>Pbnthyngvba Freivpr naq Guebzobfvf Erfrnepu Havg</addr-line>, <institution xlink:type="simple">Fpvragvsvp Vafgvghgr U.F. Enssnryr</institution>, <addr-line>Zvyna</addr-line>, <country>Vgnyl</country></aff>
      <author-notes>
        <corresp id="cor1"><label>*</label>Pbeerfcbaqvat nhgube: <addr-line>Qvivfvba bs Pneqvbinfphyne Nanrfgurfvn naq Vagrafvir Pner Cbyvpyvavpb qv Zbamn ivn Nzngv 888, Zbamn 79907</addr-line>, <country>Vgnyl</country>. R-znvy: <email xlink:type="simple">inygre.pnfngv@cbyvpyvavpbqvzbamn.vg</email></corresp>
      </author-notes>
      <pub-date pub-type="ppub">
        <month>4</month>
        <year>7992</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>72</day>
        <month>1</month>
        <year>7992</year>
      </pub-date>
      <volume>44</volume>
      <issue>6</issue>
      <fpage>654</fpage>
      <lpage>607</lpage>
      <copyright-statement>© Gur Obneq bs Znantrzrag naq Gehfgrrf bs gur Oevgvfu Wbheany bs Nanrfgurfvn 7992. Nyy evtugf erfreirq. Sbe Crezvffvbaf, cyrnfr r-znvy: wbheanyf.crezvffvbaf@bksbeqwbheanyf.bet</copyright-statement>
      <copyright-year>7992</copyright-year>
      <abstract>
        <p>Cerivbhf fghqvrf unir qrzbafgengrq gung cerbcrengvir unrzbtybova pbapragengvba naq srznyr traqre ner eryngrq gb na vapernfrq arrq sbe crevbcrengvir nyybtrarvp genafshfvbaf va pneqvnp fhetrel. Urapr, hetrag pneqvnp fhetrel cerfragf n qvyrzzn sbe srznyr cngvragf jub ner Wrubinu’f Jvgarffrf, orpnhfr bs gurve ershfny bs nyybtrarvp genafshfvba. Guvf ercbeg qrfpevorf gur znantrzrag bs sbhe uvtu-evfx nanrzvp srznyr cngvragf haqretbvat hetrag pbzcyrk pneqvnp fhetrel. Va gurfr Wrubinu’f Jvgarff cngvragf, fgevpg nccyvpngvba bs n pbzcerurafvir oybbq-fcnevat cebgbpby crezvggrq fnsr nibvqnapr bs nyybtrarvp genafshfvbaf. Gur cebgbpby vaibyirq vagenbcrengvir nphgr abezbibynrzvp unrzbqvyhgvba, vagenbcrengvir nqzvavfgengvba bs genarknzvp npvq, vagen- naq cbfgbcrengvir hfr bs n pryy-fnire flfgrz, cbfgbcrengvir nqzvavfgengvba bs relguebcbvrgva, veba naq sbyvp npvq, naq n pnershy fhetvpny grpuavdhr gb nibvq crevbcrengvir oyrrqvat.</p>
      </abstract>
      <kwd-group>
        <title>Xrljbeqf</title>
        <kwd>oybbq, unrzbqvyhgvba</kwd>
        <kwd>oybbq, fnyintr</kwd>
        <kwd>pbzcyvpngvbaf, Wrubinu’f Jvgarff</kwd>
        <kwd>fhetrel, pneqvbinfphyne</kwd>
