Nail Tumors 2013 Clinics in Dermatology

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  • 8/18/2019 Nail Tumors 2013 Clinics in Dermatology

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    Ob`f tuhcrsImrtrboe Y`ngmrt, HE, [gE⁏, [buf`om Fmnmrl, HE, Hbr`m Nbunbobs, HE,

     Acsmttm Boerà, HE

     Empbrthmot cl Emrhbtcfcjy, ]o`vmrs`ty Gcsp`tbfs Irujhboo, ^t [`mrrm boe Rummo Lbi`cfb‐ s Ng`fermo Gcsp`tbf,

    ]o`vmrs`tà F`irm em Iruxmffms, NG] ^b`ot [`mrrm, Yum Gbutm >99, 2;;; Irussmfs, Imfj`uh

    Bistrbnt  Hcst omcpfbshs cl tgm ob`f bppbrbtus gbvm e`llmrmot nf`o`nbf bppmbrbonms, ncursms, boe i`cfcj`nbf imgbv`crs bs nchpbrme w`tg s`h`fbr tuhcrs fcnbtme mfsmwgmrm co tgm sd`o. ^chm cl tgmsm tuhcrs brm uo`qum

    tc tgm ob f̀, sung bs coyngchbtr̀ nchb. Bs b jmomrbf rufm, imo`jo fms`cos rmspmnt tgm jmomrbf brng`tmnturm cl tgm

    ob`f bppbrbtus, wgmrmbs hbf`jobot coms brm emstrunt`vm. Cur rmv`mw ncvmrs tgm hcst nchhco ob`f tuhcrs,

    lrch imo`jo coms tc tgm hcst lrmqumot ob`f hbf`jobony, tgm squbhcus nmff nbrn`ochb, wg`ng bntubffy `s tgm

    jrmbtmst s`hufbtcr. Zm w`ff bfsc e`snuss omw bpprcbngms tc tgm e`bjocs`s boe trmbthmot cl hmfbochb cl tgm

    ob`f bppbrbtus. [gys`n`bos sgcufe im bwbrm cl tgmsm ncoe`t`cos boe tgm`r hbobjmhmot.

    © 9;2> Mfsmv`mr @on. Bff r`jgts rmsmrvme.

    Imo`jo tuhcrs

    [ycjmo`n jrboufchb

     Ob`f pycjmo`n jrboufchb ([J) `s b rmfbt`vmfy nchhco

    bnqu`rme imo`jo vbsnufbr tuhcr tgbt lrmqumotfy `ovcfvms tgm

    ob`f bppbrbtus, `onfue`oj tgm pmr`uojubf t`ssums boe tgm ob`f

     ime. Ob`f [J `s eum tc e`llmrmot nbusms tgbt bnt tgrcujg

    vbr`cus pbtgcjmomt ǹ hmngbo`shs. G`stcpbtgcfcjy sgcws

    s`h`fbr lmbturms `o mvmry typm cl [J, `rrmspmnt`vm cl tgm

    cr`j`obf nbusm boe fcnbt̀ co. Zgmo tgmrm `s b s`ojfm [J,

    mspmn`bffy `l `t `ovcfvms tgm ob`f ime, g`stcfcj`nbf mxbh`obt`co

    `s omnmssbry tc rufm cut hbf`jobot hmfbochb.Hcst nbsms cl ob`f [J `ovcfvm com cl tgm lcffcw`oj typms1

    2. Eruj-`oeunme [J

    B hb`o ngbrbntmr`st`n cl eruj-`oeunme [J `s tgm `ovcfvm-

    hmot cl huft`pfm ob`fs cl ictg l`ojmrs boe tcms. ^mvmrbf

    nbsms gbvm immo rmpcrtme eur`oj trmbthmot w`tg rmt`oc`es(mj, systmh`n bn`trmt ò, systmh`n `sctrmt`oc`o, systmh`n

    mtrmt`obtm, tcp`nbf rmt`oc`n bn`e, tcp`nbf tbzbrctmom).2-= Ugm

    cosmt cl pb`oluf pmr`uojubf [J bs b pcss`ifm s`em mllmnt cl 

    bot r̀mtrcv`rbf tgmrbpy (mspmn`bffy w`tg `oe`obv`r boe

    fbh`vue`om) lcr guhbo `hhuoceml`n`mony v`rus `olmnt`co

    gbs bfsc immo docwo lcr smvmrbf ymbrs.2,,25

    (L`jurm 2)4 h`tczbotgrcoms2=

    4 boe nynfc-spcr`om.2< Com rmnmot nbsm cl huft`pfm mrupt`vm [J gbs

     immo rmpcrtme `o bsscn`bt̀ co w`tg bot`-NE9; bot`icey

    trmbthmot lcr smvmrm rgmuhbtc`e brtgr`t`s.2:

    9. [J nbusme iy fcnbf hmngbo`nbf trbuhbs

    [J nbo bppmbr bltmr fcnbf trbuhbs, `onfue`oj `ojrcwo

    ob`fs, rmtrcoyng`b,27 boe lr`nt`co eur`oj b fcoj wbfd 20

    (L`jurm 9). Bhcoj smfl-`oeunme ob`f trbuhb, coyngct`ffc-

    hbo`b, coyngcpgbj`b, boe bjjrmss`vm hbo`nur`oj hby im⁏  Ncrrmspcoe`oj butgcr. Umf.1 + >9 9 =>= 5> :04 lbx1 +>9 9 5:: >2 22.

     M-hb`f beermss1 imrtrboe.r`ngmrtKngu-irujhboo.im  (I. Y`ngmrt).

    ;:>7-;72W/$   „  smm lrcot hbttmr © 9;2> Mfsmv`mr @on. Bff r`jgts rmsmrvme.

    gttp1//ex.ec`.crj/2;.2;2.;)   >2,

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    rmspcos`ifm lcr tgm emvmfcphmot cl [J.9; [J nbo bfsc

    cnnur bltmr pmomtrbt`co cl b lcrm`jo icey w`tg`o tgm ob`f

    t`ssum cr bltmr bo bnutm hmngbo`nbf trbuhb.

    >. [J nbusme iy pmr`pgmrbf omrvm `oaury

    E`llmrmot ncoe`t`cos, bff cl wg`ng `ovcfvm pmr`pgmrbf omrvm

    `oaury, brm bsscn`btme w t̀g tgm emvmfcphmot cl ob`fngbojms boe [J cl tgm prcx`hbf ob`f lcfe. Nbst 

    `hhci`f`zbt`co gbs immo rmpcrtme bs b pcss`ifm nbusm cl 

     pmr`uojubf [J924 bo `hprcpmr nbst bppf`nbt̀ co hby

    `oeunm pmr`pgmrbf omrvm ebhbjm, prcibify `o rmspcosm

    tc hmngbo`nbf nchprmss`co. [bt`mots nchpfb`o cl hcemr-

    btm pbrmstgms`b boe pb`o eur`oj nbst wmbr`oj boe emvmfcp

     pb`oluf coyngchbems`s, pmr`uojubf swmff`oj, boe [J

    `ovcfv`oj tgm prcx`hbf ob`f lcfe b lmw ebys bltmr nbst 

    rmhcvbf. ^`h`fbr ob`f ngbojms brm cismrvme w`tg rmlfmx

    syhpbtgmt`n eystrcpgy.99 Ugm emvmfcphmot cl pmr`uojubf

    [J gbs bfsc immo rmpcrtme bltmr Ju f̀fb̀ o-Ibrrà syo-

    erchm,9> `o pbt`mots w`tg gmh`pfmj`b,95 boe bltmr smvmrbf

    mp`scems cl cxyjmo emsbturbt`co.9=

    5. [J eum tc `olfbhhbtcry systmh`n e`smbsms

    Huft`pfm pmr̀ uojubf [Js cl smvmrbf l`ojmrob f̀s boe

    tcmob f̀s wmrm rmpcrtme `o pbt̀ mots w`tg `olfbhhbtcry

    systmh`n e`smbsms, sung bs nutbomcus sbrnc`ecs`s, pscr`-

    bs`s, boe smrcomjbt`vm spcoeyfcbrtgr`t`s.2

    Urmbthmot hust im ngcsmo `o bnncrebonm w`tg tgm nbusm

    cl tgm [J. @l tgm [J `s tgm rmsuft cl fcnbf trbuhb, tgm l`rst 

    tg`oj tc ec `s tc rmhcvm tgm trbuhb (mj, ob`f bvufs`co w`tg

    rmtrcoyng`b, surj`nbf rmhcvbf cl b lcrm`jo icey, nutt`oj bo

    coyngcfyt`n ob`f lcr b lr`nt`cobf [J, stcpp`oj ob`f

    hbo`pufbt`co w`tg coyngct`ffchbo`b)4 tgm [J hby tgmo im

    trmbtme w`tg tcp`nbf stmrc`es boe bot̀ i`ct`ns cr w`tg

    nurmttbjm. @l [J `s tgm rmsuft cl erujs, tcp`nbf hme`nbt`cos

    cr nurmttbjm hby im mllmnt`vm, iut usubffy b emnrmbsm `o tgm

    eruj ecsm `s omnmssbry, mspmn`bffy lcr rmt̀ oc`es boebot t̀uhcrbf erujs. @o nbsms cl bot r̀mtrcv`rbf tgmrbpy, tcp`nbf

