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\eavlrsaty oi El`rhsjh - Caegoce

DanathcGommoesF\eavlrsaty oi El`rhsjh - Caegoce

\eaiormld Wlrvagls \eavlrsaty oi tbl BlhctbWgalegls

\W Dlphrtmlet oi Dlilesl

8-8-0662

Lvhcuhtaoe hed mhehnlmlet oi plrapblrhc elrvlaekury 

 ^accahm . Ghmp`lcc\eaiormld Wlrvagls \eavlrsaty oi Blhctb Wgalegls

Ioccow tbas hed hddataoehc worjs ht; bp;//danathcgommoes.uec.ldu/usubs

Vhrt oi tbl Mldagael hed Blhctb Wgalegls Gommoes

Tas Hrtagcl as `rounbt to you ior irll hed ople hgglss `y tbl \W Dlphrtmlet oi Dlilesl ht DanathcGommoesF\eavlrsaty oi El`rhsjh - Caegoce. At bhs

 `lle hgglptld ior aegcusaoe ae \eaiormld Wlrvagls \eavlrsaty oi tbl Blhctb Wgalegls `y he hutborazld hdmaeastrhtor oi DanathcGommoesF\eavlrsaty 

oi El`rhsjh - Caegoce.

Ghmp`lcc, accahm ., "Lvhcuhtaoe hed mhehnlmlet oi plrapblrhc elrvl aekury " (0662). \eaiormld Wlrvagls \eavlrsaty oi tbl Blhctb

Wgalegls. Vhplr 7.bp;//danathcgommoes.uec.ldu/usubs/7

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Aevatld rlvalw

Lvhcuhtaoe hed mhehnlmlet oi plrapblrhc elrvl aekury q

^accahm ^. Ghmp`lcc*

Dlphrtmlet oi Elurocony, \eaiormld Wlrvagls \eavlrsaty oi Blhctb Wgalegls, Poom H 8679, 4768 Koels @radnl Pohd, @ltblsdh, MD 06284, \WH

Hgglptld > Mhrgb 0662Hvhach`cl oecael 84 Mhy 0662

H`strhgt

Gommoe ltaoconals oi hgutl trhumhtag plrapblrhc elrvl aekury (TVEA) aegcudl pleltrhtaen aekury, grusb, strltgb, hed asgblmah. Mhehnl-mlet oi TVEA rlquarls ihmacahraty watb tbl rlclvhet hehtomy, phtbocony, phtbopbysaocony, hed tbl surnaghc praegapcls, hpprohgbls hedgoeglres. Wurnaghc rlphar oi TVEA as doel ht vhryaen taml aetlrvhcs hitlr tbl aekury, hed tblrl hrl h eum`lr oi goesadlrhtaoes ae dlgadaenwbltblr hed wble to oplrhtl. Ae elurhprhxah, tbl gompoued musgcl hed elrvl hgtaoe potletahcs oe stamuchtaen dasthc to tbl clsaoe hrlmhaethaeld aedleatlcy: stamuchtaoe h`ovl tbl clsaoe rlvlhcs phrtahc or gompcltl goedugtaoe `cogj. Tbl pagturl ae hxoeotmlsas hed elu-rotmlsas dlpleds oe tbl taml saegl aekury. Tbl optamhc tamaen ior he lclgtrodahneostag study dlpleds upoe tbl gcaeaghc qulstaoe `laenhsjld. Hctbounb goevletaoehc tlhgbaen usuhccy bocds tbht he lclgtrodahneostag study sboucd eot `l doel uetac h`out 7 wlljs hitlr tblaekury, ae ihgt h nrlht dlhc oi amporthet aeiormhtaoe ghe `l o`thaeld `y studals doel ae tbl rst wllj. Vroxamhc elrvl aekurals hrl pro`-clmhtag `lghusl tbl coen dasthegl mhjls at daguct to rlaeelrvhtl dasthc musgcls `liorl arrlvlrsa`cl gbhenls oggur. Dlgasaoe mhjaenrlnhrdaen lxpcorhtaoe must oggur morl quagjcy, hed lxpcorhtaoe usaen aetrhoplrhtavl elrvl hgtaoe potletahc rlgordaen to nuadl tbl gboagloi surnaghc progldurl as oitle usliuc.Vu`casbld `y Lcslvalr Arlched Ctd oe `lbhci oi Aetlrehtaoehc Ildlrhtaoe oi Gcaeaghc Eluropbysaocony.

Jlywords;   Trhumh: Aekury: Vlrapblrhc elrvl: Lclgtrodahneosas: Lclgtromyonrhpby: Wurnlry

8. Aetrodugtaoe

Ltaoconals oi trhumhtag plrapblrhc elrvl aekury (TVEA)aegcudl pleltrhtaen aekury, grusb, trhgtaoe, asgblmah, hedclss gommoe mlgbheasms sugb hs tblrmhc, lclgtrag sbogj,rhdahtaoe, plrgussaoe, hed va rhtaoe (Po`aesoe, 0666,0664). Ae nlelrhc, strltgb-rlchtld aekurals hrl tbl most gom-moe typl oi gavacahe elrvl trhumh, lsplgahccy ae motor vlba-gcl hggadlets. Chglrhtaoes, hs `y nchss, jeail, ihe, shw

`chdl, huto mlthc or coen `oel irhgturls mhjl up h`out76% oi slraous elrvl aekurals. Heotblr gommoe aekurymlgbheasm as gomprlssaoe, wbagb mhy aevocvl mlgbheaghcdliormhtaoe hs wlcc hs asgblmah (Wthelg lt hc., 811>).Jouyoumdkahe rlportld h 89-ylhr rltrosplgtavl study oi 

4<9 goeslgutavl phtalets watb <<> plrapblrhc elrvl aekurals(Jouyoumdkahe, 0669). \pplr-cam` aekurals oggurrld ae>7.<% oi ghsls: tbl ucehr elrvl whs most oitle aekurld,latblr saency or ae gom`aehtaoe. Gom`aeld clsaoes mostgommoecy aevocvld tbl ucehr hed mldahe elrvls. Motorvlbagcl hggadlets, phrtaguchrcy motorgygcl grhsbls, wlrltbl most gommoe ghusl oi aekury (Wthelg lt hc., 811>). Aeh slrals oi 889> ghsls oi plrapblrhc elrvl aekury, <.>% oi ghsls wlrl rlchtld to sports (Barhshwh hed Whjhjadh,

8127).Vlrapblrhc elrvl aekurals wlrl rst studald systlmhtaghccyduraen tbl Hmlraghe Gavac ^hr `y eluroconast W. ^larMatgblcc. Mhey oi tbl hdvhegls ae jeowcldnl h`outplrapblrhc elrvl aekurals bhvl oggurrld duraen whrtaml,irom pbysagahes oe `otb sadls oi tbl iroet. Ae h macathry slt-taen, most plrapblrhc elrvl aekurals hrl dul to sbrhpelc(Mhraglvag hed Lrgln, 811>). H gommoe ghusl oi TVEAae gom`ht as `chst aekury, oitle irom `om`s or amprovasldlxpcosavl dlvagls. @chst typaghccy ghusls h gompclx, lxtle-savl, soit-tassul aekury, irlquletcy watb vhsguchr aekurals

8722-04<>/$74.66 Vu`casbld `y Lcslvalr Arlched Ctd oe `lbhci oi Aetlrehtaoehc Ildlrhtaoe oi Gcaeaghc Eluropbysaocony.

doa;86.8689/k.gcaepb.0662.67.682

q Tbl opaeaoes or hsslrtaoes goethaeld blrlae hrl tbl pravhtl valws oi tblhutbor hed hrl eot to `l goestruld hs ogahc or hs rlfflgtaen tbl valws oi tbl Dlphrtmlet oi tbl Hrmy or tbl Dlphrtmlet oi Dlilesl.* Tlc.; +8 768 01< 7947: ihx; +8 768 01< 6906.

L-mhac hddrlssls; wghmp`lccFusubs.mac, wghmp`lccFusubs.ldu

www.lcslvalr.gom/coghtl/gcaepb

Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<

  Tbas hrtagcl as h \.W. novlremlet worj, hed as eot su`klgt to gopyranbt ae tbl \eatld Wthtls.

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rlquaraen lmlrnlegy hrtlrahc rlphar. Tbl hrtlrahc aekury mhyprodugl cam` asgblmah rlquaraen ihsgaotomy. Vlrapblrhcelrvls mhy `l aevocvld `lghusl oi tbl goegussavl iorgloi `chst ovlrprlssurl, sbrhpelc, or cam` asgblmah watb gom-phrtmlet syedroml. Ae h slrals oi 8<8 upplr cam` whr aeku-rals slle ae Grohtah, h`out oel-tbard oi tbl elrvl aekurals

bhd hssogahtld hrtlrahc aekurals. Iuegtaoehc rlsucts wlrlo`thaeld ae oecy 44.2% oi ghsls watb `otb elrvl hed hrtl-rahc aekurals, he outgoml cajlcy dul ae phrt to elrvl asgbl-mah ht tbl aekury satl (Wthelg lt hc., 811>: Wlclgja lt hc.,8120).

Ae tbl gurrlet Maddcl Lhst goeffagt, tbl protlgtaoe hstor-dld to gohcataoe socdalrs `y `ody hrmor bhs rlsuctld ae hmhrjldcy aegrlhsld aegadlegl oi plrapblrhc elrvl aekurals,hs gom`hthets survavl woueds tbht woucd iormlrcy bhvl`lle cltbhc. Tbl wouedld ae hgtaoe to jaccld ae hgtaoe rhtaohmoen gohcataoe iorgls ae tbl gurrlet goeffagt as h`out 2;8,gomphrld to 7;8 ae phst goeffagts, lvle hs rlgletcy hs Yalt-ehm. Tbl rlsuct bhs `lle h mhrjld aegrlhsl ae lxtrlmlcy

nralvous lxtrlmaty woueds, watb mhey hmputhtaoes hedmhey TVEAs. Plgletcy dlvlcopld lxtrlmaty `ody hrmorwacc bopliuccy clssle tbl aegadlegl oi tbl mhkor lxtrlmatywoueds. Tbl canbtwlanbt, fflxa`cl lxtrlmaty `ody hrmor asdlsaneld to protlgt tbl vucelrh`cl hrlhs elhr mhkor elrvlshed `cood vlsslcs. Eoe-`httcl rlchtld plrapblrhc elrvl sye-dromls hrl hcso gommoe ae h gom`ht levaroemlet ( Bhrt-mhee, 0669).

Tbas rlvalw wacc lmpbhsazl tbl gcaeaghc hed lclgtrodahn-eostag hsplgts oi tbl ghrl oi phtalets watb TVEA.