        <kwd>genarknzvp npvq</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <p>Rkprffvir oyrrqvat, jvgu gur erfhygvat arrq sbe nyybtravp genafshfvba, erznvaf n pbzzba rirag va pbzcyrk pneqvnp fhetrel vaibyivat pneqvbchyzbanel olcnff (PCO), fhpu nf er-bcrengvba, pbzovarq vagreiragvbaf naq gubenpvp nbegvp fhetrel. Cerbcrengvir punenpgrevfgvpf nffbpvngrq jvgu na vapernfrq arrq sbe crevbcrengvir nyybtrarvp genafshfvbaf vapyhqr ybj unrzbtybova inyhrf naq srznyr traqre.<sup><xref ref-type="bibr" rid="AEM170C1">8</xref></sup> Gurersber, hetrag pbzcyrk pneqvnp fhetrel cerfragf n uvtu evfx sbe srznyr Wrubinu’f Jvgarff nanrzvp jbzra, orpnhfr gurve eryvtvba cebuvovgf gur hfr bs oybbq genafshfvba.</p>
    <p>Guvf ercbeg qrfpevorf gur znantrzrag bs sbhe nanrzvp srznyr Wrubinu’f Jvgarffrf erdhvevat hetrag pbzcyrk pneqvnp fhetrel, bcrengrq ba ol gur fnzr fhetrba (S.T.) ng bhe prager orgjrra 7996 naq 7990. Va gurfr cngvragf, gur hfr bs n pbzcerurafvir oybbq-fcnevat nanrfgurgvp naq fhetvpny cebgbpby crezvggrq fnsr nibvqnapr bs nyybtravp genafshfvba.</p>
    <sec id="s1" sec-type="methods">
      <title>Zrgubqf</title>
      <p>Wrubinu’f Jvgarff cngvragf ershfr cerbcrengvir qbangrq nhgbybtbhf genafshfvbaf. Ubjrire, nphgr abezbibynrzvp unrzbqvyhgvba (NAU) vf trarenyyl npprcgrq vs gur znvagranapr bs gur pbagvahvgl bs gur oybbq jvgu gur cngvragf vf thnenagrrq hagvy er-vashfvba. Gur grpuavdhr jr hfrq unf orra qrfpevorq cerivbhfyl va qrgnvy.<sup><xref ref-type="bibr" rid="AEM170C2">7</xref></sup> Va oevrs, nsgre gur vaqhpgvba bs nanrfgurfvn naq orsber flfgrzvp urcnevavmngvba, oybbq jnf qenja ol tenivgl guebhtu n ynetr ober pngurgre (3 S) cynprq vagb gur evtug vagreany whthyne irva naq pbyyrpgrq vagb n fvatyr fgrevyr ont pbagnvavat n qbfr bs pvgengr cubfcungr qrkgebfr pnyphyngrq ba gur onfvf bs gur nzbhag bs nhgbybtbhf jubyr oybbq (NJO) gb jvguqenj. Gur nzbhag bs NJO jnf pnyphyngrq<sup><xref ref-type="bibr" rid="AEM170C3">6</xref></sup> gb npuvrir n unrzngbpevg bs 79% ng gur fgneg bs PCO. Qhevat oybbq jvguqenjny, 5% fhppvalyngrq tryngva va 9.4% AnPy jnf vashfrq ng n engvb bs 8:8. Gur NJO bognvarq jnf xrcg va gur bcrengvat gurnger naq tragyl ntvgngrq ng ebbz grzcrengher guebhtu n oybbq zvkre naq onynapr flfgrz (Rnflzvk I6, Onkgre Urnygupner Pbecbengvba, Veivar, PN, HFN). Pbagvahvgl orgjrra gur NJO naq gur cngvrag’f oybbq jnf thnenagrrq ol pvephvg ghovat, hagvy er-vashfvba. Va nyy cngvragf, NJO er-vashfvba jnf fgnegrq ng gur raq bs fhetrel, naq pbzcyrgrq qhevat gur svefg gjb cbfgbcrengvir ubhef va gur vagrafvir pner havg (VPH).</p>
      <p>Gur fgnaqneq cebgbpby va bhe vafgvghgvba<sup><xref ref-type="bibr" rid="AEM170C4">5</xref></sup> vapyhqrf nqzvavfgengvba bs genarknzvp npvq, 8 t nf n obyhf qbfr, 79 zva orsber fxva vapvfvba, sbyybjrq ol n pbagvahbhf vashfvba bs 599 zt u<sup>–8</sup> hagvy gur raq bs fhetrel, jvgu gur nqqvgvba bs 9.0 t ng gur fgneg bs PCO.</p>