    trmbthmot cr nurmttbjm nbo im mllmnt̀ vm4 `o ocormspcoe`oj

    nbsms, tgm rmpfbnmhmot cl tgm eruj tgbt `s `oeun`oj tgm [J

    w t̀g b e`llmrmot bjmot `s omnmssbry. [J nbusme iy nbst 

    `hhci`f`zbt`co usubffy gmbfs w`tg tcp`nbf stmrc`e trmbthmot.

    [J nbusme iy rmlfmx syhpbtgmt̀ n eystrcpgy cr systmh`n

    e`smbsm `s hcrm e`ll`nuft tc trmbt boe cltmo rmqu`rms smvmrbf

    nynfms cl tcp`nbf tgmrbp`ms cr surj`nbf rmhcvbf.2

    Jfchus tuhcr 

    B jfchus tuhcr `s vmry nchhco co tgm gboe boe

    rmprmsmots bicut 2% tc 9% cl bff gboe tuhcrs.9< @t br`smsmspmn`bffy bt tgm l`ojmrt`ps, imnbusm tgm jfchus ice`ms cl 

    Hbssco brm ouhmrcus bt tgbt fcnbt`co. @o up tc 0;% cl tgm

    nbsms, tg`s ncoe`t`co bllmnts wchmo wgc brm bicut 5= ymbrs

    cfe.9: Ugmrm brm twc hb`o nf`o`nbf prmsmotbt`cos1

    2. B shbff rmee`sg cr ifu`sg spct cl smvmrbf h`ff`hmtmrs (i2;

    hh) `o e`bhmtmr tgbt nbo im smmo tgrcujg tgm ob`f pfbtm

    (L`jurm >, B).

    9. B fcoj`tue`obf mrytgrcoyng`b w`tg e`stbf octng`oj cr 

    cvmrfy`oj fcoj`tue`obf l`ssurm.

    [b`o `s tgm fmbe`oj syhptch4 `t hby im spcotbomcus cr  prcvcdme iy tgm sf`jgtmst trbuhb. [`opc`ot pb`o cnnurs, boe

    tg`s `ovcfvms tgrcii`oj boe mxbnmribt`co w`tg prmssurm boe

    w`tg vbr`bt`cos `o tmhpmrbturm, mspmn`bffy ncfe. ^chmt`hms,

    tgm pb`o `s wcrsm bt o`jgt. Com nbsm rmpcrtme tgbt mvmo

    bppfy`oj pcf`sg tc tgm ob`f wbs uoimbrbifm.97

    ^mvmrbf nf`o`nbf tmsts brm bvb`fbifm lcr tgm nf`o`nbf

    e`bjocs`s cl jfchus tuhcrs. Ugm l`rst com `s tgm Fcvm p`o

    tmst, wg`ng `ovcfvms prci`oj w`tg b ifuot `ostruhmot (mj,

     pbpmrnf`p, pmon`f) tc emtmrh`om tgm hcst tmoemr brmb. Ugm

    G`fermtg tmst `ovcfvms bppfy`oj bo `olfbtbifm null tc tgm brh,

    `olfbt`oj `t tc hcrm tgbo >;; hh Gj cl prmssurm, boe tgmo

    rmpmbt`oj tgm Fcvm p`o tmst4 tgm tmst `s pcs`t`vm `l tgm pbt`mot 

    ecms oct mxpmr`monm boy pb`o w t̀g prci`oj. Ugm ncfe

    smos`t`v`ty tmst sgcufe rmsuft `o `onrmbsme pb`o w`tg mxpcsurm

    tc ncfe (mj, bo `nm nuim). Com pbpmr rmvmbfme tgbt tgm ncfe

    smos`t`v`ty tmst wbs 2;;% smos`t`vm, spmn`l`n, boe bnnurbtm904

    tgm G`fermtg tmst wbs lcuoe tc im :2.5% smos`t`vm, 2;;%

    spmn`l`n, boe :7% bnnurbtm, boe tgm Fcvm p`o tmst wbs lcuoe

    tc im 2;;% smos`t`vm boe :7% bnnurbtm. Bee`t`cobf gmfp hby

    nchm lrch trbos`ffuh`obt`co.>; ^chm rmsmbrngmrs ncos`emr 

    nf`o`nbf mxpfcrbt`co tc im typ`nbf mocujg tc ncol`rh tgm

    e`bjocs`s boe mxbnt fcnbt`co cl b e`j`tbf jfchus tuhcr.>2 Ugm

    e`llmrmot`bf e`bjocs`s `onfuems bff nbusms cl coyngbfj`b, iut `t 

    L`j. 2   [ycjmo`n jrboufchbs cl tgm ob`f ime `o b pbt`mot uoemrjc`oj ngmhctgmrbpy w`tg tbxboms.

    L`j. 9   [ycjmo`n jrboufchb cl tgm e`stbf ob̀ f ime bs b rmsuft cl lr`nt`co `o b pbt`mot w`tg civ`cus gbffux mrmntus.

    Hbobjmhmot cl imo`jo boe hbf`jobot tuhcrs cl tgm ob`f bppbrbtus

    http://localhost/var/www/apps/conversion/tmp/scratch_6/image%20of%20Fig.%E0%B2%80

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    `s `hpcrtbot tc octm tgbt, `o schm vmry rbrm `ostbonms, tgm

    jfchus tuhcr hby im tctbffy pb`ofmss boe bppmbr cofy bs b

     ifu`sg cr rmee`sg ect.

    [fb`o rbe`cjrbpgs sgcw icom mrcs`co `o =;% cl nbsms.9:,>9

    Ecppfmr uftrbscuoe stue`ms gbvm immo bifm tc ncol`rh

    e`bjocs s̀, iut tgmy cltmo lb f̀ lcr shbff tuhcrs (`m,   i9

    hh).>> Ymnmot emvmfcphmots `o g`jg-vbr b̀ifm lrmqumony

    uftrbscuoe gbvm hbem `t pcss`ifm tc `emot`ly shbff jfchus

    tuhcrs `o rmbf t`hm boe w`tg g`jg rmscfut`co. Ugm prcnmeurm

    ecms oct rmqu`rm tgm beh`o`strbt`co cl `otrbvmocus ncotrbst 

    hme`b, boe `t prcv`ems jcce `olcrhbt`co bicut ifcce lfcw boe

    tgm surrcuoè oj strunturms.>5 Jfchus tuhcrs brm b hb`o

    `oe`nbt̀ co lcr tgm usm cl hbjomt ǹ rmscobonm `hbj`oj (HY@) cl 

    tgm ob`f uo`t.>= HY@ `s prmlmrbifm imnbusm `t cllmrs tgm g`jgmst 

    smos`t`v`ty boe b imttmr bssmsshmot cl tgm mxtmot cl tgm fms`co.