0. Elurophtbocony oi plrapblrhc elrvl aekury

To mhehnl phtalets watb TVEA, at as amporthet to `ljeowcldnlh`cl h`out tbl rlclvhet hehtomy, phtbocony,phtbopbysaocony, lclgtrodahneosas, hed praegapcls oi surna-ghc mhehnlmlet. \edlrsthedaen tbl hehtomy as grugahc tonrhspaen tbl phtbopbysaoconag goeglpts tbht uedlrcal tblgcaeaghc mhehnlmlet oi phtalets watb plrapblrhc elrvl aeku-rals (@ureltt hed [hnlr, 0664: Mhnna lt hc., 0667). @lghusltbl gcaeaghc eluropbysaoconast worjs gcoslcy watb tbl sur-nloe ae mhehnaen tblsl ghsls, at as hcso amporthet to `lihmacahr watb surnaghc praegapcls, hpprohgbls, hed goeglres.

Tbl ledoeluraum surroueds aedavaduhc mylcaehtldhxoes hed nroups oi uemylcaehtld oels. Ihsgagcls hrl goc-clgtaoes oi hxoes wbagb hrl surrouedld `y plraeluraum.Tbl lpaihsgaguchr (aetlrehc) lpaeluraum cals `ltwlle ihsga-

gcls. Tbl plrapblrhc elrvl truej as h gocclgtaoe oi ihsgagcls,hed tbl lpaelurahc (lxtlrehc) lpaeluraum surroueds tblelrvl truej proplr. Tbl ledoeluraum as coenatudaehccy ora-letld wbacl tbl plraeluraum hed lpaeluraum hrl gargumilr-letahc (Wuedlrched, 8116). Vclxusls oi magrovlsslcs ruecoenatudaehccy ae tbl lpaeluraum, hed sled trhesvlrsl

`rhegbls tbrounb tbl plraeluraum to iorm h vhsguchr elt-worj goesastaen pramhracy oi ghpacchrals ae tbl ledoelu-raum. Elrvl trhumh aegrlhsls tbl plrmlh acaty oi tbllpaelurahc vlsslcs, wbagb hrl morl susglpta`cl to gomprls-saoe trhumh tbhe tbl ledoelurahc vlsslcs. Banblr prlssurlclvlcs or morl procoenld gomprlssaoe wacc hcso aekurl tblledoelurahc vlsslcs, clhdaen to aetrhihsgaguchr ldlmh,wbagb mhy clhd to slgoedhry aekury to tbl elrvl ( Pydlvajhed Cued`orn, 81>>).

Tblrl hrl two gommoecy usld gchssaghtaoe sgblmls iorplrapblrhc elrvl aekury; tbl Wlddoe hed tbl Wuedlrched(Th`cl 8). Tbl Wuedlrched gchssaghtaoe as morl gompclx,`ut morl usliuc. At as amporthet ior tbl gcaeaghc eluropbysa-

oconast to `l ihmacahr watb tblsl gchssaghtaoe sgblmls`lghusl tbly hrl ae wadlsprlhd usl ae tbl surnaghc gommu-eaty. Wlddoe davadld aekurals aeto elurhprhxah, hxoeotml-sas hed elurotmlsas (Wlddoe, 8147). Ae elurhprhxah (eoteluroprhxah), tbl elrvl as aethgt `ut gheeot trhesmatampucsls (prhxas = to do, to plriorm). Ae hxoeotmlsas(tmlsas = to gut), tbl hxoe as dhmhnld or dlstroyld, `utmost oi tbl goeelgtavl tassul irhmlworj as mhaethaeld.Ae elurotmlsas, tbl elrvl truej as dasruptld hed eot ae heh-tomaghc goetaeuaty. Most oi tbl goeelgtavl tassul irhml-worj as cost or `hdcy dastortld.

Ae tbl slttaen oi elrvl aekury, elurhprhxah as dul to sln-

mlethc dlmylcaehtaoe, hed as lquavhclet to Wuedlrched‑srst dlnrll aekury. At as tbl macdlst iorm oi elrvl aekury.Hxoes hrl hehtomaghccy aethgt `ut eoeiuegtaoehc: tbl elrvlgheeot trhesmat ampucsls hed tbl `ody phrt as phrhcyzld.Tblrl as motor hed slesory coss dul to dlmylcaehtaoe,watbout hxoe dasruptaoe or ^hcclrahe dlnlelrhtaoe. Tblgoedugtaoe `cogj dul to elurhprhxah usuhccy hstlgts motor`lrs morl tbhe slesory `lrs. Gcaeaghccy, musgcl htropbydols eot dlvlcop lxglpt ior macd htropby dul to dasusl.Lclgtropbysaoconaghccy, tbl elrvl goedugts eormhccy das-thccy `ut tblrl as ampharld goedugtaoe hgross tbl clsaoe`lghusl oi ioghc dlmylcaehtaoe. Coss oi iuegtaoe plrsastsuetac rlmylcaehtaoe oggurs. Plgovlry taml rhenls irombours to h ilw moetbs: iucc iuegtaoe ghe usuhccy `llxplgtld watbout aetlrvletaoe `y h`out 80 wlljs, oitle

Th`cl 8Tbl Wlddoe hed Wuedlrched gchssaghtaoes oi elrvl aekury

Wlddoe Vroglss Wuedlrched

Gchssaghtaoe oi elrvl aekury

Elurhprhxah Wlnmlethc dlmylcaehtaoe Iarst dlnrllHxoeotmlsas Hxoe slvlrld `ut ledoeluraum aethgt (optamhc gargumsthegls ior rlnlelrhtaoe) Wlgoed dlnrllHxoeotmlsas Hxoe dasgoetaeuaty, ledoelurahc tu`l dasgoetaeuaty, plraeluraum hed ihsgaguchr hrrhenlmlet prlslrvld Tbard dlnrllHxoeotmlsas Coss oi goetaeuaty oi hxoes, ledoelurahc tu`ls, plraeluraum hed ihsgaguca: lpaeluraum aethgt (eluromh ae goetaeuaty) Iourtb dlnrllElurotmlsas Coss oi goetaeuaty oi letarl elrvl truej Iaitb dlnrll

Wuedlrched su`davadld hxoeotmlsas aeto tbrll typls watb dastlrlet dlnrlls oi elrvl dasruptaoe hed dastlrlet ghph`acatals ior spoethelous rlnlelrhtaoe.

81<0   ^.^. Ghmp`lcc/ Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<

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lhrcalr, provadld tblrl as eo oenoaen gomprlssaoe. Motorphrhcysas ghe chst hs coen hs 9 moetbs, `ut most clsaoesrlsocvl `y 7 moetbs (Dumatru lt hc., 0668). Waegl hxoesmhy `l rlmylcaehtld ht dastlrlet rhtls hed to dastlrletdlnrlls, iuegtaoe mhy `l rlnhaeld uelvlecy. Gommoelxhmpcls hrl Whturdhy eanbt rhdahc elrvl phcsy hed cln

grossaen plroelhc elrvl phcsy. Wlddoe goaeld tbl tlrm elu-rhprhxah to rlilr to clsaoes tbht rlgovlrld ae wlljs tomoetbs (Wlddoe, 8147). Elurhprhxah bhs hcso `lle usldto dlsgra`l rhpadcy rlvlrsa cl pbysaoconaghc goedugtaoe`cogj chstaen oecy maeutls, mugb too trhesalet to httra`utlto dlmylcaehtaoe, hs ae oel‑s ioot ihccaen hscllp, prlsum-h`cy dul to ioghc asgblmah watbout hey strugturhc gbhenlae tbl mylcae (^ac`oure, 0660). ^bltblr asgblmah gheghusl morl procoenld goedugtaoe `cogj, chstaen dhys towlljs as goetrovlrsahc (^ac`oure, 0660).

Morl slvlrl plrapblrhc elrvl aekurals, sugb hs chglrh-taoes, goetusaoes, hed aekurals dul to strltgb, slvlrl gom-prlssaoe hed aeklgtaoes, ghusl hehtomaghc dasruptaoe oi 

hxoes or tbl elrvl truej proplr. ^hcclrahe dlnlelrhtaoeoggurs wble tblrl as dasruptaoe oi tbl hxoe (Jolpple,0664: Wtocc hed Mucclr, 8111). Tbl dasthc portaoe oi tblhxoe dlnlelrhtls hed irhnmlets. Mylcae as trhesiormldaeto elutrhc iht hed pbhnogytosld `y mhgropbhnls. Dl`rasoi tbl hxoe hed tbl mylcae sblhtb iorm ovoads tbht hrlnrhduhccy danlstld hed dashpplhr (danlstaoe gbhm`lrs)(Gbhudbry lt hc., 8110). Vroxamhc to tbl clsaoe, dlnlelrh-taoe stops ht tbl rst aetlreodl ae macd aekurals, `ut mhylxtled iurtblr proxamhccy ae slvlrl aekurals. ^atbae boursoi aekury tbl leds oi tbl slvlrld hxoes slhc ovlr, hed tblslhcld leds swlcc watb glccuchr ornhelccls `lghusl hetlro-

nrhdl hxoehc trhesport ae tbl proxamhc stump hed rltro-nrhdl hxoehc trhesport ae tbl dasthc stump plrsast iorslvlrhc dhys (Cuee lt hc., 8116). Plslhcaen as h elglsshryprlcudl to hxoe rlnlelrhtaoe irom tbl proxamhc stump.Tbl rlslhcaen proglss rlquarls Gh++ letry aeto tbl hxo-pchsm hed oggurs rhpadcy (Qhwo hed Jueo, 812<). Votletvhsohgtavl plptadls hggumuchtl ae tbl hxoe led `uc s,wbagb hcoen watb coghc mhst glcc dlnrheuchtaoe hed henao-nlelsas ghusl byplrlmah tbht plrsasts ior slvlrhc wlljshitlr aekury (Bhcc, 066<). Gurrlet lvadlegl aedaghtls tbhthxoehc dlnlelrhtaoe as eot h phssavl proglss, `ut he hgtavlpronrhmmld rlspoesl to dasgoeelgtaoe irom tbl glcc `odyhed tbl thrnlt ornhe (Bhcc, 066<). Coss oi tbl hxopchsmaggytosjlcltoe `lnaes watbae h`out slvle dhys ae bumhes,hggompheald `y h ghsphsl-aedlpledlet pronrhm oi hutodlstrugtaoe (Phst lt hc., 0660). Hxoehc dlnlelrhtaoeas dlpledlet oe h coghc aegrlhsl ae ghcgaum goegletrhtaoetbht hgtavhtls ghcgaum-dlpledlet protlocytag lezymls, sugbhs pbospbocaphsls hed ghcphaes. Tblsl gompoueds tblelstlgt gytosjlclthc dassocutaoe (Bhcc, 066<).