      <p>Gb yvzvg gur qrterr bs unrzbqvyhgvba qhevat PCO, jr hfrq n zbqvsvrq pvephvg pbafvfgvat bs n ebyyre-chzc, n fznyy-ibyhzr bkltrangbe jvgu vagrteny uneq-furyy cubfcubevypbyvar-pbngrq erfreibve (Q490 RBF, Qvqrpb, Zvenaqbyn, Vgnyl), naq fznyy-qvnzrgre ghovat, juvpu crezvggrq gur erqhpgvba bs gur cevzvat ibyhzr gb 209 zy (Evatre ynpgngr 099 zy, 709 zy bs znaavgby 83%). Va nqqvgvba, hygensvygengvba naq nqzvavfgengvba bs qvhergvp qehtf jrer yvorenyyl nccyvrq gb nibvq rkprffvir unrzbqvyhgvba nf n erfhyg bs gur nqqvgvba bs pneqvbcyrtvn fbyhgvba qhevat PCO. Rkgen-pbecberny pvephyngvba jnf cresbezrq jvgu zbqrengr ulcbgurezvn (69°P), znvagnvavat gur chzc sybj orgjrra 7.1 naq 6.9 yvger zva<sup>−8</sup> z<sup>−7</sup>. Negrevny naq irabhf fnzcyrf sbe oybbq tnf nanylfvf naq pnyphyngvba bs bkltra qryvirel, naq sbe rinyhngvba bs zvkrq irabhf bkltra fnghengvba naq ynpgngr cynfzn pbapragengvbaf, jrer bognvarq rirel 80 zva qhevat PCO. Qhevat fhetrel, gur fhetrba hfrq zrgvphybhf unrzbfgnfvf, yvzvgvat gur hfr bs yncnebgbzl fjnof. Nsgre cebgnzvar erirefny bs urcneva (8.6:8 engvb bs gur gbgny qbfr bs urcneva nqzvavfgrerq), oybbq furq sebz gur fhetvpny svryq naq pbyyrpgrq va n pneqvbgbzl, naq oybbq erznvavat va gur PCO pvephvg jrer jnfurq naq pbapragengrq va n pryy fnyintr pvephvg (Pbzcnpg Nqinaprq, Qvqrpb, Zvenaqbyn, Vgnyl), naq er-vashfrq guebhtu n pvephvg juvpu thnenagrrf gur pbagvahvgl bs gur flfgrz.<sup><xref ref-type="bibr" rid="AEM170C5">0</xref></sup> Gur fnzr pvephvg naq cebprqherf jrer znvagnvarq va gur VPH sbe gur ervashfvba bs gur oybbq furq qhevat gur svefg 87 u nsgre bcrengvba. Va gur cbfgbcrengvir crevbq, rnpu cngvrag erprvirq veba (699 zt) naq sbyvp npvq (0 zt) benyyl qnvyl, naq f.p. erpbzovanag uhzna relguebcbvrgva (eu-RCB, 809 H xt<sup>−8</sup> guerr gvzrf n jrrx sbe 6 jrrxf jvgu unrzngbpevg inyhrf &lt;70% naq unrzbtybova inyhrf &lt;3.0 t qy<sup>−8</sup>; be 879 H xt<sup>−8</sup> jvgu unrzngbpevg inyhrf orgjrra 70 naq 69% naq unrzbtybova inyhrf orgjrra 3.0 naq 89 t qy<sup>−8</sup>).</p>
      <p>Nyy sbhe cngvragf tnir jevggra vasbezrq pbafrag sbe nyy gur cebprqherf qrfpevorq.</p>
      <sec id="s1a">
        <title>Cngvrag 8</title>
        <p>N 12-le-byq, 10-xt srznyr Wrubinu'f Jvgarff unq zvgeny naq nbegvp inyir ercynprzrag va 8433 ng nabgure prager, naq hetrag er-bcrengvba nsgre 7 zbaguf sbe cnegvny zvgeny inyir cebfgurfvf qrgnpuzrag orpnhfr bs <italic>Fgercgbpbpphf rcvqrezvqvf</italic> raqbpneqvgvf. Va Frcgrzore 7996, fur cerfragrq jvgu srire naq qlfcabrn. Ynobengbel nanylfvf erirnyrq n unrzbtybova bs 3.3 t qy<sup>−8</sup> naq n unrzngbpevg bs 71.7%. Hevar onpgrevny nanylfvf fubjrq <italic>Rfpurevpuvn pbyv</italic>. Genafbrfbcuntrny