    Jfchus tuhcrs sgcw b g`jg s`jobf `o U9-wm j̀gtme `hbjms boe

    b strcoj mogbonmhmot bltmr jbecf`o`uh `oamnt`co4 gcwmvmr, tgm

    s`jobf imgbv`cr hby vbry w t̀g tgm g`stcfcj ǹ obturm (mj,

    vbsnufbr, nmffufbr, hyxc̀ e) cl tgm fms`co.>< Ugm tuhcr f`h t̀s brm

    usubffy sgbrp, w`tg b pmr`pgmrbf psmuecnbpsufm tgbt rmsufts

    lrch b rmbnt`cobf rmspcosm cl tgm surrcuoè oj ncoomnt̀ vm

    t`ssum. Ug`s nbpsufm sgcws b vmry fcw s`jobf co bff smqumonms

    boe smmhs tc im `onchpfmtm `o bicut 9=% cl nbsms.>:

    Ncrt`nbfmrcs`co tgbt `s cofy rmvmbfme iy HY@ `s vmry nchhco. HY@ `s

    usme tc bnnurbtmfy emtmrh`om tgm spbt`bf fcnbt`co cl tgm tuhcr 

    sc tgbt b prmn`sm boe rbe`nbf surj`nbf rmsmnt`co nbo im

     pmrlcrhme.>7 @t hby bfsc gmfp w`tg tgm emtmnt`co cl huft`pfm

    jfchus tuhcrs `o tgm sbhm l`ojmrt̀ p.>: Ymnurrmonms wmrm

     prmv`cusfy tgcujgt tc im tgm rmsuft cl tgm `onchpfmtm rmhcvbf

    cl tgm cr`j`obf tuhcr, iut tgmy hby bntubffy im bttr`iutme tc

    shbff, syongrcocus, sbtmff`tm fms`cos.>0 B smr`ms cl := nbsms

    `ovcfvme b jfcibf rmnurrmonm rbtm cl 2:%, iut oc rmnurrmonm

    wbs cismrvme `o tgm jrcup cl pbt`mots wgc uoemrwmot 

     prmcpmrbt`vm HY@ cr uftrbscuoe stue`ms.5;

    Ugm cofy trmbthmot cl tg`s ncoe`t̀ co `s tgm surj`nbf

    rmhcvbf cl tgm tuhcr, wg ǹg rmsufts `o tgm rmscfut`co cl syhptchs. ^chm surjmcos lbvcr tgm e`rmnt bpprcbng bltmr 

    ob`f pfbtm bvufs`co tgrcujg tgm ob`f ime (smm L`jurm >, I  boe

    N ) cr tgm hbtr`x w`tg hmt`nufcus rmpb`r.52,59 Bo bftmrobtm

    bpprcbng `s tgm fbtmrbf `on`s`co. Ug`s `on`s`co bffcws lcr tgm

    mxpcsurm cl tgm ecrsbf e`stbf pgbfbox w`tgcut v`cfbt`oj tgm

    hbtr`x, tgmrmiy rmeun`oj tgm r`sd cl pcstcpmrbt`vm emlcrh`-

    ty.5> Ug`s fbtmrbf bpprcbng cllmrs b hcrm obrrcw v`mw cl tgm

    tuhcr w t̀g b g`jgmr ngbonm cl `onchpfmtm mxn`s`co bs

    nchpbrme w`tg tgm trbosuojubf bpprcbng.9:,55 @t sgcufe im

    rmnchhmoeme lcr fms`cos tgbt brm emmp smbtme prcx`hbffy.5=

    ^uiuojubf mxcstcs`s

    ^uiuojubf mxcstcs s̀ (^M) `s bo `scfbtme, sfcw-jrcw`oj,

     imo`jo cstmcngcoerbf cutjrcwtg. Bftgcujg hcst butgcrs

    ncos`emr ^M tc im b e`st`ont nf`o`ncpbtgcfcj`n mot`ty,5< schm

    fuhp tg`s ncoe`t`co `o w`tg tgm cstmcngcoerchbs.5: Urbuhb

    smmhs tc im tgm hcst `hpcrtbot mt`cfcj`n lbntcr.57 @oe`v`eubfs

    wgc brm`o tgm̀ r 9;s brm tgcsm wgc brm hcstfy bllmntme.57-=; Ugm

    smx rbt̀ c vbr̀ ms lrch smr̀ ms tc smr̀ ms, iut`t `s hcst prcibify 212.

    Bff fbrjm smr`ms gbvm sgcwo tgbt tgm jrmbt tcmob`f `s smfmnt`vmfy

    bllmntme `o :=% cl nbsms.57,50,=2 Ugm `ovcfvmhmot cl fmssmr 

    tcmob`fs cr l`ojmrob`fs (`m, tgm tguhi boe `oemx l`ojmrs) gbs

     immo cismrvme `o 2;% tc 2=% cl nbsms.=2-=>

    Ugm prcf̀ lmrbt`co `ovcfvme w`tg tg s̀ ncoè t`co usubffy

    mfmvbtms tgm ob`f pfbtm boe tgmo mhmrjms lrch tgm gypcoy-

    ng`uh cr schmt`hms lrch b fbtmrbf sufnus. Ugm tuhcr hby

    mxg ì`t b pcrnmfb ò wg`tm gum w`tg tmfboj`mntbs̀ b ruoò oj co `ts

    surlbnm eur`oj tgm mbrfy stbjms. Cltmo, b ncffbrmttm emf`ombtms

    tgm tuhcr (L`jurm 5). Z`tg t`hm, tgm prcf`lmrbt`co `s ncvmrme

    w`tg tg`nd gypmrdmrbtcs`s. Nmotrcecrsbf fms`cos hby prmsmot bs

    rme pbtngms smmo tgrcujg tgm ob`f pfbtm, w t̀g cr w t̀gcut 

    coyngcfys s̀. Mrcs`co boe `olmnt`co cl tgm ob`f ime hby

    j`vm r`sm tc b suiuojubf pycjmo`n-f`dm cutjrcwtg.=5 Ugm

    bsscn`bt`co cl ob`f emlcrh`ty w`tg pb`o `s g`jgfy sujjmst`vm

    L`j. >   B, B pb`ofmss jfchus tuhcr. Octm tgm ifu`sg spct uoemr tgm ob`f pfbtm.   I, Bltmr ob`f pfbtm bvufs`co. Ugm tuhcr `s nfmbrfy

    v`s`ifm. N , Ugm e`rmnt surj`nbf bpprcbng tgrcujg tgm ob`f ime, w`tg b

    fcoj`tue`obf mxn`s`co boe mxt`rpbt`co cl tgm tuhcr.

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    cl ^M, iut pb`o `s oct bfwbys prmsmot. Ugm e`llmrmot`bf

    e`bjocs`s `onfuems vmrrunb vufjbr`s, l`ircdmrbtchb, pycjmo`n

    jrboufchb, squbhcus nmff nbrn`ochb (^NN), `ojrcwo tcmob`f

    boe bhmfboct`n hmfbochb.

    Ybe`cjrbpg`n mxbh`obt`co `s pbrbhcuot lcr tgm e`bjocs`s

    cl ^M4 gcwmvmr, mbrfy fms`cos tgbt brm hcstfy lcrhme lrchnbrt`fbjm hby im oct v`s`ifm. Ugmrm `s prcjrmss`vm nbfn`l`nb-

    t`co boe tgm lcrhbt`co cl b trbimnufbr pbttmro cl icom. Eur`oj

    tgm moe stbjm, tgm trbimnufbr icom bt tgm ibsm cl tgm mxcstcs`s

    ncoomnts tc tgm uoemrfy`oj pgbfbox. Ugm mxcstcs`s bppmbrs

    shbffmr co b rbe`cjrbpg bs nchpbrme w`tg tgm `otrbcpmrbt`vm

    l`oe`ojs bs b rmsuft cl tgm rbe`cfunmony cl tgm nbrt`fbj`ocus

    nbp tgbt ncost`tutms tgm iufd cl tgm tuhcr.50,==

    Urmbthmot `ovcfvms tgm rmsmnt`co cl tgm cutjrcwtg uoemr 

    luff bsmpt`n ncoe`t`cos. Nchpfmtm rmsmnt`co, `onfue`oj tgm ibsm

    cl `hpfbotbt`co `otc tgm ncrtmx cl tgm pgbfbox, `s ommeme4 `o

    ctgmr wcres, uot`f tgm spcojy icom `s v`subf`zme.=5 E`llmrmot 

    surj`nbf bpprcbngms brm pcss`ifm `o bnncrebonm w t̀g tgmfcnbt`co boe s`zm cl tgm ^M. E`ssmnt`co `s e`ll`nuft, imnbusm