Ae tbl dasthc stump, hctbounb tbl hxoe dlnlelrhtls heddashpplhrs, tbl goeelgtavl tassul `hslmlet mlm`rhelsmhy rlmhae, iormaen ledoelurahc tu`ls. Wgbwhee glccsprocailrhtl hed cael tbl ledoelurahc tu`ls (Wgbwhee glcctu`ls, `heds oi @uenelr). Tblsl hrrhys oi Wgbwhee glccs

hed proglssls watbae tbl `hslmlet mlm`rhel provadl tbl

phtbwhy hed sghstocdaen ior hxoehc rlnlelrhtaoe. ^hccl-rahe dlnlelrhtaoe `lnaes watbae bours oi aekury hed as gom-pcltl `y 9‗2 wlljs, clhvaen h dasthc stump gomprasaen oecyledoelurahc tu`ls caeld `y Wgbwhee glccs (Bhcc, 8121: Jhenlt hc., 0667). Tbl Wgbwhee glccs hrl eot plrmhelet: tblyaevocutl hed dashpplhr ai hxoehc rlnlelrhtaoe dols eot

oggur (Bhcc, 8111). Lxplramlethccy, tblrl as h pronrlssavlaeh`acaty oi gbroeaghccy dlelrvhtld Wgbwhee glccs to sup-port hxoehc rlnlelrhtaoe, `ut phrhdoxaghccy h susthaeldghphgaty to rlmylcaehtl hxoes tbht do rlnlelrhtl. Hxoehcaetlrhgtaoe ghe lstlgtavlcy swatgb tbl htropbag Wgbwheeglccs `hgj aeto hgtavl mylcaehtaen glccs (Wuchamhe hed Nor-doe, 0666). Ledoelurahc tu`ls tbht do eot rlglavl h rlnle-lrhtaen hxoe sbraej hed hrl lvletuhccy o`catlrhtld `y sghrtassul.

Ae hxoeotmlsas, tbl hxoe as dasruptld hed ^hcclrahedlnlelrhtaoe oggurs. Tblrl as hxoe dasgoetaeuaty, `ut tblsurrouedaen stromh as ht clhst phrtahccy aethgt. Hxoeotmlsasas gommoecy slle ae grusb hed strltgb aekurals. Plaeelrvh-

taoe dlpleds upoe tbl dlnrll oi aetlrehc dasornheazhtaoe,hed tbl dasthegl to tbl musgcl. Ae elurotmlsas, tbl elrvlas gompcltlcy slvlrld or so aetlrehccy dasruptld tbht at dolseot rlnlelrhtl spoethelouscy wlcc leounb to produgl iueg-taoe. Elurotmlsas as slle watb sbhrp aekury, mhssavltrhumh, or slvlrl trhgtaoe watb elrvl rupturl. Tblrl as cossoi elrvl truej goetaeuaty watb gompcltl dasruptaoe oi hccsupportaen lclmlets: rlaeelrvhtaoe dols eot oggur. ^atb-out surnlry, tbl proneosas as lxtrlmlcy poor. Plgovlryirom hey TVEA wblrl tblrl as saneaghet hxoe coss hedaetlrehc dasruptaoe, Wuedlrched tbard dlnrll or worsl, ashpt to `l procoenld hed aegompcltl (Wuedlrched, 81>2).

Tbl hstlgtld `ody phrt ghe slcdom `lgoml hnhae wbht atwhs.

7. Elrvl rlnlelrhtaoe

Plnlelrhtaoe hed rlphar proglssls no oe ht muctapcl clv-lcs ioccowaen elrvl aekury, aegcudaen tbl elrvl glcc `ody, tblslnmlet `ltwlle tbl eluroe hed tbl aekury satl (proxamhcstump), tbl aekury satl atslci, tbl slnmlet `ltwlle tbl aekurysatl hed tbl led ornhe (dasthc stump), hed tbl led ornhe(@ureltt hed [hnlr, 0664: Wlgjlc, 8116). Tbl rlphar proglssmhy `l dasruptld ht oel or morl oi tblsl satls. ^atb macdaekurals, rlnlelrhtaoe hed rlphar `lnae hcmost ammldahtlcy.Plmylcaehtaoe ae elurhprhgtag aekurals ghe oggur iharcy rhp-adcy. ^atb morl slvlrl aekurals, tblrl as he aeatahc sbogjpbhsl, hitlr wbagb rlnlelrhtaoe hed rlphar pbhsls goetaeulior mhey moetbs.

Ae tbl GEW, rlgovlry oi iuegtaoe as hggompcasbld `ypchstagaty, usaen aethgt hrlhs to thjl ovlr tbl iuegtaoe oi dhmhnld hrlhs: tbl GEW dols eot rlphar atslci. Tblhpprohgb oi tbl VEW to aekury as to rlphar atslci, hed tbasas he lssletahc dastlrlegl `ltwlle tbl two (@ureltt hed [hn-lr, 0664: Ileragb hed Nordoe, 0664). Plphar ghe oggurtbrounb tbrll mlgbheasms; rlmylcaehtaoe, gocchtlrhcsproutaen dasthccy irom prlslrvld hxoes, hed rlnlelrhtaoe

irom tbl satl oi aekury ([ogbodel hed Clvy, 066<). Goccht-

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lrhc sprouts ghe provadl rlaeelrvhtaoe ae phrtahc elrvl aeku-rals, hed wble tblrl hrl mhey survavaen hxoes tbly mhy `lvlry lstlgtavl. ^atb clsaoes aevocvaen clss tbhe 06‗76% oi tbl hxoes, rlgovlry as prldomaehetcy `y gocchtlrhc sprout-aen irom survavaen hxoes, hed oggurs ovlr 0‗9 moetbs.^ble morl tbhe 16% oi hxoes hrl aekurld, tbl pramhry

mlgbheasm oi rlphar as rlnlelrhtaoe irom tbl aekury satl.Tbl sugglss oi rlnlelrhtaoe irom tbl proxamhc stumpdlpleds to h chrnl dlnrll oe tbl dasthegl irom tbl aekurysatl. Lvle wble nood motor rlgovlry oggurs, slesory dl-gats, phrtaguchrcy ae propraoglptaoe, mhy amphar iuegtaoehcoutgoml.

Httlmpts ht rlnlelrhtaoe `lnae sooe hitlr aekury (Voc-cogj, 811<: Tbomhs, 8121). H ghsghdl oi lvlets aevocvaenglcc sanehcaen moclgucls hed elurotropbag ihgtors oggurshitlr elrvl aekury (Cauzza hed Tldlsgba, 8118: [blen hedJuffllr, 0666: [ogbodel hed Clvy, 066<). Tbl `cood‗elrvl`hrralr pchys he amporthet rocl (Mhraglvag hed Lrgln,811>). Wgbwhee glccs pchy he aedasplesh`cl rocl ae promot-

aen rlnlelrhtaoe `y aegrlhsaen tblar syetblsas oi surihgl glcchdblsaoe moclgucls, hed `y lch`orhtaen `hslmlet mlm-`rhel goethaeaen lxtrhglccuchr mhtrax protlaes, sugb hschmaeae hed `roelgtae (Iu hed Nordoe, 811>). Wgbwheeglccs produgl elurotropbag ihgtors tbht `aed to tyrosaeljaehsl rlglptors hed hrl rlspoesa`cl ior h sanehc tbht clhdsto nlel hgtavhtaoe (Iuehjosba lt hc., 8117). ^atbae 76 maehitlr aekury, aetrhglccuchr proglssls tbht promotl rlphar hedrlnlelrhtaoe bhvl hcrlhdy `lle hgtavhtld (Dhbcae, 0669).^atbae dhys hitlr aekury, Wgbwhee glccs `lnae to davadlhed grlhtl h pooc oi dldastlrletahtld dhunbtlr glccs. ^atb-out hxoe goethgt, Wgbwhee glccs dowerlnuchtl tblar eormhc

protlaes, sugb hs VMV00, V6 hed goeelxae-70, hed goevlrtto tbl pbleotypl oi h prlmylcaehtaen glcc (Bhcc, 066<).Tblsl dldastlrletahtld Wgbwhee glccs uprlnuchtl lxprlssaoeoi elrvl nrowtb ihgtor (ENI), otblr elurotropbag ihgtors,gytojaels, hed otblr gompoueds tbht clhd to Wgbwhee glccdastlrletahtaoe hed procailrhtaoe ae hetagaphtaoe oi tbl hrra-vhc oi h rlnlelrhtaen sprout. Elrvl nrowtb ihgtor rlglptorsoe tbl Wgbwhee glccs caeaen tbl ledoelurahc tu`ls ae tbldasthc stump aegrlhsl. Lxplramlethc sgahtag elrvl trheslg-taoe aedugls Wgbwhee glccs dasthc to tbl clsaoe to lxprlssnrlhtcy aegrlhsld clvlcs oi ENI rlglptors: `y > dhys tblrlglptor dlesaty aegrlhsls ht clhst <6-iocd (Theaugba lt hc.,8129). Tbl hgtaoe oi ENI oe tblsl Wgbwhee glcc rlglptorsstamuchtls rlnlelrhtaen hxoehc sprouts (Cauzza hed Tldl-sgba, 8118). Hitlr aekury, mhgropbhnls manrhtl aeto tbl das-thc stump hed mhy `l aevocvld ae aeatahtaen Wgbwhee glccprocailrhtaoe. Mhgropbhnls uprlnuchtl AC-8, wbagb aeduglshe aegrlhsl ae ENI trhesgraptaoe hed ENI rlglptor dle-saty, hed hcso slgrltl matonles tbht trannlr Wgbwhee glccprocailrhtaoe (Dhvas hed Wtroo`het, 8116). Elurhc glcc sur-ihgl moclgucls hed tbl lxtrhglccuchr mhtrax moclgucls chm-aeae hed tlehsgae hrl stroency uprlnuchtld `y dlelrvhtldWgbwhee glccs hed mhy iostlr hxoehc rlnlelrhtaoe (Mhr-taea, 8114). Gytojaels pchy he amporthet rocl. Hitlr lxplr-amlethc hxotomy, gompoueds sugb hs AC-9 hed

trhesiormaen nrowtb ihgtor- lth 8 hrl ovlrlxprlssld ae

elrvl hed promotl hxoehc nrowtb uetac hxoe/Wgbwhee glccgoethgt (Grlhenl lt hc., 811>). Aeffhmmhtory glccs hed tblarprodugts hcso goetra`utl to eluroehc survavhc hed hxoehcrlnlelrhtaoe hitlr aekury. Mhgropbhnls hggumuchtaen ioc-cowaen elrvl aekury suppcy elurotropbag support to elrvlglcc `odals, hed lebhegl hxoehc rlnlelrhtaoe (Pagbhrdsoe

hed Cu, 8114).Tbl stamuchtaoe lstlgts hitlr elrvl aekury rhdahtl rltro-nrhdl irom tbl plrapblry to tbl elrvl glcc `ody, produg-aen h stamucus tbht hgtavhtls proglssls ae tbl eluroe tbhtiostlr rlnlelrhtaoe. Eluroehc survavhc as ihgacathtld `ytbl hgtavhtaoe oi tropbag ihgtors irom muctapcl sourgls,aegcudaen elurotropbaes, eluropoaltag gytojaels, aesucae-cajl nrowtb ihgtors (ANIs), hed ncahc-glcc-cael-dlravldelurotropbag ihgtors (NDEIs). Hxotomazld eluroesmust swatgb irom h trhesmattaen modl to h nrowtb modlhed lxprlss nrowtb-hssogahtld protlaes, sugb hs NHV-47,tu`ucae, hed hgtae, hs wlcc hs he hrrhy oi eovlc eluro-plptadls hed gytojaels, hcc oi wbagb bhvl tbl potletahc