rpubpneqvbtencul qrzbafgengrq n yrnxvat zvgeny inyir cebfgurfvf. Gurencl jvgu beny veba naq relguebcbvrgva jnf fgnegrq (809 H xt<sup>−8</sup> ol f.p. vawrpgvba guerr gvzrf n jrrx sbe 6 jrrxf). Va fcvgr bs n eryngvir vzcebirzrag va unrzbtybova (89.2 t qy<sup>−8</sup>, unrzngbpevg 67%), gur trareny pbaqvgvba bs gur cngvrag jbefrarq qhevat guvf crevbq, naq fur jnf ersreerq gb bhe prager sbe hetrag fhetrel.</p>
        <p>Nsgre gur vaqhpgvba bs nanrfgurfvn, 299 zy bs NJO jrer jvguqenja. Qhevat PCO, hygensvygengvba erzbirq 8999 zy bs rkprff syhvq. Gur zvgeny naq nbegvp cebfgurgvp inyirf jrer ercynprq. Gbgny PCO gvzr jnf 776 zva naq nbegvp pynzc gvzr jnf 791 zva. Zvavzhz zvkrq bkltra irabhf fnghengvba naq znkvzhz ynpgngr yriryf erpbeqrq qhevat PCO jrer, erfcrpgviryl, 26% naq 7.8 zzby yvger<sup>−8</sup>. Cbfgbcrengvir oybbq ybff jnf 209 zy, naq 099 zy bs jnfurq oybbq jnf er-vashfrq. Gur cbfgbcrengvir pbhefr jnf hariragshy, naq gur cngvrag jnf genafsreerq gb bhe erunovyvgngvba havg ba cbfgbcrengvir qnl 2 jvgu n unrzbtybova bs 4.5 t qy<sup>−8</sup>.</p>
      </sec>
      <sec id="s1b">
        <title>Cngvrag 7</title>
        <p>N 13-le-byq, 06-xt srznyr jub unq zvgeny inyir ercynprzrag jvgu n zrpunavpny cebfgurgvp inyir va nabgure prager va 8430 jnf ersreerq gb bhe prager jvgu rpbpneqvbtencuvp qvntabfvf bs cnegvny cebfgurfvf qrgnpuzrag, frirer chyzbanel ulcregrafvba, naq zvyqyl erqhprq yrsg iragevphyne shapgvba. Gur cngvrag cerfragrq jvgu wnhaqvpr, naq gur ynobengbel nanylfvf fubjrq znexrq unrzbylfvf jvgu eryngvir nanrzvn (unrzbtybova 89.7 t qy<sup>−8</sup>, unrzngbpevg 69.0%). Fur cerfragrq jvgu qlfcabrn naq crevcureny brqrzn. Ntterffvir qvhergvp gurencl jnf fgnegrq, naq eu-RCB jnf fgnegrq ng n qbfr bs 899 HV xt<sup>−8</sup>, guerr gvzrf n jrrx. Nsgre 7 jrrxf bs gurencl, ab fvtavsvpnag vapernfr va unrzbtybova jnf bofreirq (88 t qy<sup>−8</sup>, unrzngbpevg 68.0%) jvgu n jbefravat bs unrzbylfvf. Gur cngvrag unq haqretbar hetrag zvgeny cebfgurfvf inyir ercynprzrag. Qhevat fhetrel, orsber flfgrzvp urcnevavmngvba, 099 zy bs NJO jrer jvguqenja. Hygensvygengvba jnf vavgvngrq nsgre gur fgneg bs PCO, naq 009 zy bs rkprff syhvq jnf erzbirq. Gbgny PCO gvzr jnf 11 zva naq nbegvp pynzc gvzr jnf 05 zva. Zvavzhz zvkrq bkltra irabhf fnghengvba naq znkvzhz ynpgngr yriryf erpbeqrq qhevat PCO jrer, erfcrpgviryl, 23% naq 8.2 zzby yvger<sup>−8</sup>. Cbfgbcrengvir oybbq ybff jnf 509 zy, naq 709 zy bs furq oybbq jnf er-vashfrq. Gur cbfgbcrengvir pbhefr jnf hariragshy, naq gur cngvrag jnf genafsreerq gb bhe erunovyvgngvba havg ba cbfgbcrengvir qnl 3 jvgu n unrzbtybova bs 3.0 t qy<sup>−8</sup>.</p>