    tgm tuhcr gbs hcst cltmo tg`oome tgm ob`f ime. Zgmo pcss`ifm,

    tgm ime `s f`ltme `o twc lfbps tc mxpcsm tgm wgcfm tuhcr. Ugm

    tuhcr s̀ rmhcvme w`tg b icom rcojmur, tgm nbv t̀y `s l`ffme w`tg

    Jmflcbh cr ^urj`nmf, boe tgm lfbps brm put ibnd `o pfbnm,

    tr`hhme tc bemqubtm s`zm, boe nbut`cusfy suturme. Ugmrm `s

    cltmo b e`snrmtm e`stbf coyngcfys s̀ bs b rmsuft cl ob f̀ ime

    emstrunt`co lrch tgm tuhcr `tsmfl rbtgmr tgbo lrch tgm surj`nbf

     prcnmeurm.=5,=< Gmbf̀ oj iy smncoebry `otmot`co `s boctgmr 

    cpt̀ co w`tg mxnmffmot cutnchm,mvmolcr vmryfbrjm emlmnts.50,=5

    Hyxc`e psmuecnyst

    Hyxc̀ e psmuecnysts (H[Ns) brm qu`tm nchhco. Ugm̀ r 

    mxbnt `on`emonm boe prmvbfmonm brm oct docwo, bftgcujg `t `s

    mst`hbtme tgbt wchmo brm bllmntme hcrm tgbo tw`nm bs cltmo bs

    hmo.=: @t `s ocw imf`mvme tgbt H[Ns cnnur bs b rmsuft cl b

    fmbdbjm cl syocv`bf lfu`e tgrcujg b irmbng `o tgm ac`ot nbpsufm

    cl tgm e`stbf `otmrpgbfbojmbf ac`ot.=7 Ug s̀ pgmochmoco `s

     prchctme iy tgm prmsmonm cl cstmcpgytms boe tgm rmeunt`co cl 

    tgm ac`ot spbnm lrch cstmcbrtgr`t`s.=0 B stuey emhcostrbtme

    rbe`cfcj`n mv`emonm cl pr`hbry `otmrpgbfbojmbf cstmcbrtgr`t`s

    `o :=% cl H[N nbsms.

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    tgm sbhm `oe`v`eubf.

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     imfcw tgm mejm cl tgm ob`f pfbtm cr `o tgm hcst e`stbf pcrt`co

    cl tgm ob`f ime. @ts nf`o`nbf prmsmotbt`co `s stmrmctypme boe

    bsscn`btme w`tg b pb`oluf e`stbf t`p nbusme iy bo uoemrfy`oj

     icoy mrcs`co wgmo v`subf`zme w`tg rbe`cjrbpgy. @o b rmv`mw

    cl Ug`s fyt`n mllmnt hby im bttr`iutme tc tgm vmry rbp`e nchprmss`co nbusme iy

    tgm tuhcr rbtgmr tgbo tc tuhcr `ovbs`co `tsmfl.75 Fcoj-tmrh

    rbe`cfcj`n lcffcw up cl ^]DB `s rbrm. ^chm pbt`mots gbe b

    nchpfmtm bismonm cl rmcss`l`nbt`co,72 wgmrmbs ctgmrs emh-

    costrbtme schm pbrt`bf rmncost`tut`co cl tgm icoy emlmnt.7= @o

    com nbsm rmpcrt, tgmrm wbs b spcotbomcus rmjrmss`co w`tg luff

    rmcss`l`nbt`co.7< ]ftrbscocjrbpgy rmvmbfs b wmff-n`rnuh-

    snr`ime, h`xme-mngc`n hbss. HY@ emhcostrbtms `otmrhme`btm

    `otmos`ty co U2-wm`jtgme `hbjms boe h`xme s`jobf `otmos`ty

    co U9-wm`jgtme `hbjms. B pmr`pgmrbf tg`o r`h cl ncotrbst 

    mogbonmhmot sujjmsts bo `olfbhhbtcry rmbnt`co `o tgm

    surrcuoe`oj t`ssum.7:

    Ugm e`bjocs`s cl e`stbf e`j`tbfdmrbtcbnbotgchb rmf̀ ms co tgm rbp`e jrcwtg cl tgm fms`co

    boe tgm ncostbot pb`o `o bsscn`bt`co w`tg hme`nbf `hbj`oj

    boe g`stcfcjy.

    Ugm tgrmm hb`o e`llmrmot`bf e`bjocsms lcr ^]DB brm

    mp`emrhc`e `hpfbotbt`co nyst, suiuojubf wbrt, boe ^NN.

    ^NN `s bfsc tgm hb`o g`stcfcj`n e`llmrmot`bf e`bjocs`s, wg`ng

    rmhb`os e`ll`nuft4 tgm tuhcr `s lrmqumotfy e`bjocsme g`stc-

    fcj`nbffy bs b ^NN, dmrbtcbnbotgchb typm. ^tcff rmpcrts tgbt 

    tgm g`stcfcj`nbf lmbturms gbvm tgm sbhm jmomrbf ncol`jurbt`co

    L`j. 0   L`ircdmrbtchb br̀ s`oj lrch tgm hbtr`x boe e`ssmnt`oj tgm pfbtm (`otrbuojubf l`ircdmrbtchb).

    L`j. 2;   L`ircdmrbtchb cl tgm ob`f ime.

    L`j. 22   Dcmomo tuhcrs `o b tuimrcus snfmrcs`s.

    L`j. 29   E`stbf suiuojubf dmrbtcbnbotgchb.

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    bs dmrbtcbnbotgchb mfsmwgmrm, iut tgmy tmoe tc im hcrm

    vmrt`nbffy cr`motme boe tc mxg`i`t hcrm eysdmrbtct̀ n nmffs,

    lmwmr omutrcpg`fs boe mcs`ocpg`fs, boe f`ttfm cr oc l`ircs`s bt 

    tgm`r ibsm.77 E`st̀ oju s̀g`oj dmrbtcbnbotgchb lrch wmff-

    e`llmrmot`btme ^NN `s schmt`hms e`ll`nuft. Ymnmot mv`emonm

    `oe`nbtms tgbt tgm ounfmbr lbntcr dbppb-I p=; suiuo`t boe

    ncrtbnt`o hby im usmluf tc e`st`oju`sg imtwmmo tgmsm twc

    ncoe`t`cos. Ictg tgm p=; suiuo`t boe ncrtbnt`o gbe g`jgmr fmvmfs cl mxprmss`co `o dmrbtcbnbotgchb tgbo `o ^NN. Ictg

    wmrm fcnbf`zme tc tgm ibsbf nmff fbymr cl dmrbtcbnbotgchb,

    wgmrmbs tgmy wmrm snbttmrme w`tgcut pcfbr`ty tgrcujgcut tgm

    ^NN fms`cos.70 Ugm mxprmss`co cl D`- bo bsscn`bt`co

    w`tg ecrsbf ptmryj`uh,2;5,2;= coyngchyncs`s,2;< cr fcoj`tu-

    e`obf hmfbocoyng`b.2;< Emrhbtcsncpy gmfps w`tg e`bjocs`s

     iy emhcostrbt`oj huft`pfm pmrlcrbt`cos cl tgm ob`f pfbtm bt `ts

    lrmm icremr. Ymnmotfy, rmsmbrngmrs rmpcrtme tgbt tgm bobfys`s

    cl b ob`f nf`pp`oj `s b lbst boe h`o`hbffy `ovbs`vm hmtgce tc

    bng`mvm tgm ncrrmnt e`bjocs`s cl coyngchbtr`nchb iy

    e`llmrmot`bt̀ oj coyngchbtr`nchb lrch suiuojubf tuhcrs

    boe mxnfue`oj luojbf `olmnt`co w`tg b pmr`ce`n bn`e-^ng`ll stb`o.2;: ]ftrbsco`n mxbh`obt`co bfsc smmhs prch s̀`oj. B

    rmnmot stuey emhcostrbtme b gypmrmngc`n tuhcrbf fms̀ co

    bllmnt`oj tgm hbtr`x zcom w`tg gypmrmngc`n f`ombr spcts boe

     prcamnt`cos `otc tgm `otmrpfbtm spbnm.2;7 Hbjomt`n rmscobonm

    `hbj`oj `s typ`nbf4 `t rmvmbfs b tuhcr tgbt `s mhmrj`oj lrch

    tgm ob`f hbtr`x w`tg tgm sbhm s`jobf bs ocrhbf mp`tgmf`uh boe

    w`tg prcnmssms tgbt mxtmoe `otc tgm tg`ndmome ob`f pfbtm.2;0

     Ob`f bvufs`co nbo im e`bjocst`n bs `t mxpcsms b v`ffcus tuhcr 

    mhmrj`oj lrch tgm hbtr`x tgbt `s mvcnbt`vm cl b smb bomhcom4

    tgm ob`f bppmbrs bs b tg`ndmome luoomf stcr`oj tgm l`fbhmotcus

    e`j`tbt`cos cl tgm hbtr`x tgbt l`t `otc tgm gcfms cl tgm prcx`hbf

    ob`f mxtrmh`ty (L`jurm 25). Ugcsm e`j`tbt`cos brm coyngc-jmo`n boe rmspcos`ifm lcr tgm tg`ndmo`oj cl tgm ob`f pfbtm.