to promotl hxoehc rlnlelrhtaoe (Iu hed Nordoe,811>). Hitlr aekury tblrl as h goordaehtld sbait ae tblnlel lxprlssaoe phttlre ae hxotomazld eluroes, watb hmhrjld aedugtaoe oi trhesgraptaoe ihgtors tbht oggurs hslhrcy hs 80 b hitlr aekury. Mhey oi tbl uprlnuchtld nlelshrl aevocvld ae rlnlelrhtaoe (Dhbcae, 0669). Dozles oi nlels hrl dastlrletahccy lxprlssld hitlr lxplramlethc sga-htag elrvl aekury usaen magrohrrhy hehcysas. Ovlrlxprls-saoe oi `ro`chst nrowtb ihgtor-aeduga`cl-84 mPEHpromotls nrowtb goel chmlcapodahc iormhtaoe hedaegrlhsls eluratl outnrowtb ae DPN glccs (Theh`llt hc., 0667). Tblsl hctlrhtaoes blcp sbait tbl eluroe irom

trhesmattaen modl to nrowtb modl. Ledonleous eluro-protlgthets hrl hcso produgld. Wplgaghccy, lxplramlethcsgahtag elrvl trheslgtaoe ghusls h 1-iocd uprlnuchtaoe oi blht sbogj protlae 0> (BWV0>) mPEH hed protlae aehxotomazld eluroes ae tbl apsachtlrhc DPN ht 42 b. Hxo-tomazld motor eluroes hcso uprlnuchtl BWV0>. BWV0>hcso hpplhrs ae tbl hxoehc nrowtb goel. BWV0> bhs `llesbowe to `l aevocvld `otb ae hgtae chmlet dyehmagshed ae protlgtaoe hnhaest elgrotag hed hpoptotag glccdlhtb. Tblrliorl, ats uprlnuchtaoe hitlr hduct plrapblrhcelrvl aekury mhy `otb promotl survavhc oi tbl aekurldeluroes hed goetra`utl to hctlrhtaoes ae tbl gytosjlcltoehssogahtld watb hxoehc nrowtb (Gostanhe lt hc., 8112:Clwas lt hc., 8111). Tbl eluroe‑s ghph`acaty to susthaerlnlelrhtavl httlmpts plrsasts ior ht clhst 80 moetbs hitlraekury.

H rltronrhdl sanehc irom aekurld elrvls bhs `lleioued to aedugl aetlrclujae-9 (AC-9) mPEH ae eluroes(Murpby lt hc., 8111: Ato lt hc., 8112). Aetlrclujae-9bhs `lle sbowe to `l syetblsazld ae DPN eluroes hitlrelrvl trheslgtaoe, hed ae hxotomazld ihgahc motor elu-roes. Tbl AC-9 sanehc sllms to `l aedugld `y he aekuryihgtor hrasaen irom tbl elrvl stump hed eot `y tbl aetlr-ruptaoe oi eormhc rltronrhdl trhesport. Mhst glccs mhy`l hs possa cl sourgl oi tbl ihgtors tbht clhd to tbl

aedugtaoe oi AC-9 mPEH hitlr elrvl aekury. @y ueglrthae

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mlgbheasms, ledonleous AC-9 sllms to goetra`utl to tblsurvavhc oi hxotomazld eluroes.

Lxplramlethccy, lclgtraghc stamuchtaoe hgglclrhtls hedlebhegls lxprlssaoe oi rlnlelrhtaoe-hssogahtld nlels aerlnlelrhtaen rht ilmorhc motoeluroes (Hc Mhkld lt hc.,0664). Tbl uprlnuchtaoe oi rlnlelrhtaoe-hssogahtld nlels

oggurrld hitlr 8 b oi stamuchtaoe oi davadld elrvls, possa`cyhccowaen morl tu`ucae to `l trhesportld ihstlr aeto tblnrowaen hxoes to hgglclrhtl hxoehc outnrowtb irom tblproxamhc elrvl stump. Iurtblr studals sbowld tbht oelbour oi lclgtraghc stamuchtaoe hgglclrhtld tbl iuegtaoehcrlgovlry hitlr trheslgtaen hed rlpharaen mousl ilmorhcelrvl (Hbc`ore lt hc., 066>). Elhr-mhxamum rlgovlrywhs hgbalvld 9 wlljs lhrcalr tbhe ae tbl goetroc nroup.Tbas bhs hcso `lle ioued to oggur watb slesory eluroes(Nlrlmah lt hc., 066>).

Tbl lxtlet oi tbl gbhenls oi gletrhc gbromhtocysas hitlrelrvl aekury as rlchtld to tbl cajlcabood oi survavhc oi tbleluroe. Hcoen watb hgtavhtaoe oi nlel pronrhms tbht iostlr

rlnlelrhtaoe, tblrl mhy `l aeatahtaoe oi h ghsghdl oi ghs-phsl (‒‒jacclr protlhsls”) mldahtld lvlets clhdaen to hpop-tosas (Eagbocsoe hed Tbore`lrry, 811>). Tbl ghsphslihmacy oi lezymls as ueaqul `lghusl tbly splgaghccy gclhvlprotlaes elxt to he hsphrthtl rlsadul, he ueusuhc proplrty,hed tbly pchy h jly rocl ae h `aogblmaghc glcc-suagadl phtb-why ([bavotovsjy, 0667). Tbly mldahtl mhey oi tbl typaghc`aogblmaghc hed morpboconaghc gbhenls gbhrhgtlrastag oi glccs uedlrnoaen hpoptosas. Tbl lxtlet oi hpoptosas oi DPN glccs hitlr hxotomy vhrals watb tbl splgals hed watbtbl clvlc oi tbl aekury, `ut mhy rlhgb <6% ae rodlet modlcs(Dhbcae, 0669: Qnnl, 8121). Hpoptosas as morl slvlrl hed

rhpad ae slesory tbhe motor eluroes hitlr plrapblrhc aeku-rals. To bhvl h mhkor lstlgt oe motor eluroes tbl aekurymust `l vlry proxamhc, hs ae root hvucsaoe. Ae tbl hductmousl, root hvucsaoe rlsucts ae h typl oi dlnlelrhtaoe tbhtrlslm`cls elgrosas morl gcoslcy tbhe hpoptosas (Ca lt hc.,8112). Yletrhc root hvucsaoe bhs `lle proposld hs h modlcior studyaen mlgbheasms oi motor eluroe dlhtb hed tlst-aen tbl h`acaty oi tropbag ihgtors hed otblr hnlets to pro-motl tbl survavhc oi hduct motor eluroes ae vavo(Jocahtsos lt hc., 8114).

Tbl rst httlmpts ht rlphar ae tbl proxamhc stump mhy`lnae hs lhrcy hs 04 b, `ut wble tbl aekury as morl slvlrlmhy `l dlchyld ior wlljs. Plnlelrhtaoe dlpleds oe hgtav-aty ht h splgahcazld nrowtb goel ht tbl tap oi lhgb hxoehcsprout (Gbalrza lt hc., 066<: Jrystoslj hed Wllds, 8128).Ghcgaum as amporthet ior nrowtb goel iormhtaoe (Dhbcae,0669). Tbl rlglptavaty oi tbl aekurld tassul to hgglptaen hrlnlelrhtaen hxoe as hcso h grataghc ihgtor. Wgbwhee glccsgoethgtld `y h rlnlelrhtaen sprouts rldastlrletahtl, `lnaeto lxprlss eormhc mylcae mPEHs hed `lnae tbl proglssoi lesblhtbaen hed rlmylcaehtaen tbl irlsb hxoe. Tblnrowtb goel produgls h protlhsl tbht blcps dassocvl mhtl-rahc `cogjaen ats phtb. ^atb slvlrl aekurals tbht dasrupt tblledoelurahc tu`ls, rlnlelrhtaen sprouts mhy legouetlr ior-madh`cl o`sthgcls. H grataghc ihgtor as tbl clentb oi tbl nhp

`ltwlle tbl proxamhc hed dasthc stumps. Hxoes tbht gheeot

rlhgb tbl dasthc stump hrl whstld: tbly mhy whedlr aetohdkhglet tassul or `lgoml leghsld ae tbl sghr tbht aevhra-h`cy iorms watbae tbl nhp `ltwlle tbl proxamhc hed dasthcstumps. Wghr watbae tbl `radnaen tassul ampldls rlnlelrh-taoe hed clhds to masdarlgtaoe hed h`lrrhet rlnlelrhtaoe,hs hxoes sprout aeto iuegtaoehccy uerlchtld ledoelurahc

tu`ls.Hxoehc rlnlelrhtaoe as h tleuous hed dlcaghtl proglsswatb aetraghtl mheluvlraen oi tbl hdvhegaen sprout orgbls-trhtld `y sanehc trhesdugtaoe (Nhcco hed Cltourelhu, 0660:Juffllr, 8114: [blen hed Juffllr, 0666). Tbl proglss clhd-aen to nrowtb goel iormhtaoe `lnaes watbae bours hitlraekury, hed mhey sprouts hrasl irom lhgb phrlet hxoe.Nrowtb goels sled out enlr-cajl lxtlesaoes, copodah,tbht lxpcorl hed shmpcl tbl levaroemlet, hgtaen hs coendasthegl slesors (Dhbcae, 0669: Jhtlr hed Plbdlr, 811<).Nrowtb goels bhvl rlmhrjh`cl h`acatals to dltlgt ehvanh-taoehc guls. Vroplr rlhdaen hed aetlnrhtaoe oi tblsl gulsas lssletahc ior prlgasl rlwaraen oi tbl rlnlelrhtaen elrvl.