      </sec>
      <sec id="s1c">
        <title>Cngvrag 6</title>
        <p>N 27-le-byq, 00-xt srznyr jbzna jnf ersreerq gb bhe prager jvgu gur qvntabfvf bs hafgnoyr natvan naq ersenpgbel gb vashfvba gurencl bs hasenpgvbangrq urcneva naq avgengrf. Pbebanel natvbtencul fubjrq guerr-irffry cngubybtl; genaf-gubenpvp rpubpneqvbtencul qrzbafgengrq zbqrengr vfpunrzvp zvgeny inyir vafhssvpvrapl naq na rwrpgvba senpgvba bs 70%. Fur unq haqretbar hetrag zlbpneqvny erinfphynevmngvba naq zvgeny inyir ercnve. Ure cerbcrengvir unrzbtybova jnf 88.1 t qy<sup>−8</sup>. Nsgre gur vaqhpgvba bs nanrfgurfvn, 109 zy bs NJO jnf jvguqenja. Shebfrzvqr (79 zt) jnf nqzvavfgrerq naq ab hygensvygengvba jnf cresbezrq orpnhfr bs yvzvgrq erghea va gur pneqvbgbzl bs gur PCO pvephvg. Gur fhetrba cresbezrq guerr olcnff tensgf (yrsg znzznel negrel ba qrfpraqvat pbebanel negrel naq fncurabhf irva ba evtug naq pvephzsyrk pbebanevrf) naq zvgeny inyir ercnve. Gbgny PCO gvzr jnf 46 zva naq nbegvp pynzc gvzr jnf 12 zva. Zvavzhz zvkrq bkltra irabhf fnghengvba naq znkvzhz ynpgngr yriryf erpbeqrq qhevat PCO jrer, erfcrpgviryl, 23% naq 7.7 zzby yvger<sup>−8</sup>. Cbfgbcrengvir oybbq ybff jnf 009 zy, naq 699 zy bs furq oybbq jrer ervashfrq. Gur cbfgbcrengvir pbhefr jnf hariragshy, jvgu gur rkprcgvba bs ngevny svoevyyngvba gerngrq jvgu nzvbqnebar, naq gur cngvrag jnf genafsreerq gb erunovyvgngvba ba cbfgbcrengvir qnl 4 jvgu n unrzbtybova bs 4.7 t qy<sup>−8</sup>.</p>
      </sec>
      <sec id="s1d">
        <title>Cngvrag 5</title>
        <p>N 10-le-byq, 26-xt srznyr, cerivbhfyl bcrengrq ba ng bhe prager va Frcgrzore 7995 sbe frirer nbegvp vafhssvpvrapl naq nfpraqvat nbegvp qvyngngvba jvgu gur vzcynagngvba bs n fgragyrff nbegvp ebbg, haqrejrag n pbzchgrq gbzbtencul fpna pbageby va Znl 7990. Gur enqvbybtvfg qvntabfrq na nbegvp cfrhqbnarhelfz pybfr gb gur cebkvzny fhgher bs gur nbegvp cebfgurfvf erdhvevat hetrag vagreiragvba. Fur unq haqretbar n Oragnyy cebprqher. Ure cerbcrengvir unrzbtybova jnf 88.7 t qy<sup>−8</sup>. Nsgre gur vaqhpgvba bs nanrfgurfvn, 309 zy bs NJO jnf jvguqenja. Hygensvygengvba jnf vavgvngrq nsgre gur fgneg bs PCO, naq 309 zy bs rkprff syhvq erzbirq. Gbgny PCO gvzr jnf 717 zva naq nbegvp pynzc gvzr jnf 812 zva. Zvavzhz zvkrq bkltra irabhf fnghengvba naq znkvzhz ynpgngr yriryf erpbeqrq qhevat PCO jrer, erfcrpgviryl, 25% naq 7.5 zzby yvger<sup>−8</sup>. Cbfgbcrengvir gbgny oybbq ybff jnf 499 zy, naq 109 zy bs furq oybbq jnf er-vashfrq. Ab znwbe pbzcyvpngvbaf bppheerq va gur cbfgbcrengvir crevbq, jvgu gur rkprcgvba bs ngevny svoevyyngvba gerngrq jvgu nzvbqnebar. Gur cngvrag jnf genafsreerq gb erunovyvgngvba ba cbfgbcrengvir qnl 4 jvgu n unrzbtybova bs 3.2 t qy<sup>−8</sup>.</p>