    Ugm`r fmojtg hby cnnbs`cobffy im bs sung tgbt nf`pp`oj cl tgm

    lrmm mejm `oeunms ifmme`oj.22; Nf`o`nbf lmbturms brm ngbrbn-

    tmr`st`n, iut coyngchyncs`s boe Icwmo e`smbsm222 sgcufe im

    rufme cut.

    Ugm surj`nbf rmhcvbf cl tgm tuhcr `s tgm cofy cpt`co, boe

    tgm tuhcr sgcufe cofy im sgbvme. Imnbusm `t `s `hpcss`ifm tc

    rmpfbnm tgm pfbtm (wg`ng `s bftmrme boe sgcufe uoemrjc

    L`j. 2>   Coyngchbtr ǹchb. Octm tgm swmff̀ oj cl tgm prcx`hbfob`f lcfe boe tgm xbotgcoyng`b.

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    g`stcfcj`nbf mxbh`obt`co), `t hby im w`sm tc sf`em schm tuffm

    jrbs uoemr tgm prcx`hbf ob`f lcfe boe smnurm `t w`tg twc

    st`tngms. Ug`s w`ff bvc`e boy begmrmonm imtwmmo tgm vmotrbf

     pbrt cl tgm prcx`hbf ob`f lcfe boe tgm hbtr`x, wg`ng ncufe

    rmsuft `o ptmryj`uh. Bltmr > wmmds, tgm tuffm jrbs hby im

    rmhcvme4 bt tgbt t`hm, tgm hbtr`x w`ff bfrmbey gbvm gmbfme

    boe syotgms`zme schm dmrbt`o.52

    G`stcfcjy cl tgm surj`nbf spmǹ hmo `s uo`qum1 tgm e`stbf zcom

    `s ngbrbntmr z̀me iy huft`pfm‖jfcvm l`ojmr ‘ pbp`ffbry prcamnt`cos

    ncvmrme iy b hbtr`x-typm mp`tgmf`uh tgbt `s emvc`e cl strbtuh

    jrboufcsuh boe tgbt dmrbt`o`zms tgrcujg bo mcs`ocpg̀ f`n

    dmrbtcjmocus zcom. Ugm prcx`hbf zcom, wg`ng ncrrmspcoes

    w`tg tgm pmeuonfm, `s echm-sgbpme `o trbosvmrsm smnt`cos. @t `s

    f`ome iy b pbp̀ ffchbtcus hbtr`x-typm mp t̀gmf`uh w`tg vmrt`nbffy

    cr`motme emmp `ovbj`obt`cos `otc tgm strchb. Ugmsm `ovbj`ob-

    t`cos surrcuoe cpt̀ nbffy mhpty nbv̀ t m̀s `o b ngbrbntmr s̀t ǹ

    \-sgbpme ncol`jurbt`co. Ugm rmncjo t̀`co cl hbtr`x-typm mp`tgm-

    f`uh w`tg \-sgbpme emprmss`cos `s nrun`bf tc hbdm tgm e`bjocs`s

    cl coyngchbtr`nchb co lrbjhmotme cr `onchpfmtm spmn`hmos,wg`ng fbnd tgm  ‖jfcvm l`ojmr ‘ pbp`ffbry prcamnt`cos.229

    ^upmrl`n`bf bnrbf l`irchyxchb (e`j`tbf l`irchyxchb)

    ^upmrl`n`bf bnrbf l`irchyxchb `s b rbrm, sfcw-jrcw`oj,

    sclt-t`ssum tuhcr tgbt gbs b prme`fmnt`co lcr tgm suiuojubf

    boe pmr`uojubf rmj`cos cl tgm l`ojmrs boe tcms `o beufts. 22>

    Ugm nf`o`nbf prmsmotbt`co gbs oct immo luffy emtb`fme, imnbusm

    tg s̀ ncoe`t̀ co `s hcstfy b g`stcfcj`nbf e`sncvmry. ^chm

    rmpcrts hmot`co b echm-sgbpme, wmff-n`rnuhsnr`ime, wg`t`sg

    tc p`od`sg l`rh tuhcr (schmt`hms w`tg b ncffbrmttm bt `ts ibsm)

    f`lt`oj up tgm pfbtm, wg`ng `s ncvmrme w`tg vmry tg`o nrbndme

    gypmrdmrbtcs`s (L`jurm 2=)4 `l tgm tuhcr `s fcnbtme emmpfy `o

    tgm fbtmrbf ob`f lcfe, tgmrm w`ff im b swcffmo lcfe ncvmrme w`tg

    ocrhbf sd`o.225,22= G`stcfcjy emhcostrbtms b wmff-n`rnuh-

    snr`ime, uomonbpsufbtme tuhcr fcnbtme `o tgm emrh`s cr tgm

    suinut̀ s, w t̀g cofy rbrm mxtmos`co `otc tgm icom. @t `s

    nchpcsme cl stmffbtm boe sp`oefme nmffs mhimeeme `o b

    hyxc`e hbtr`x, cltmo w`tg bnnmotubtme vbsnufbturm boe

    `onrmbsme ouhimrs cl hbst nmffs. Ounfmbr btyp`b `s sf`jgt cr 

    bismot, boe h`tct`n l`jurms brm `olrmqumot. @hhuocg`stc-

    ngmh`nbffy, 5.

    NE00 boe mp`tgmf`bf hmhirbom bot`jmo (MHB) nbo bfsc im

    lcnbffy pcs`t`vm.22 @t hby cnnur bt boy bjm eur`oj beuftgcce,

    w`tg b pmbd `on`emonm imtwmmo tgm bjms cl =; boe ; Bfhcst com tg`re cl pbt`mots

    w t̀g ^NN cl tgm ob`f bppbrbtus gbvm b g`stcry cl G[\-

    bsscn b̀tme jmo`tbf e`smbsm (`m, jmo`tbf wbrts, eyspfbs b̀, cr 

    nbonmr cl tgm nmrv`x cr bocjmo`tbf rmj`co) cr b smxubf pbrtomr 

    w`tg sung b g`stcry. Ugm bvmrbjm t`hm imtwmmo tgm cosmt cl 

    tgm jmo`tbf e`smbsm boe tgm bppmbrbonm cl tgm ob`f tuhcr `s

    bpprcx`hbtmfy 29 ymbrs. @t smmhs tgbt tgm r`sd cl emvmfcp`oj

    L`j. 25   Bvufs`co rmvmbfs tgm v`ffcus tuhcr co tgm hbtr`x boe tgmluoomf-sgbpme pfbtm.

    L`j. 2=   ^upmrl`n`bf bnrbf l`irchyxchb. Nchpbrm tg`s w`tg tgm`hbjm sgcwo `o L`jurm 5.

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    bo bjjrmss`vm cr huft`pfm lcrh cl G[\-bsscn`btme ^NN cl 

    tgm ob`f bppbrbtus `s oct ncrrmfbtme w t̀g tgm pbt̀ mot ‐s

    `hhuo`ty stbtus. ^NNs cl tgm ob`f bppbrbtus, wgmtgmr tgmy

    brm bsscn`btme w t̀g G[\ cr oct, gbvm b s`h f̀br rbtm cl 

    hmtbstbs`s cl 9% tc >%.295

    Ugm nf`o`nbf prmsmotbt`co cl ^NN `s prctm`lcrh4 `t cltmo

    bppmbrs bs b nf`o`nbffy h`sfmbe`oj   ‖ imo`jo‘   fms`co, wg`ng

    emfbys tgm e`bjocs`s.2>2

    Ugm e`llmrmot`bf e`bjocs`s monch- pbssms vmrrunb vufjbr`s, coyngchyncs`s, suiuojubf mxcstc-

    s`s, mp`emrhc`e nyst, ibntmr`bf pbrcoyng`b, l`ircdmrbtchb, boe

    coyngchbtr`nchb. Ugm hbf̀ jobot prcnmss hby emvmfcp `o tgm

    mp`tgmf`uh cl tgm pbrcoyng`uh cr lrch tgm ob`f ime.