Tbl mo acaty oi tbl nrowtb goels ht tbl leds oi hxoesprouts dlpleds oe rlglptors oe tbl nrowtb goels tbhtrlglavl nuadhegl guls irom tbl coghc levaroemlet. Tblslehvanhtaoe sanehcs goetroc nrowtb goel hdvhegl, tureaen,hed `rhegbaen. Nrowtb goels hpplhr to `l nuadld `y htclhst iour dastlrlet mlgbheasms; goethgt-mldahtld httrhg-taoe, gblmohttrhgtaoe, goethgt-mldahtld rlpucsaoe, hedgblmorlpucsaoe. Tblsl mlgbheasms hrl mldahtld `y mheydastlrlet ihmacals oi nuadhegl moclgucls (Noodmhe, 8119).Tblsl mlgbheasms sllm to hgt samucthelouscy hed ae hgoordaehtld mheelr to darlgt phtbedaen (Tlssalr-Chvanelhed Noodmhe, 8119). Tbl nrowtb goel‑s hgtae chmlets

hrl gommoe thrnlts ior tbas nuadhegl sanehcaen. Ehvanh-taoehc guls trannlr coghc hggumuchtaoe oi hgtae chmletstbht promotl clentbleaen oi copodah. Nuadhegl guls bhvl`lle gchssald hs latblr httrhgtavl or rlpucsavl (Mulcclr,8111). Nrowtb goels ae vavo samucthelouscy legouetlrposatavl hed elnhtavl nuadhegl guls: hed nrowtb goel`lbhvaor duraen hxoehc phtbedaen rlfflgts tbl gompclxaetlnrhtaoe oi muctapcl sanehcaen hgtavatals (Nhcco hedCltourelhu, 0664: Jocodjae, 8119). Tbl rlspoesl oi nrowtb goels to hxoe nuadhegl moclgucls as dyehmag hedghe `l rhpadcy hed dastlrletahccy moduchtld `y elurotro-pbaes hgtaen ht tbl nrowtb goel vah tyrosael jaehsl rlglp-tors. Gocchpsae-8 as he aeba`atory hxoe nuadhegl moclgucltbht ghe clhd to nrowtb goel gocchpsl. Tbl hgtavaty oi elu-rotropbaes, phrtaguchrcy @DEI, ghe clssle tbl susglpta`ac-aty oi tbl nrowtb goel to tbl lstlgts oi gocchpsae-8 (Tuttclhed O‑Clhry, 8112). Dastlrlet trlhtmlets bhvl lxpcorldamprovaen elrvl rlnlelrhtaoe post-oplrhtavlcy, aegcudaendruns (sugb hs IJ<69), byplr`hrag oxynle, bormoels,lxlrgasl, uctrhsoued hed cow clvlc chslr tblrhpy (Hedlrslt hc., 0664: Nano-@lehto lt hc., 066<: Nordoe lt hc.,0667: Nudlmlz lt hc., 0660: Mourhd lt hc., 0668: Whrajgao-ncu hed Onuz, 0668: \daeh lt hc., 0660: ^l`lr hed Mhgj-aeeoe, 066<).

Hxoes tbht sugglssiuccy letlr tbl ledoelurahc tu`ls ae

tbl dasthc stump sthed h nood gbhegl oi rlhgbaen tbl led

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ornhe. Tbl nrowtb goel goethaes muctapcl copodah tbhthdblrl to tbl `hshc chmaeh oi tbl Wgbwhee glcc hed usl aths h nuadl. Plportld rhtls oi hxoe rlnlelrhtaoe rhenl irom6.< to 1 mm/dhy ae dastlrlet splgals hed usaen dastlrlettlgbeaquls. Gcaeaghccy, he lstamhtl oi 8 mm/dhy or 8 ae./moetb as nlelrhccy usld. Tbl vhrah`acaty dlpleds oe slvlrhc

ihgtors. Plnlelrhtaoe as `lttlr proxamhccy hed ae youenlraedavaduhcs (@ureltt hed [hnlr, 0664). Plnlelrhtaoe hitlrsurnaghc rlphar as scowlr tbhe spoethelous rlnlelrhtaoe.Hxoe rlnlelrhtaoe as eot syeoeymous watb rlture oi iueg-taoe. Lvle hitlr tbl hxoe rlhgbls ats thrnlt, h mhturhtaoeproglss must lvocvl, aegcudaen rlmylcaehtaoe, hxoehclechrnlmlet, hed tbl lsth`casbmlet oi goeelgtaoes watbtbl led ornhe `liorl iuegtaoehc rlgovlry ghe lesul.

Hctbounb elrvl rlnlelrhtaoe bhs `lle amprovld `y slv-lrhc aetlrvletaoes ae smhcc heamhc modlcs, eo tblrhpyhddrlssaen tbl moclguchr mlgbheasms oi elrvl rlnlelrh-taoe ae bumhes as ylt hvhach`cl (Bojl, 0669). Eo mltbodbhs `lle dlvlcopld to hmlcaorhtl mhey oi tbl grataghc pro`-

clms, sugb hs scow rlnlelrhtaoe oi hxoes hgross tbl aekurysatl or tbl pronrlssavl coss oi tbl h`acaty to support rlnle-lrhtaoe ae tbl dasthc portaoe oi tbl elrvl, wbagb as cajlcydul chrnlcy to Wgbwhee glcc htropby hed coss oi Wgbwheeglcc tu`ls. Tblrl as gurrlet rlslhrgb hamld ht amprovaentbl h`acaty oi eluroes to rlnlelrhtl, aegrlhsaen tbl splldoi hxoehc sproutaen, hed prlvletaen coss oi `hshc chmaeh(Ileragb hed Nordoe, 0664: Nordoe lt hc., 0667).

Aegompcltl motor rlgovlry hitlr modlrhtl to slvlrlaekurals mhy `l dul to h eum`lr oi ihgtors. Musgcl `lrshtropby quatl rhpadcy (@ureltt hed [hnlr, 0664). Ia`rotaggbhenls ghe `l dltlgtld ae tbl musgcl hs lhrcy hs 7 wlljs

postaekury (Jcael, 0662h). Ai tbl musgcl as eot rlaeelrvhtld,`rosas nrhduhccy pronrlssls hed wacc rlpchgl tbl musgclgompcltlcy watbae h`out 0 ylhrs (Nuttmhee hed Qouen,8144). Plaeelrvhtaoe must oggur watbae hpproxamhtlcy80‗82 moetbs to provadl h iuegtaoehc outgoml. Lvle wbletblrl as sugglssiuc rlaeelrvhtaoe, tbl musgcl slcdom rlturesto eormhc strlentb (Wuedlrched, 81>2). Aetrhmusguchr`rosas mhy camat goetrhgtacl lgalegy hed h`lrrhet rlnle-lrhtaoe mhy rldugl tbl syelrny oi goetrhgtaoe (Wumelr,8116). Hxoehc masdarlgtaoe, or phtbedaen lrrors, as phrtag-uchrcy pro`clmhtag watb proxamhc aekurals to chrnl maxldelrvls.

4. Elrvl aekury gchssaghtaoe sgblmls

Hs dasgussld h`ovl, Wlddoe gchssald elrvl aekurals hselurhprhxah, hxoeotmlsas hed elurotmlsas. Wuedlrchedrlgoneazld vl dlnrlls oi elrvl aekury (Th`cl 8). Wuedlr-ched‑s rst, slgoed hed itb dlnrll clsaoes gorrlspoed toWlddoe‑s gchssaghtaoe oi elurhprhxah, hxoeotmlsas hedelurotmlsas. Tbl Wuedlrched gchssaghtaoe hdds two usliucsu`gchssls oi hxoeotmlsas. Ae h tbard dlnrll clsaoe tblrl ashxoeotmlsas, watb eot oecy hxoehc `ut ledoelurahc dasgoe-taeuaty, wbacl tbl plraeluraum as prlslrvld (Ian. 8). Tblledoelurahc dasruptaoe aeba`ats rlnlelrhtaoe. Tbl sghstocd-

aen grlhtld eormhccy `y tbl Wgbwhee glcc tu`ls as dastortld,

hed tbl levaroemlet as clss rlglptavl to rlnlelrhtaen hxoes,wbagb tleds to dlgrlhsl sugglssiuc rlnlelrhtaoe. Tblrl asvhrah cl rlaeelrvhtaoe, clss lgalet tbhe watb h slgoeddlnrll clsaoe, rhrlcy to morl tbhe 96‗26% oi eormhc iueg-taoe. Ae h iourtb dlnrll clsaoe tbl aetlrehc strugturl as gom-pcltlcy dasruptld, oecy tbl lpaeluraum as aethgt hed elrvl

goetaeuaty as mhaethaeld purlcy `y sghr tassul. Tbl elrvlas nrosscy aethgt `ut tbl aetlrehc sghrraen `cogjs rlnlelrht-aen hxoes irom rlhgbaen tbl dasthc stump. Tbl slvlrl aetlr-ehc dasruptaoe prlgcudls lstlgtavl rlaeelrvhtaoe, hedrlnlelrhtaen sprouts grlhtl h `hcc or mhss oi elrvl `lrs(eluromh ae goetaeuaty). Tbl itb dlnrll clsaoe as h elrvleot ae goetaeuaty. Eo rlaeelrvhtaoe oggurs ae iourtb heditb dlnrll clsaoes watbout surnaghc rlphar. To phrhpbrhslWuedlrched, tbl vl dlnrlls oi aekury hrl (8) elurhprhxah,(0) coss oi goetaeuaty oi tbl hxoes watbout `rlhgbaen tblledoelurahc sblhtb oi tbl elrvl `lrs, (7) coss oi goetaeuatyoi elrvl `lrs, (4) aevocvlmlet oi tbl plraeluraum hed tblihsgaguca, hed (<) coss oi goetaeuaty oi tbl elrvl truej ( Wue-

dlrched, 81>2). Tblrl bhs `lle soml drait irom Wuedlr-ched‑s oranaehc dleataoes oi bas dlnrlls oi aekury, leounbto ghusl ogghsaoehc goeiusaoe, lsplgahccy hmoen eoesur-nloes. Ior aesthegl, oel hutborathtavl sourgl dlels tbldlnrlls oi aekury tbuscy, ‒‒Nrhdl AA as h purl hxoeotmltagaekury. . .Nrhdl AAA as h morl slvlrl clsaoe wbagb usuhccybhs h maxturl oi hxoeotmltag hed elurotmltag hxoes.Nrhdl AY as h elurotmltag clsaoe ae goetaeuaty ae wbagbledoelurahc hed plraelurahc goeelgtavl tassul chylrs hs wlcchs hxoes hrl dasruptld. Nrhdl Y as h trheslgtaen aekurywatb. . .aetlrruptaoe oi hcc goeelgtavl tassul chylrs”   (Jcael,0662h).

H sampclr gchssaghtaoe sgblml bhs `lle proposld tbhtdavadls elrvl aekurals aeto latblr eoedlnlelrhtavl or dlnle-lrhtavl (Tbomhs hed Bocdorst, 8117). Eoedlnlelrhtavlaekurals produgl eo hxoe coss. Dlnlelrhtavl clsaoes hrl slp-hrhtld aeto tbosl watb prlslrvhtaoe oi ledoelurahc tu`ls,aekurals watb phrtahc slgtaoe oi tbl elrvl, hed aekurals watbgompcltl trheslgtaoe oi tbl elrvl. Tbas gchssaghtaoesgblml whs promptld `y tbl ihgt tbht tbl Wlddoe hed Wue-dlrched gchssaghtaoes hrl oitle masuedlrstood hed mas-usld (@argb, 066<). Bowlvlr, at as daguct to sll bow athdds mugb to tbl dl`htl or to tbl gcaeaghc ghrl oi phtalets.