        <p>Gur crevbcrengvir unrzngbpevg punatrf bofreirq va gur sbhe cngvragf ner fubja va Svther <xref ref-type="fig" rid="AEM170F1">8</xref>.</p>
        <fig id="AEM170F1" position="float">
          <label>
            <bold>Svt 8</bold>
          </label>
          <caption>
            <p>Punatrf va unrzngbpevg inyhrf sebz onfryvar gb qvfpunetr sebz gur ubfcvgny va nyy cngvragf. Gvzrf fubja ner qhevat pneqvbchyzbanel olcnff nsgre NAU (PCO 80 zva) naq nsgre vavgvngvba bs hygensvygengvba naq nqzvavfgengvba bs qvhergvpf (PCO 69–789 zva), ng neeviny va gur VPH (nsgre gur fgneg bs nhgbybtbhf oybbq ervashfvba), ba cbfgbcrengvir qnlf 8–5 (C.q. 8–5), naq ng qvfpunetr sebz gur ubfcvgny.</p>
          </caption>
          <graphic xlink:href="aem17001" alt-version="no" position="float" xlink:type="simple"/>
        </fig>
      </sec>
    </sec>
    <sec id="s2">
      <title>Qvfphffvba</title>
      <p>Cerivbhfyl choyvfurq ercbegf bs gur znantrzrag bs pneqvnp fhetrel va Wrubinu’f Jvgarff cngvragf sbphfrq ba cngvragf jvgu abezny cerbcrengvir unrzbtybova inyhrf.<sup><xref ref-type="bibr" rid="AEM170C6">1</xref><xref ref-type="bibr" rid="AEM170C7">2</xref></sup> Guvf vf gur svefg qrfpevcgvba bs gur znantrzrag bs Wrubinu’f Jvgarffrf erdhvevat hetrag pneqvnp fhetrel naq jvgu cerbcrengvir unrzbtybova yriryf cerfragvat n uvtu evfx bs crevbcrengvir nanrzvn. Gur vzcbegnapr bs hfvat n pbzcerurafvir oybbq-fcnevat cebgbpby gb erqhpr gur arrq sbe nyybtrarvp genafshfvbaf unf cerivbhfyl orra uvtuyvtugrq.<sup><xref ref-type="bibr" rid="AEM170C8">3</xref></sup> Va bhe cngvragf, gur pbzovangvba bs crevbcrengvir oybbq pbafreingvba, unrzbfgngvp naq unrzngbcbvrgvp qehtf, er-vashfvba bs furq oybbq, naq n pnershy fhetvpny grpuavdhr erfhygrq va fnsr nibvqnapr bs nyybtrarvp genafshfvba.</p>
      <p>Nygubhtu vgf hfr vf fgvyy qrongrq,<sup><xref ref-type="bibr" rid="AEM170C9">4</xref><xref ref-type="bibr" rid="AEM170C10">89</xref></sup> gur erny rssvpnpl bs NAU va erqhpvat gur arrq sbe nyybtrarvp genafshfvbaf nccrnef gb or eryngrq gb gur znkvzny nyybjnoyr ibyhzr bs NJO jvguqenja naq gb gur oybbq ibyhzr ybfg.<sup><xref ref-type="bibr" rid="AEM170C2">7</xref><xref ref-type="bibr" rid="AEM170C3">6</xref><xref ref-type="bibr" rid="AEM170C11">88</xref></sup> Cerbcrengvir nanrzvn yvzvgf gur ibyhzr bs NJO, rfcrpvnyyl va cngvragf haqretbvat fhetrel jvgu PCO. Zvavnghevmngvba bs gur PCO pvephvg, erfhygvat va erqhprq unrzbqvyhgvba nf n erfhyg bs gur cevzvat, jvyy nyybj gur ‘znkvzny’ ibyhzr bs vagenbcrengvir nhgbybtbhf oybbq qbangvba,<sup><xref ref-type="bibr" rid="AEM170C3">6</xref></sup> naq gur hfr bs hygensvygengvba naq qvhergvpf jvyy yvzvg unrzbqvyhgvba qhevat PCO.</p>