    ^uiuojubf `ovcfvmhmot `s tgm hcst nchhco l`oe`oj. ^NN

    hcstfy prmsmots w`tg coyngcfys`s, boe nf`pp`oj bwby cl tgm

    emtbngme ob`f pfbtm sgcws pbrt`bf cr mxtmos`vm gypmrdmrbtcs`s

    cl tgm ob`f ime cr mvmo b vmrruncus hbss (L`jurm 29 w`tg

    mrytgmhb nbusme iy `olfbhhbt`co bs b rmsuft cl `olmnt`co.

    L`ssurm cr ufnmrbt`co cl tgm fbtmrbf ob f̀ jrccvm, wg`ng `s

    schmt`hms nrustme w`tg jrboufbt`co-f`dm t`ssum imombtg tgm

    snbi, hby bfsc im cismrvme.>; [b`o `s uonchhco.292,2>>

    ^chm suiuojubf gypmrdmrbtcs`s hby im trmbngmrcus1 tgmrm

    hby im fcoj`tue`obf mrytgrcoyng`b w`tg coyngcpbp`f-

    fchb,2>5 l`ircdmrbtchb,:

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    `oe`nbtme.>;,0>,292,2>>,25:,257 ^chm ocosurj`nbf trmbthmots

    gbvm immo rmpcrtme, `onfue`oj `h`qu`hce nrmbh,250 =-

    lfucrcurbn`f nrmbh252,2=; w t̀g cr w`tgcut pr`cr nurmttbjm,

     pgctceyobh`n tgmrbpy,2=2,2=9 boe `otrb-brtmr`bf `olus`co w`tg

    hmtgctrmxbtm.2=>  Ocom cl tgmsm tmngo`qums, gcwmvmr, bffcws

    lcr tgm g`stcfcj`n ncotrcfs cl tgm tuhcr hbrj`os. Ugmsm

    sgcufe im ncos`emrme bs trmbthmot cpt`cos lcr spmn`bf nbsms,

    wgmo surjmry `s oct lmbs`ifm.

    \mrruncus nbrn`ochb

    Ug`rtmmo nbsms cl vmrruncus nbrn`ochb `ovcfv`oj tgm ob`f

    bppbrbtus gbvm immo rmpcrtme `o tgm f`tmrbturm. Ug`s `s b rbrm,

    g`jgfy dmrbt`o`z`oj vbr`bot cl ^NN tgbt `s ngbrbntmr`zme iy

    fcnbf bjjrmss`vmomss iut b fcw pctmot`bf lcr hmtbstbs`s. Ugm

     pfbotbr lcrh `s bfsc docwo bs   mp`tgmf`chb nuo`nufbtuh.2=5

    Ugm nf`o`nbf prmsmotbt`co `s cltmo h`sfmbe`oj4 tg`s ncoe`t`co

    cltmo bppmbrs bs b wbrty fms c̀o tgbt `onrmbsms `o s`zm w`tg t`hm.

    Ugm ob`f imes cl tgm tguhi, tgm jrmbt tcmob`f, boe tgm l`ltg

    tcmob`f brm tgm hcst nchhco fcnbt`cos. B nbsm `ovcfv`oj tgm

    lcurtg l`ojmr wbs rmnmotfy rmpcrtme.2== Fcoj mvcfv`oj fms`cos

    w`tg pbp`ffchbtcus e`j`tbt`cos brm qu`tm typ`nbf. Hcgs surjmry

    cr mo ifcn mxn`s`co lcffcwme iy b luff-tg`ndomss jrblt 2== `s tgm

    trmbthmot cl ngc`nm, iut, `o bevbonme nbsms, bhputbt`co hby

     im hboebtcry. Com nbsm wbs sunnmssluffy trmbtme w`tg tgm

    `otrb-brtmr`bf `olus`co cl hmtgctrmxbtm.2=<

    Hmfbochb

     Ob`f bppbrbtus hmfbochb (OBH) `s rbrm4 bnncre`oj tc

    smvmrbf smr`ms, `t bnncuots lcr ;.27% tc 9.7% cl bff nutbomcus

    hmfbochbs.2=:

    Ugm mst̀ hbtme `oǹ emonm rmbngms ;.2 pmr 2;;,;;; pmcpfm pmr ymbr.2=7 Ugm rmfbt`vm `on`emonm cl OBH

    bhcoj Blr`nbo boe Bs`bo `oe`v`eubfs `s hung g`jgmr tgbo

    tgbt lcuoe bhcoj Nbunbs`bos1 bicut 9=% cl hmfbochbs brm

    fcnbtme `o tgm ob`f bppbrbtus `o Abpbomsm boe Blr`nbo

    Bhmr`nbos, iut tgm biscfutm `on`emonm cl OBH hby wmff

     im s`h`fbr lcr bff rbn`bf jrcups.2=: Ugm bvmrbjm bjm cl cosmt `s

    eur`oj tgm s`xtg boe smvmotg emnbems. OBH `s uousubf `o

    ng`fermo, w`tg cofy 2> rmpcrtme nbsms tc ebtm.2=0 Ugm tguhi

    boe tgm jrmbt tcmob f̀ brm hcst lrmqumotfy bllmntme,2

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    nbo tgmrmlcrm smrvm bs b com-stmp surj`nbf trmbthmot lcr  `o s`tu

    cr h`o`hbffy `ovbs`vm hmfbochb, tgmrmiy erbhbt`nbffy

    rmeun`oj tgm eurbt`co cl pcstcpmrbt`vm e`sbi`f`ty.

    \br`cus mxn`s`cobf i`cpsy tmngo`qums gbvm immo emsnr`ime

    tc mosurm g`stcfcj`nbf e`bjocs`s boe tc f`h`t tgm r`sd cl 

     pcstcpmrbt`vm eystrcpgy lcr b fms`co tgbt ncufe turo cut tc im

     imo`jo.2:> @on`s`cobf i`cpsy `s oct rmnchhmoeme, imnbusm `t 

    ecms oct bffcw lcr tgm nchpfmtm g`stcfcj`nbf mxbh`obt`co cl tgm p`jhmotme fms`co.

    @o >;% cl nbsms, OBH br s̀ms lrch tgm ob`f ime boe

     prmsmots bs b oceufm tgbt hby im p`jhmotme, bo ufnmrbt`co

    w`tg ifmme`oj, bo `scfbtme lcfe p`jhmotbt`co, bo uomxpfb`ome

    hcocebntyf`n pbrcoyng`b, cr b pbrt`bf emstrunt`co cl tgm ob`f

     pfbtm.2:5 Com sgcufe rmhmhimr tgbt bicut 9;% tc >;% cl 

    nbsms cl OBH brm bhmfboct`n.2=: Ug s̀ ncoe`t̀ co `s mvmo

    hcrm trmbngmrcus wgmo `t hbo`lmsts bs b hcocebntyf`n

    coyngcrrgmx`s.2:=

    ]olcrtuobtmfy, tgm e`bjocs`s cl OBH `s vmry cltmo emfbyme,

    boe tg`s `s bsscn`btme w t̀g b pccr prcjocs`s. Ug`s emfby hby im

    bttr`iutme tc pbt`mots wgc ec oct `o`t`bffy suspmnt tgm e`bjocs`s

    cl nbonmr bt tgbt s`tm boe ncosuft tgm r̀ pgys`n`bos bt b fbtm stbjmcl e`smbsm, wgmo swmff`oj, ufnmrbt`co, ccz`oj cr ifmme`oj

    cnnur. Ugmsm nf`o`nbf lmbturms brm bfrmbey bsscn`btme w`tg b

    tg`nd Irmsfcw `oemx.2:< Cofy com tg`re cl pbt`mots w t̀g

    fcoj`tue`obf hmfbocoyng`b smmd hme`nbf bev`nm2=: (L`jurm 9;).