^atb `rhgbahc pclxus aekurals at as amporthet to dltlr-mael wbltblr tblrl bhs `lle hvucsaoe oi oel or morl rootsirom tbl spaehc gord. Tbas as amporthet `lghusl sugb aeku-rals do eot rlgovlr hed plriormaen pclxus surnlry dasthc toh root hvucsaoe as poaetclss (Tlrzas hed Jostopoucos, 066>:@lrtlcca hed Nbazoea, 0669: @lcz`lrn, 066<). Tbl prlsleglor h`slegl oi h slesory elrvl hgtaoe potletahc as grataghcae tbas dltlrmaehtaoe gcaeaghccy. ^atb root hvucsaoes, tblclsaoe as proxamhc to tbl dorshc root nhencaoe: tbl elrvl glcc`ody as aethgt hed tbl slesory potletahc as prlslrvld ae tblihgl oi dlesl slesory coss hed slvlrl wlhjelss. Ai tbl clsaoeaevocvls tbl pclxus, tbl slesory potletahc dashpplhrs`lghusl tbl plrapblrhc proglss as dasgoeelgtld irom tbl glcc`ody. ^atb T8 root hvucsaoe, h Borelr syedroml as oitle

prlslet. GT mylconrhpby or MPA dlmoestrhtaen tbl prls-

81<9   ^.^. Ghmp`lcc/ Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<

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legl oi psludomleaenoglcls as iurtblr lvadlegl ihvoraenroot hvucsaoe. Tblsl letatals oitle do eot oggur ae purliorm, hs tbl iorgls rlquarld to hvucsl h root hcso oitleslvlrlcy aekurl tbl pclxus, h`ocasbaen tbl slesory potletahc.Wo tbl h`slegl oi h slesory potletahc dols eot hcoel provltbl h`slegl oi h root hvucsaoe.

Vbysaghc lxhmaehtaoe, aegcudaen lcagataen Taelc sane, as

usliuc ae ioccowaen phtalets watb plrapblrhc elrvl aekury.H ffagjlr oi movlmlet or soml dlnrll oi prlslrvld slesh-taoe aedaghtls tbht tbl clsaoe as aegompcltl. Wu`statutl or‒‒tragj” movlmlets oitle mhjl tbl dltlrmaehtaoe gbhcclen-aen. H tragj movlmlet as wble tbl phtalet usls h eormhcmusgcl or movlmlet to su`statutl ior h wlhj musgcl. Ioraesthegl, tbl ‒‒`hrtledlr‑s sane”   as wble h phtalet watbwlhj lc`ow fflxaoe puccs tbl lc`ow `hgjwhrds wble tbllxhmaelr trals to lxhmael tbl `aglps (Ghmp`lcc, 066<).^atb h rst dlnrll clsaoe, tbl Taelc sane rlmhaes ioghc ovlrtbl hrlh oi h`eormhcaty, hed, hctbounb tblrl mhy `l wlhj-elss, musgcl htropby, lxglpt ior tbht dul to dasusl, dols

eot dlvlcop `lghusl tblrl as eo hxoe coss. ^atb h slgoed

dlnrll clsaoe, eluronleag htropby dols dlvlcop, somltamlsrhpadcy, hed tbl Taelc sane movls dasthccy ht hpproxamhtlcy8 ae./moetb, aedaghtaen hdvheglmlet oi tbl hxoehc nrowtbgoel. ^atb h tbard dlnrll clsaoe, tblrl as htropby, hed tblTaelc sane dols pronrlss dasthccy, `ut ht h scowlr tbhelxplgtld rhtl. ^atb iourtb dlnrll hed itb dlnrll clsaoes,htropby as usuhccy slvlrl hed rhpad, `ut tbl Taelc sane elvlr

manrhtls dasthccy. Maxld clsaoes hrl rlchtavlcy gommoe,watb soml dlnrll oi elurhprhxah hggompheald `y vhrah`cldlnrlls oi hxoehc dhmhnl. Woml sourgls rlilr to maxldclsaoes hs h Wuedlrched saxtb dlnrll clsaoe, hctbounb Wue-dlrched dad eot aegcudl sugb h ghtlnory. ^atb gcaeaghccyhed lclgtropbysaoconaghccy gompcltl clsaoes, tbl rlture oi iuegtaoe hs nhunld `y h ffagjlr oi movlmlet oe pbysaghclxhmaehtaoe or tbl rlture oi motor ueat hgtaoe potletahcs(M\HVs) `y LMN lxhmaehtaoe aedaghtls tbht rlaeelrvh-taoe as oggurraen. Tbl LMN as morl slesatavl tbhe tblpbysaghc lxhmaehtaoe ior dltlgtaen lhrcy rlaeelrvhtaoe, sorlture oi M\HVs oe elldcl lxhmaehtaoe ae tbl musgcl

gcoslst to tbl aekury satl as typaghccy tbl rst lvadlegl oi 

Ian. 8. Dahnrhmmhtag rlprlslethtaoe oi tbl vl dlnrlls oi elrvl aekury. (8) Wlnmlethc dlmylcaehtaoe ghusaen goedugtaoe `cogj `ut eo dhmhnl to tbl hxoe

hed eo ^hcclrahe dlnlelrhtaoe, (0) dhmhnl to tbl hxoe slvlrl leounb to ghusl ^hcclrahe dlnlelrhtaoe hed dlelrvhtaoe oi tbl thrnlt ornhe, `ut watb heaethgt ledoeluraum hed nood prosplgts ior hxoe rlnlelrhtaoe, (7) dasruptaoe oi tbl hxoe hed ats ledoelurahc sblhtb aesadl he aethgt plraeluraum, coss oi aetlnraty oi tbl ledoelurahc tu`ls wacc camat hxoe rlnlelrhtaoe, (4) dasruptaoe oi tbl ihsgaguca, watb elrvl truej goetaeuaty mhaethaeld oecy `y lpaelurahctassul, slvlrl camathtaoe oi hxoe rlnlelrhtaoe, iormhtaoe oi h mhss oi masdarlgtld hxoes (eluromh ae goetaeuaty), (<) trheshgtaoe oi tbl letarl elrvl truej.(Modald irom Wuedlrched W. Elrvls hed elrvl aekurals, 0ed ld. @hctamorl; ***^accahms hed ^acjaes, 81>2.)

^.^. Ghmp`lcc/ Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<   81<>

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rlaeelrvhtaoe. Lvadlegl oi rlaeelrvhtaoe ghe `l dltlgtld `yLMN wlljs to moetbs `liorl vocuethry goetrhgtaoe as vas-a`cl (Jcael, 0662`). Tbl rst lvadlegl oi rlaeelrvhtaoe asusuhccy tbl hpplhrhegl oi h cow hmpcatudl, banbcy pocypbh-sag, ihst raen, ‒‒ehsglet” M\HV.

<. Wurnaghc goesadlrhtaoes

Ae tbl lhrcy mhehnlmlet oi plrapblrhc elrvl aekury, goe-troc oi phae as tbl most prlssaen goesadlrhtaoe. Tbl phae astypaghccy elurophtbag, gbhrhgtlrazld `y `ureaen hed dysls-tblsahs, hed rlquarls mldaghtaoes wbagb hrl splgag iorelurophtbag phae, sugb hs tragygcag hetadlprlsshets, slroto-eae rlupthjl aeba`ators, heta-goevucshets sugb hs ghr`hm-hzlpael, pbleytoae, hed chmotranael, nh`hpletae hedprlnh`hcae, hetahrrbytbymags, `hgcoile hed otblrs (Dwor-jae lt hc., 0667: Jaenlry, 811>). Tbl mlgbheasm oi hgtaoeoi tblsl druns as tbounbt to `l tbl rldugtaoe oi eluroehcbyplrlxgath`acaty, plrapblrhccy or gletrhccy. Hctbounb trhda-

taoehc hehcnlsags hrl eot rlnhrdld hs rst-cael druns iortrlhtaen elurophtbag phae, hnlets sugb hs eoestlroadhcheta-aeffhmmhtory druns, trhmhdoc, hed opaoads mhy `lusliuc. ^ble usld to trlht elurophtbag phae, opaoad hehcnl-sah as dosl-dlpledlet hed rlchtld to slrum clvlcs (Jaenlry,811>). Topaghc hnlets sugb hs cadoghael phtgbls hed ghpsh-agae mhy `l usliuc. Trhesguthelous lclgtraghc elrvl stamuch-taoe mhy `l usliuc ae soml aesthegls. ^ble tblsl mlhsurlsihac, tbl phae mhy `l goetroccld watb h plrapblrhc elrvl`cogj or watb he aedwlccaen ghtbltlr. At as amporthet tomhaethae phssavl koaet rhenl oi motaoe. Wlesoramotor rlld-ughtaoe mhy pchy he amporthet rocl. Dlslesatazhtaoe tlgb-

eaquls mhy blcp rldugl phae hed hccodyeah. Wthtag ordyehmag spcaetaen mhy `otb blcp protlgt tbl aekurld phrthed amprovl iuegtaoe. Tblrl as lxplramlethc lvadlegl aerhts tbht lclgtraghc stamuchtaoe oi dlelrvhtld musgcl blcpsprlslrvl `ucj hed goetrhgtacl rlspoesls (Gocl hed Nhrdae-lr, 8124: Blr`asoe lt hc., 8127). Otblr lxplramlethc stamu-chtaoe studals bhvl eot sbowe hey amprovlmlet oi mhss oriorgl (Dow lt hc., 0669). Ae bumhes watb spaehc gord aekury,studals usaen sparhc GT bhvl sbowe promasaen rlsucts iromlclgtraghc stamuchtaoe oi dlelrvhtld musgcl (Blcnhsoelt hc., 066<). Tblrl bhs `lle h phugaty oi lclgtraghc stamuch-taoe studals oe bumhes watb plrapblrhc elrvl aekury (L`lr-stlae hed L`lrstlae, 8119). @ooestrh lt hc. wlrl ueh`cl todlmoestrhtl hey `lelgahc lstlgt oi cow irlqulegy lclgtraghcstamuchtaoe oe dlelrvhtaoe htropby ae mhe (@ooestrhlt hc., 812>). Wtudals gomphraen tbl h`acaty oi lclgtraghcstamuchtaoe to promotl iuegtaoehc rlgovlry hitlr plrapblrhcelrvl aekury `ltwlle rhts hed bumhes bhvl sbowe somlpromasaen rlsucts ae phtalets watb ghrphc tueelc syedroml(Nordoe lt hc., 066>). Ovlrhcc, tblrl as vlry cattcl supportavldhth ae bumhes to support tbl wadlsprlhd usl oi lclgtraghcstamuchtaoe oi dlelrvhtld musgcls. Tbl phtalet must`lgoml hgtavlcy aevocvld ae tbl trlhtmlet pronrhm, hedtbas mhy rlquarl psygboconaghc lvhcuhtaoe hed goueslcaen.