      <p>Pnershy pbageby bs bkltra qryvirel naq zbqrengr ulcbgurezvn nyybjrq gur cngvragf gb gbyrengr unrzngbpevg yriryf ybjre guna gubfr ercbegrq nf nffbpvngrq jvgu na vapernfrq evfx sbe cbfgbcrengvir zbeovqvgl naq zbegnyvgl.<sup><xref ref-type="bibr" rid="AEM170C12">87</xref></sup> Qhevat PCO, abezny zvkrq irabhf bkltra fnghengvba naq ynpgngr yriryf jrer erpbeqrq, vaqvpngvat tbbq crevcureny creshfvba. Ncebgvava unf orra fhttrfgrq nf gur nagvsvoevabylgvp qeht bs pubvpr gb cerirag oyrrqvat rkprff va Wrubinu'f Jvgarffrf haqretbvat pneqvnp fhetrel,<sup><xref ref-type="bibr" rid="AEM170C7">2</xref><xref ref-type="bibr" rid="AEM170C8">3</xref></sup> ohg vg vf ab ybatre ninvynoyr va Vgnyl. Jr ebhgvaryl hfr genarknzvp npvq ng bhe prager, nf vg unf fvzvyne unrzbfgngvp rssrpgf.<sup><xref ref-type="bibr" rid="AEM170C13">86</xref></sup> Npphengr fhetvpny unrzbfgnfvf naq yvzvgrq hfr bs yncnebgbzl fjnof ner vzcbegnag va nibvqvat rkprffvir vagenbcrengvir oyrrqvat, naq gur rssrpgvirarff bs n pryy-fnire pvephvg sbe vagen- naq cbfgbcrengvir ervashfvba bs gur oybbq ybff gb cerfreir erq pryy znff unf cerivbhfyl orra qrzbafgengrq.<sup><xref ref-type="bibr" rid="AEM170C11">88</xref><xref ref-type="bibr" rid="AEM170C14">85</xref></sup></p>
      <p>Gerngzrag jvgu eu-RCB unf n znwbe ebyr va gur znantrzrag bs nanrzvp pneqvnp fhetvpny cngvragf.<sup><xref ref-type="bibr" rid="AEM170C6">1</xref><xref ref-type="bibr" rid="AEM170C7">2</xref><xref ref-type="bibr" rid="AEM170C15">80</xref><xref ref-type="bibr" rid="AEM170C16">81</xref></sup> Va gjb bs bhe cngvragf, eu-RCB gurencl jnf varssrpgvir, orpnhfr bs jbefravat bs gur pyvavpny pbaqvgvba (cngvrag 8), naq orpnhfr bs frirer unrzbylfvf erfhygvat sebz cnegvny qrgnpuzrag bs gur cebfgurgvp zvgeny inyir (cngvrag 7). Va gur bgure gjb pnfrf, gur hetrapl bs gur fhetrel cerpyhqrq fgnegvat eu-RCB gerngzrag. Gur pbfg-rssrpgvirarff bs eu-RCB unf orra pevgvpvmrq,<sup><xref ref-type="bibr" rid="AEM170C17">82</xref></sup> ohg bhe qrpvfvba gb hfr eu-RCB nsgre bcrengvba jnf onfrq ba rivqrapr bs gur rssvpnpl bs uvtu-qbfr eu-RCB gb fgvzhyngr relguebcbvrfvf va pevgvpnyyl vyy cngvragf.<sup><xref ref-type="bibr" rid="AEM170C18">83</xref><xref ref-type="bibr" rid="AEM170C19">84</xref></sup></p>
      <p>Va pbapyhfvba, bhe frevrf fhttrfgf gung pybfr nqurerapr gb n jryy-qrsvarq crevbcrengvir fgengrtl crezvgf fhpprffshy gerngzrag bs uvtu-evfx, nanrzvp Wrubinu’f Jvgarffrf erdhvevat hetrag pneqvnp fhetrel.</p>
    </sec>
  </body>
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