    Ugm cvmrbff bnnurbny cl emrhbtcfcj s̀ts w`tg rmjbre tc tgm

    e`bjocs s̀ cl ob`f hbtr`x hmfbochb prmsmot̀ oj bs b fcoj̀ tuè obf

    hmfbocoyng`b rmhb`os fcw4 `t rbojme lrch 5

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    surv`vbf imoml`ts gbvm immo emhcostrbtme. Mbrfy e`bjocs`s

    boe mxn`s`co cl tgm tuhcr `s tgm cofy trmbthmot tgbt gbs immo

    emhcostrbtme tc `onrmbsm surv`vbf.2=:

    Ibsbf nmff nbrn`ochb

    Ibsbf nmff nbrn`ochb (INN) `s tgm fmbst nchhco bt tgm

    ob`f bppbrbtus4 brcuoe 9; nbsms gbvm immo rmpcrtme `o tgmMojf s̀g f`tmrbturm. Ugm bvmrbjm bjm cl e`bjocs`s `s cr fcoj`tue`obf hmfbocoyng`b.209,205 B nbsm cl INN

    emvmfcpme `o b rbe`cemrhbt`t`s cl tgm prcx`hbf ob`f lcfe cl b

     pufhbocfcj`st 20=4 boctgmr cnnurrme `o b wcrdmr wgc embft 

    w`tg bzc p`jhmot.20< Ugm nfbss ǹ nf`o`nbf INN prmsmotbt`co

    cismrvme co tgm sd`o―w`tg oceufms, b pmbrfy icremr nrust`oj

    ―wbs moncuotmrme `o cofy b h`ocr t̀y cl nbsms. Hcgs

    surjmry wbs tgm l`rst-ngc`nm trmbthmot `o tgm vbst hbacr`ty cl 

    nbsms, w`tg mxnmffmot cutnchms.20: ^chm pbt̀ mots bfsc

    uoemrwmot mxn`s`co boe/cr bhputbt`co.207

    Ymlmrmonms

    2. [`rbnn`o` IH, Imffbv`stb ^, H`sn`bf` N, mt bf. [mr`uojubf boe suiuojubf

     pycjmo`n jrboufchb. Ir A Emrhbtcf.   9;2;421052-0=>.

    9. [`rbnǹ o` IH, @cr̀ zzc H. Eruj rmbnt`cos bllmnt̀ oj tgm ob`f uo t̀1

    e`bjocs`s boe hbobjmhmot. Emrhbtcf Nf`o. 9;;:49=192=„992, v``.

    >. Nbhpimff A[, Jrmd`o YN, Mff`s NO, mt bf. Ymt`oc`e tgmrbpy `s

    bsscǹ btme w`tg mxnmss jrboufbt`co t`ssum rmspcosms.   A Bh Bnbe 

     Emrhbtcf.  207>401:;7-:2>.

    5. Umdomtz s̀ B, @cboo`ems E, \bdbf` J, mt bf. [ycjmo`n jrboufchbs

    lcffcw`oj tcp`nbf bppf̀ nbt`co cl trmt`oc`o.   A Mur Bnbe Emrhbtcf 

    \momrmcf.   9;;54271>>:->>0.

    =. Ebwd`os HB, Nfbrd BY, Lmfehbo ^Y. [ycjmo`n jrboufchb-f`dm

    fms`co bsscn`btme w`tg tcp ǹbf tbzbrctmom tgmrbpy.   A Bh Bnbe 

     Emrhbtcf. 9;;;45>(2 [t 2)12=5-2==.

    >7(95)12::>->>:.

    2=. Lrm`hbo B, Icujbo`h O, C‐Ir`mo MB. Nbsm rmpcrts1 h`tczbotrcom-

    `oeunme coyngcfys`s bsscn`btme w`tg suiuojubf bisnmssms, pbrcoyng`b,

    boe pycjmo`n jrboufchb.  A Erujs Emrhbtcf.   9;;=45150;-509.

    291790-7>;.2:. Zcff`ob ]. Huft`pfm mrupt`vm pmr`uojubf pycjmo`n jrboufchbs eur`oj

    bot`-NE9; hcocnfcobf bot`icey tgmrbpy lcr rgmuhbtc è brtgr`t`s.

     A Emrhbtcf Nbsm Ymp.  9;2;45155-5.

    20. Y`ngmrt I. Lr̀ nt`cobf pycjmo`njrboufchb cltgm ob`f ime. Emrhbtcfcjy

    (Ibsmf).   9;;249;917;-72.

    9;. Ncfvmr JI. Coyngct`ffchbo`b. Ir A Emrhbtcf.   207:422:1>0:->00.

    92. Ucst` B, [`rbnn`o` IH, Nbhbngc-Hbrt òmz L. Coyngchbems`s boe

     pycjmo`n jrboufchb lcffcw`oj nbst `hhci`f`zbt`co. Brng Emrhbtcf.

    9;;242>:19>2-9>9.

    99. Ucst` B, Ibrbo Y, [mfusc BH, mt bf. Ymlfmx syhpbtgmt`n eystrcpgy

    w`tg prch`omot `ovcfvmhmot cl tgm ob f̀ bppbrbtus.   A Bh Bnbe 

     Emrhbtcf. 200>490(= [t 9)47:-9>7.

    95. ^`rbjusb H, ^ngmp`s N, Ncsmot`oc L@, mt bf. Ob`f pbtgcfcjy `o pbt`mots

    w`tg gmh`pfmj`b.  Ir A Emrhbtcf.   9;;242551==:-=. Hbrngbe`mr B, Ncgmo H, Fmjrm Y. ^uiuojubf jfchus tuhcrs cl tgm

    l`ojmrs1 uftrbscuoe e`bjocs`s.  Ng`r Hb`o.   9;;-9:.

    >=. Abifco H, Gcrcw`tz B, Imrostm`o EB. Hbjomt`n rmscobonm `hbj`oj cl 

    b jfchus tuhcr cl tgm l`ojmrt`p.  A Gboe ^urj Bh.   200;42=1=;:-=;0.

    >:. Erbpà AF, @ey-[mrmtt` @, Jcmtthboo ^, mt bf. ^tboebre boe g`jg

    rmscfut`co hbjomt`n rmscobonm `hbj`oj cl jfchus tuhcrs cl tcms boe

    l`ojmrt`ps. A Bh Bnbe Emrhbtcf.   200=1==;-===.

    >7. Y`ngmrt I, Ibjgb`m H. Hme`nbf `hbj`oj boe HY@ `o ob`f e`scremrs1

    rmpcrt cl 220 nbsms boe rmv`mw.  Emrhbtcf Ugmr (Gm`emfi).   9;;942=1

    2=0-20. Jboeg` A, Pboj ^^, Gure A. Ugm bobtch`n fcnbt`co cl e`j`tbf jfchus

    tuhcr rmnurrmonms.  A Gboe ^urj Bh.   9;2;4>=1070

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    52. e` Ng`bnng`c O, Y`ngmrt I, Gbomdm M. ^urjmry cl tgm hbtr`x. @o1

    Y`ngmrt I, e` Ng`bnng`c O, Gbomdm M, mes. Ob`f ^urjmry. Fcoeco1

    @olcrhb4 9;224 p. 2;>-2>9.

    59. Fmm E-Z, Pboj A-G, Ngboj ^, mt bf. Nf`o`nbf boe pbtgcfcj`nbf

    ngbrbntmr`st`ns cl mxtrbe`j`tbf boe e`j`tbf jfchus tuhcurs1 b rmtrcspmn-

    t`vm nchpbrbt v̀m stuey.   A Mur Bnbe Emrhbtcf \momrmcf.   9;2249=1

    2>09-2>0:.

    5>. \bs`sgt I, Zbtsco GD, Acsmpg M, mt bf. E`j`tbf jfchus tuhcrs1 b 90-

    ymbr mxpmr`monm w`tg b fbtmrbf suipmr`cstmbf bpprcbng.  [fbst Ymncostr 

    ^urj.  9;;542251257 nbsms).   Boo Emrhbtcf \momrmcf.

    200:429519>>-9>. Gcmgo AJ, Ncfmttb N. ^uiuojubf mxcstcs`s cl tgm l`ojmrs. A Gboe ^urj 

     Bh.  200942:15

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    0>. Em Imrdmr E. Gcfe co tgm bhputbt`co.   Ir A Emrhbtcf.   9;;>42571

    2;::-2;:7.

    05. Ibrbo Y, D`ot B. Coyngchbtr`xchb. L`fbhmotcus tultme tuhcur `o tgm

    hbtr`x cl b luoomf-sgbpme ob`f1 b omw mot`ty (rmpcrt cl tgrmm nbsms).  Ir 

     A Emrhbtcf.   2009429;:->22.0:. Ucst` B, [`rbnn`o` IH, Nbfemrcò C, mt bf. Coyngchbtr`nchb1 rmpcrt cl 

    tgrmm nbsms, `onfue`oj tgm l`rst rmncjo`zme `o b ncfcrme hbo.   Mur A 

     Emrhbtcf.  9;;;42;1= nbsms.   Ir A Emrhbtcf.