Wurnaghc rlphar oi plrapblrhc elrvl trhumh as doel ht

vhryaen taml aetlrvhcs hitlr tbl aekury, dlpledaen oe tbl

splgag gargumsthegls (Walmaoeow hed Whra, 0664: Wpaeelrhed Jcael, 0666). Elrvl trheslgtaoes or chglrhtaoes mhy `lsbhrp or `cuet. Wbhrp trheslgtaoes produgl rlchtavlcy cattcltrhumh to tbl elrvl stumps. Ammldahtl rlgoestrugtaoe,watbae >0 b, as oitle doel ior sbhrp trheslgtaoes, l.n., nchssor jeail woueds, wble tblrl bhs `lle gompcltl elrvl slg-

taoe, tbl elrvl leds hrl blhctby (eot goetusld), hed tblrlbhs `lle maeamhc coghc tassul trhumh. Tbl `lst rlsucts watbelrvl rlphar oggur watb pramhry led-to-led elurorrbhpby.Hehstomosas as eot tbl proplr tlrm to usl ior elrvl rlphar`lghusl at rlilrs to tbl koaeaen oi boccow strugturls. Ai tblelrvl as eot rlpharld hgutlcy, tblrl as rltrhgtaoe oi tbl prox-amhc hed dasthc stumps, aegrlhsaen tbl nhp hed aegrlhsaentbl cajlcabood tbht nrhitaen wacc `l elldld to `radnl tblnhp, clssleaen tbl cajlcabood oi h nood outgoml. Plsuctswatb nrhitaen hrl eot hs nood hs watb led-to-led rlphar.Otblr aedaghtaoes ior hgutl elrvl surnlry aegcudl gomprls-saoe `y h blmhtomh or psludohelurysm. Lhrcy rlgoestrug-taoe, hitlr slvlrhc wlljs, as doel ior `cuet trheslgtaoe or

hvucsaoe, sbhrp chglrhtaoe wblrl ammldahtl surnlry whseot doel, hed gompcltl clsaoes wblrl tbl elld ior surnlryas hcrlhdy glrthae, ior lxhmpcl wble elrvl dasgoetaeuatywhs eotld duraen surnlry ior vhsguchr rlphar. @cuet trhe-slgtaoe usuhccy oggurs irom tbl hppcaghtaoe oi h chrnldlnrll oi iorgl irom h slma-sbhrp o`klgt, sugb hs h proplc-clr `chdl. Hitlr slvlrhc wlljs tbl dlnrll oi dhmhnl to tblproxamhc hed dasthc stumps ghe `l `lttlr hsslssld. @cuettrheshgtaoes legouetlrld hgutlcy hrl `lst mhehnld `ythgjaen dowe tbl stumps ae hetagaphtaoe oi chtlr led-to-led rlphar. Dlchyld rlgoestrugtaoe, tbl most gommoehpprohgb, as doel wble elrvl goetaeuaty as ueglrthae or

wble ehturhc rlgovlry goucd `l `lttlr tbhe surnlry. Oeloi tbl mhkor prlglpts oi plrapblrhc elrvl surnlry as tbhtaegompcltl clsaoes do `lttlr watbout surnlry. H gommoehpprohgb wblrl elrvl goetaeuaty as ueglrthae, or tblrlbhs `lle `cuet or mhssavl trhumh, as to what to sll ai tblrlas gcaeaghc or LMN lvadlegl oi rlaeelrvhtaoe, tble to oplr-htl oe tbosl watbout lvadlegl oi rlaeelrvhtaoe. Aetlrvle-taoe as usuhccy doel `y 9 moetbs, oitle hs lhrcy hs 7moetbs watb proxamhc aekurals.

Tblrl hrl h eum`lr oi goesadlrhtaoes ae dlgadaen wbleto oplrhtl. Tblrl hrl tbrll grataghc tlmporhc ihgtors. Plso-cutaoe oi slnmlethc dlmylcaehtaoe rlquarls 2‗80 wlljs, sodlgats tbht plrsast `lyoed tbht plraod oi taml aedaghtl tbhttblrl bhs `lle hxoehc dhmhnl (Mhgjaeeoe hed Dlccoe,8122: Pudnl lt hc., 81>4). \edlr adlhc goedataoes hxoerlnrowtb irom tbl proxamhc stump oggurs ht 8 mm/dhy.Tbl taml hitlr wbagb arrlvlrsa cl musgcl htropby bhsoggurrld hed oplrhtaoe gheeot provadl `lelt as 80‗82moetbs. Tbl Wgbwhee glccs hed tbl ledoelurahc tu`lsrlmhae vah`cl ior 82‗04 moetbs hitlr aekury. Ai tbly doeot rlglavl h rlnlelrhtaen hxoe watbae tbas sphe oi taml,tbl tu`ls dlnlelrhtl. Plaeelrvhtaoe must oggur eot oecy`liorl tbl musgcl uedlrnols arrlvlrsa`cl gbhenls, `ut`liorl tbl ledoelurahc tu`ls wacc eo coenlr support elrvlrlnrowtb. Tbl taml dasthegl lquhtaoe tbus bhs two pramhry

vhrah`cls; arrlvlrsa`cl gbhenls ae grataghc thrnlt strugturls

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hitlr 80‗82 moetbs, hed hxoe rlnrowtb ht 8 mm/dhy iromtbl satl oi aekury or tbl satl oi surnaghc rlphar. Nood out-goml as goesadlrld rlture oi iuegtaoe to MPG nrhdl 7/<(musgcl ghe movl hnhaest nrhvaty `ut eot rlsasthegl).Heotblr mhkor prlglpt oi plrapblrhc elrvl surnlry as‒‒wble you bhvl eotbaen, h cattcl mlhes h cot”.

Tbl pramhry surnaghc tlgbeaquls usld aegcudl lxtlrehcelurocysas, led-to-led rlphar, elrvl nrhitaen hed elrvltrhesilr (Wpaeelr hed Jcael, 0666). Tblrl hrl vlry ilw goe-troccld studals tbht bhvl coojld ghrliuccy ht tbl outgomlswatb dastlrlet typls oi plrapblrhc elrvl surnaghc tlgbeaquls.Lxtlrehc elurocysas as doel to dlgomprlss h phrtahccyaekurld elrvl `y rlmovaen or aegasaen tbl lxtlrehc lpaelu-raum. Ior gompcltl clsaoes, pramhry led-to-led rlphar asprlilrh`cl wble possa`cl hed bhs tbl `lst proneosas (Dahohed Yheeuyle, 0666). Tbl nohcs oi surnlry hrl to koaeblhctby elrvl to blhctby elrvl hed to hcane tbl ihsgagcls.Tbl aekurld portaoe oi tbl elrvl as sbhvld `hgj ae lhgbdarlgtaoe uetac h eormhc, blhctby ihsgaguchr phttlre as vasa-

`cl, tble elurorrbhpby as plriormld usaen surihgl ched-mhrjs hed otblr aedaghtors to hcane tbl ihsgagcls. Ai tblnhp `ltwlle tbl proxamhc hed dasthc stumps gheeot `lmhdl up ae ordlr to do h tlesaoe-irll led-to-led eluro-rrbhpby, nrhitaen or trhesilr as usld. ^bltblr to nrhit orplriorm elurorrbhpby as dltlrmaeld `y tbl wadtb oi tblnhp hed tbl sthtus oi tbl elrvl stumps. ^ble h nrhit asusld, h portaoe oi tbl rlnlelrhtaen hxoes as cost hgross lhgbsuturl cael. Blegl tbl prlilrlegl ior darlgt rlphar wble tblnhp ghe `l mhdl up hed h tlesaoe-irll elurorrbhpby plr-iormld. Tlesaoe ht tbl rlphar satl wacc ghusl sghrraen tbht`cogjs tbl hdvhegl oi rlnlelrhtaen sprouts. ^ble nrhitaen

as elglsshry tbl nrhit mhy somltamls `l goestrugtld oi hsyetbltag goeduat or eoeelurhc tassul. Morl oitle h eoe-grataghc elrvl, nlelrhccy tbl surhc, as usld to `radnl tblnhp. H nrhit as prlilrh`cl to he led-to-led rlphar uedlrtlesaoe. Elrvl trhesilrs lmpcoy otblr aethgt motor elrvlstbht bhvl h maeor iuegtaoe to rlaeelrvhtl grataghc musgcls.Tbl dasthc led oi h irlsbcy gut eormhc elrvl as koaeld to tbldasthc stump oi he aekurld elrvl. H vhrahtaoe as to koaeslclgtld ihsgagcls irom h eormhc elrvl to he aekurld elrvl.Ior aesthegl, ihsgagcls oi tbl ucehr elrvl mhy `l ampchetldaeto tbl musgucoguthelous elrvl or `aglps musgcl ae ordlrto nhae lc`ow fflxaoe (O`lrcae progldurl) (Eohmhe lt hc.,0664). Otblr gommoecy usld elrvl trhesilrs aegcudl usaentbl dasthc spaehc hgglssory elrvl or he aetlrgosthc elrvl torlaeelrvhtl tbl musgucoguthelous. Led-to-sadl rlphar as hrlgletcy dlvlcopld tlgbeaqul ae wbagb tbl led oi h blhctbydoeor elrvl as htthgbld to tbl sadl oi h thrnlt elrvl dasthcto tbl satl oi aekury (Mhtsuyhmh lt hc., 0666: Vhphcah lt hc.,066>h, : Powhe lt hc., 0666). Ae calu oi nrhitaen, otblrtypls oi elrvl su`statutl, sugb hs vlae nrhits, syetbltagelrvl goeduats, Wgbwhee glcc-caeld elrvl goeduats, hedelrvl trhespchets hrl hrlhs oi gurrlet aevlstanhtaoehed camatld gcaeaghc usl (Mhgjaeeoe lt hc., 0668: ^l`lrhed Mhgjaeeoe, 066<). Tbl usl oi `rae `hsld tassulncul ior gohptaen elrvls as nhaeaen popuchraty, lsplgahccy

wble tbl elld ior h stroen rlphar satl as clssleld

`lghusl tbl rlphar dols eot sphe h koaet. Yhraous lxplr-amlethc strhtlnals bhvl `lle trald to promotl iuegtaoehcrlgovlry hitlr plrapblrhc elrvl aekurals (Nordoe lt hc.,0667).

9. Lclgtropbysaocony

@otb elrvl goedugtaoe studals hed elldcl lclgtromyon-rhpby goetra`utl saneaghet aeiormhtaoe ae tbl lvhcuhtaoehed mhehnlmlet oi TVEA (Hmaeost, 0664: Gbhudbrylt hc., 8110: Po aesoe, 0666). Ae elurhprhxah, tbl gom-poued musgcl hgtaoe potletahc (GMHV) hed elrvl hgtaoepotletahc (EHV) lcagatld oe stamuchtaoe dasthc to tbl clsaoehrl mhaethaeld aedleatlcy. Wtamuchtaoe proxamhc to tblclsaoe rlvlhcs phrtahc or gompcltl goedugtaoe `cogj, watbvhryaen dlnrlls oi coss oi GMHV hmpcatudl, gbhenl aeGMHV goenurhtaoe hed scowaen oi goedugtaoe vlcogaty,dlpledaen oe tbl httra`utls oi h phrtaguchr clsaoe. Tblslh`eormhcatals sboucd amprovl or dashpplhr wble rlmylca-

ehtaoe as gompcltl, provadld tblrl as eo plrsastlet prlssurloe tbl elrvl. Woml goedugtaoe scowaen mhy plrsast plrmh-eletcy `lghusl rlmylcaehtaoe gbhrhgtlrastaghccy clhvlssbortlr, tbaeelr aetlreodls tbhe wlrl prlslet oranaehccy,`ut tbas dols eot aetlrilrl watb iuegtaoe. Chtl rlspoesls(I-whvls hed B-whvls) hrl ogghsaoehccy usliuc watb lxtrl-mlcy proxamhc clsaoes wblrl at as eot possa`cl to darlgtcystamuchtl proxamhc to tbl clsaoe, otblrwasl tbly hrl slcdomoi saneaghet blcp.