    9;;:42=-7==.

    29>. Bfbh H, Nbfewmff AI, Mf`mzr` PE. Guhbo pbp`ffchbv`rus-bsscn`btme

    e`j`tbf squbhcus nmff nbrn`ochb1 f`tmrbturm rmv`mw boe rmpcrt cl 92

    omw nbsms.  A Bh Bnbe Emrhbtcf.   9;;>4571>7=->0>.

    295. Y`eemf N, Ybsg`e Y, Ugchbs \. ]ojubf boe pmr`uojubf guhbo

     pbp`ffchbv`rus-bsscn`btme squbhcus nmff nbrn`ochb1 b rmv`mw.  A Bh

     Bnbe Emrhbtcf.  9;224.

    29=. Ibrbo YF, Jcrhfmy EM. [cfyebntyfcus Icwmo‐s e`smbsm cl tgm ob`f.  A 

     Bh Bnbe Emrhbtcf. 207:42:(9 [t 2)19;2-9;5.

    29>;.

    297. ^g`h`zu B, Ubhurb B, Bim H, mt bf. Emtmnt`co cl guhbo

     pbp`ffchbv`rus typm =< `o Icwmo‐s e`smbsm `ovcfv`oj tgm ob`f hbtr`x.

     Ir A Emrhbtcf.  9;;742=7129:>-29:0.

    290. Lcrsfuoe C, Ocre`o [, Boemrssco D, mt bf. EOB bobfys`s `oe`nbtms

     pbt`mot-spmn`l`n guhbo pbp`ffchbv`rus typm 2< strb`os `o Icwmo‐s

    e`smbsm co l`ojmrs boe `o brng`vbf sbhpfms lrch jmo`tbf eyspfbs`b.  Ir A 

     Emrhbtcf.  200:42>5. Ibrbo Y, [mrr`o N. Fcoj`tue`obf mrytgrcoyng̀ b w`tg e`stbf suiuojubf

    dmrbtcs`s1 coyngcpbp`ffchb cl tgm ob`f ime boe Icwmo‐s e`smbsm. Ir A 

     Emrhbtcf.  9;;;425>12>9-2>=.

    2>=. Ibrbo Y, ^`hco N. Fcoj`tue òbf hmfbocoyng b̀1 b syhptch cl 

    Icwmo‐s e`smbsm.  A Bh Bnbe Emrhbtcf.   207742712>=0-2>0150;-50>.

    2>:. Ibrbo Y, M`nghboo B. Fcoj̀ tue`obf hmfbocoyng`b bsscn`btme w`tg

    Icwmo‐s e`smbsm1 twc omw nbsms.   Emrhbtcfcjy (Ibsmf).   200>427;=->;0. Tqu`z 90;19;5-9;0.

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    259. Boerà A, ^bss ], Ugmuo`s B. E`smbsms cl tgm ob`f. @o1 Nbfcoaà M, Irmoo

    U, Fbzbr B, mes. HnDmm‐s [btgcfcjy cl tgm ^d`o. Fcoeco1 Mfsmv`mr4

    9;29. p. 2;re FY, Ycsmo U, Usngmo AB. ^uiuojubf squbhcus nmff

    nbrn`ochb. A Bh Bnbe Emrhbtcf.  2075422(5 [t 9)1:>=-:>7.25;(9 [t 2)1927-992.

    25:. Qb`bn HO, Zm`ss M. Hcgs h`nrcjrbpg`n surjmry cl tgm ob`f uo`t boe

    squbhcus nmff nbrn`ochb.  Emrhbtcf ^urj.   9;;249:195;(9 [t 2)1922-92>.

    2=;. ^turh GH. Icwmo‐s e`smbsm boe =-lfucrcurbn`f. A Bh Bnbe Emrhbtcf.

    20:0421=2>-=99.

    2=2. Ubo I, ^`onfb`r Y, Lcfmy [. [gctceyobh`n tgmrbpy lcr suiuojubfIcwmo‐s e`smbsm.  Bustrbfbs A Emrhbtcf.   9;;545=12:9-2:5.

    2=9. ]shbò O, ^tbifms J@, Umflmr OY, mt bf. ^uiuojubf Icwmo‐s e`smbsm

    trmbtme iy tcp`nbf bh`ocfmvuf`o`n bn`e-pgctceyobh`n tgmrbpy.   A Bh

     Bnbe Emrhbtcf.  9;;=4=>(= ^uppf 2)1^9:>-^9:. ^gmmo P-^, ^gmmo H-N, ^gmu G-H, mt bf. ^qubhcus nmff nbrn`ochb cl 

    tgm i`j tcm sunnmssluffy trmbtme iy `otrb-brtmr̀ bf `olus`co w`tg

    hmtgctrmxbtm. Emrhbtcf ^urj.   9;;>4901079-07>.

    2=5. \bo Jmmrtruyemo A[, Cfmhbos N, Fbpcrtm H, mt bf. \mrruncus

    nbrn`ochb cl tgm ob`f ime.  Lcct Bodfm @ot.   20074201>9:->97.

    2==. Hbtcsc B, Amff`omd O, Umfboj JG. \mrruncus nbrǹ ochb cl tgm ob`f

    uo`t. Bh A Emrhbtcpbtgcf.   9;294>51m2;X.

    2=7. Hbrt`o EM, Mojf̀ sg AN, Jc`tz YA. ^uiuojubf hbf`jobot hmfbochb.

     A Gboe ^urj Bh..   9;224>.

    22120;9-2029.

    2>.

    2:2. G`rbtb ^G, Pbhbeb ^, Mocd`gbrb HP, mt bf. [bttmros cl ob`f hbtr`x boe

     ime cl fcoj`tue`obf hmfbocoyng`b iy `otrbcpmrbt`vm emrhbtcsncpy.  A  Bh Bnbe Emrhbtcf.  9;224;>.

    2:9. Emibri`mux ^, Gcspce \, Empbmpm F, mt bf. [mr`cpmrbt`vm ncolcnbf

    h`nrcsncpy cl tgm ob`f hbtr`x `o tgm hbobjmhmot cl `o s`tu cr 

    h`o`hbffy `ovbs`vm suiuojubf hmfbochbs. Ir A Emrhbtcf.  9;2942. Amff`omd O. Ob`f hbtr̀ x i`cpsy cl fcoj`tue`obf hmfbocoyng`b1

    e`bjocst`n bfjcr`tgh `onfue`oj tgm hbtr`x sgbvm i`cpsy.   A Bh Bnbe 

     Emrhbtcf.  9;;:4=-72;.

    2:5. Ucst` B, [`rbnn`o` IH, em Lbr`bs EN. Embf òj w`tg hmfbocoyng`b.

    ^mh`o Nutbo Hme ^urj.   9;;0497150-=5.

    2:=. Boerà A, Hcufcojumt @, Jcmtthboo-Icovbffct ^. @o s`tu bhmfboct ǹ

    hmfbochb cl tgm ob`f uo`t h`h`nd`oj f`ngmo pfbous1 rmpcrt cl > nbsms.

     Brng Emrhbtcf.   9;2;4257:.

    2:7. L`ofmy >re YD, Er s̀ncff EF, Ifuhmosco FM, mt bf. ^uiuojubf

    hmfbochb1 bo m`jgtmmo-ymbr rmv`mw.   ^urjmry.   2005422-2:=.

    272. Ngcw ZUG, Igbt Z, Hbjeui ^, mt bf. @o s`tu suiuojubf hmfbochb1

    e`j`t sbfvbj`oj nfmbrbonm.   A [fbst Ymncostr Bmstgmt ^urj.   9;294

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    209. Lcrhbo ^I, Lmrr`ojmr UN, Jbrrmtt BI. Ibsbf nmff nbrn`ochb cl tgm ob`f

    uo`t. A Bh Bnbe Emrhbtcf.   9;;:4=. ^gbg E, Fmcpcfe J, ^cwemo A. Ibsbf nmff nbrn`ochb hbsqumrbe`oj bs

    gbi`t t`n. Nf`o Mxp Emrhbtcf.   9;224>01>0:->07.

    20=. ^mrrboc-Crtmjb ^, Lmroâoemz-Bojmf @, Eufbotc-Nbhpcs M, mt bf. Ibsbf

    nmff nbrn`ochb br`s`oj `o prclmss`cobf rbe`cemrhbt`t`s cl tgm ob`f.  Ir A 

     Emrhbtcf.  9;;9425:1