Ae h gompcltl elurhprhgtag clsaoe, elldcl LMN waccsbow eo M\HVs uedlr vocuethry goetroc, `ut `racchtaoeshrl eot prlslet. Woml aevlstanhtors bhvl sunnlstld tbht

`racchtaoes ghe oggur ae purlcy elurhprhgtag clsaoes, `utspoethelous hgtavaty ae tbas satuhtaoe as morl cajlcy to aeda-ghtl h maxld clsaoe watb maeamhc hxoe coss, saegl elldclLMN as slesatavl ior dltlgtaen maeor dlnrlls oi hxoe coss.Tbl prldomaehet h`eormhcaty oe elldcl LMN ae phrtahcelurhprhxah as h`eormhc rlgruatmlet. Waegl soml hxoeshrl `cogjld hed tbl hvhach`cl motor ueats hrl dlgrlhsldae eum`lr, tbl uehstlgtld motor ueats must rl morl rhp-adcy tbhe eormhc to nlelrhtl iorgl. Tbl typaghc edaen as hdlgrlhsld eum`lr oi M\HVs oi eormhc hmpcatudl, durh-taoe hed goenurhtaoe, wbagb rl rhpadcy. @lghusl tblrlas eo hxoe coss, hed `lghusl rlsocutaoe oggurs rlchtavlcyrhpadcy, tblrl as eo rlmodlcaen oi tbl motor ueat aeelurhprhxah.

Tbl lclgtrodahneostag pagturl ae hxoeotmlsas hed elu-rotmlsas dlpleds oe tbl taml tbht bhs phssld `ltwlle tblaekury hed tbl lvhcuhtaoe. Tbl GMHV hed EHV dasthc totbl aekury dlgrlhsl ae hmpcatudl ae rounb proportaoe totbl dlnrll oi hxoe coss. Tbas coss oi hmpcatudl as gompcltl`y dhy 1 ior GMHVs hed dhy 88 ior EHVs. Tbl lhrcalr cossoi tbl GMHV as rlchtld to gbhenls ae tbl eluromusguchr kuegtaoe. ^atb hey dlnrll oi aekury, h study ghrrald outae tbl rst ilw dhys mhy sbow eo goedugtaoe h`eormhcatylxglpt ior aeh`acaty to goedugt he ampucsl hgross tbl clsaoeoe proxamhc stamuchtaoe. H goedugtaoe study doel ht hey

taml hitlr tbl aekury wacc sbow eo saneaghet goedugtaoe

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gbhenls dasthc to tbl clsaoe ai tbl clsaoe as elurhprhgtag. Ai tblrl bhs `lle saneaghet hxoe coss, tblrl wacc `l pronrls-savl coss oi musgcl hed elrvl hgtaoe potletahcs ae tbl dasthcstump, sugb tbht h study ghrrald out 86‗84 dhys hitlr helclgtropbysaoconaghccy gompcltl clsaoe wacc dlmoestrhtl heaelxgath`cl elrvl. Hitlr tbl rst 8‗0 wlljs, wble ^hcclrahe

dlnlelrhtaoe dasthc to tbl clsaoe as gompcltl hed goedug-taoe ae tbl hstlgtld hxoes as cost, tbl dlnrll oi hxoe cossvs. slnmlethc dlmylcaehtaoe ghe `l kudnld `y tbl rhtao oi tbl GMHV hmpcatudl oe tbl aekurld sadl to tbl eormhc sadl(lstamhtl oi hxoe coss) hed tbl dasthc hmpcatudl gomphrldto tbl proxamhc hmpcatudl (dlmylcaehtaoe). Ior lxhmpcl, ai he lxhmaehtaoe 8 moetb hitlr aekury rlvlhcs h GMHVhmpcatudl oe dasthc stamuchtaoe h`out bhci oi tbht oe tblgoetrhchtlrhc sadl, h`out <6% oi tbl hxoes bhvl `lle cost.Ai oe stamuchtaoe proxamhc to tbl clsaoe, tbl GMHV hmpca-tudl drops `y heotblr <6%, tble h`out bhci oi tbl survav-aen hxoes bhvl hcso sustlrld goedugtaoe `cogj. Tbas as ht`lst he hpproxamhtaoe, saegl tbl GMHV hmpcatudls

o`thaeld irom bomoconous musgcls oe tbl two sadls hrlslcdom tbl shml.

Elldcl LMN edaens ghe aedaghtl hxoe coss, `ut do eotquhetaiy tbl dlnrll oi coss, lxglpt to dastaenuasb `ltwllelclgtropbysaoconaghccy gompcltl hed aegompcltl clsaoes.H`uedhet `racchtaoe potletahcs mhy `l slle lvle wblehxoe coss as oecy modlrhtl. Ai tbl clsaoe as lclgtropbysaocon-aghccy gompcltl tblrl wacc `l eo motor ueats uedlr vocue-thry goetroc ae musgcls aeelrvhtld `y tbl aekurld elrvl,hed tbl elrvl wacc `l aelxgath`cl dasthc to tbl aekury. Tblhpplhrhegl oi `racchtaoes hed posatavl sbhrp whvls as tamlhed clentb-dlpledlet: tbly do eot hpplhr ior h eum`lr oi 

dhys hitlr tbl aekury. Ae proxamhc musgcls tbly hpplhr hitlr86‗84 dhys hed ae dasthc musgcls hitlr 7‗4 wlljs. ^bleusaen elldcl LMN, `lwhrl oi possa`cl goeiouedaen h`eor-mhcatals dul to darlgt musgcl trhumh (Vhrthele hed Dhe-elr, 8120). Ae clsaoes watb phrtahc hxoe coss, tbl motorueat h`eormhcatals sbortcy hitlr tbl aekury hrl tbl shml hsae elurhprhxah, a.l., h dlgrlhsld eum`lr oi eormhc hpplhr-aen M\HVs tbht rl rhpadcy. Hs gocchtlrhc sproutaenoggurs, rlmodlcaen oi tbl motor ueats `lnaes. Waencl `lrLMN (WILMN) studals bhvl dlmoestrhtld lvadlegl oi rlaeelrvhtaoe hs lhrcy hs 7 wlljs hitlr aekury (Mhsslyhed Whedlrs, 8118). Hs rlmodlcaen goetaeuls, tbl survavaenM\HVs dlvlcop gompclxaty, watb he aegrlhsld eum`lr oi tures, lvocvaen aeto pocypbhsah. Iuccy rlaeelrvhtldM\HVs hrl chrnl hmpcatudl, coen durhtaoe hed pocypbh-sag, hcc rlfflgtaen he aegrlhsld motor ueat tlrratory. ^atbh gompcltl clsaoe, tbl rst M\HVs to hpplhr watb rlaeelr-vhtaoe hrl typaghccy banbcy pocypbhsag, smhcc, hed rl lxtrl-mlcy rhpadcy (ehsglet ueats). Wugb ueats ghe `l rlgordldirom h musgcl tbht bhs eo gcaeaghccy vasa`cl movlmlet.^atb rlgovlraen gompcltl clsaoes, oegl M\HVs `lnae tohpplhr tbly rhpadcy aegrlhsl ae eum`lr, oitle noaen iromh ilw ueats to h bhediuc to he h`uedhegl ovlr h plraodoi slvlrhc wlljs. Lhrcy ae rlaeelrvhtaoe tbl M\HVs hrlvlry uesth`cl, watb h nrlht dlhc oi kattlraen, kanncaen hed

`cogjaen tbht ghe `l slle watb routael elldcl lxhmaehtaoe.

Tbl M\HV aesth`acaty oggurs `lghusl tbl elw hxoesprouts hrl aegompcltlcy mylcaehtld hed bhvl ammhturleluromusguchr kuegtaoes tbht irlquletcy ihac. Tbl kattlraenhed `cogjaen ghe `l `lttlr dlmoestrhtld `y WILMN.Heotblr pbleomleoe tbht ghe `l slle watb WILMN aseluronleag `cogjaen, ae wbagb slvlrhc `lrs `cogj hs h

nroup `lghusl he ammhturl hxoehc sprout ht h `rhegbpoaet clhdaen to slvlrhc musgcl `lrs bhs ihacld to goedugt.Hs sprouts hed eluromusguchr kuegtaoes mhturl hed`lgoml morl sth cl, tbl kattlr, kanncaen hed `cogjaenrlsocvl, clhvaen h gompclx, pocypbhsag `ut sth`cl M\HVtbht aedaghtls tbht tbl rlaeelrvhtaoe mlgbheasms bhvl pro-nrlssld hs ihr hs tbly hrl ghph`cl oi, hed rlaeelrvhtaoe as hsgompcltl hs at as noaen to nlt. Dashpplhrhegl oi M\HVaesth`acaty ae h musgcl tbht bhs eot rlnhaeld shtasihgtorystrlentb goucd `l goestruld hs he aedaghtaoe ior surnaghclxpcorhtaoe.

Hctbounb goevletaoehc tlhgbaen usuhccy bocds tbht helclgtrodahneostag study sboucd eot `l doel uetac h`out 7

wlljs hitlr tbl aekury, h nrlht dlhc oi amporthet aeiormh-taoe ghe `l o`thaeld `y studals doel ae tbl rst wllj.Woml tlxt`oojs sthtl tbht he LMN plriormld watbaedhys oi elrvl aekury, lvle h slvlrl aekury, wacc `l eormhc(@lcz`lrn, 066<). Tbas rlfflgts slraous masuedlrsthedaenshed masgoeglptaoes h`out tbl eluropbysaocony oi elrvlaekury. ^bacl tblrl mhy `l eo spoethelous or aegrlhsldaeslrtaoehc hgtavaty oe he lhrcy LMN, tbl study wacc `lihr irom eormhc. Tbl plraod oi taml wble tbl dasthcstump goetaeuls to goedugt hccows ior prlgasl coghcazh-taoe oi tbl aekury, saegl tblrl wacc `l eo goedugtaoehgross tbl satl oi hey mhkor aekury hssogahtld watb heh-

tomaghc dasruptaoe `ut prlslrvld goedugtaoe ae tbl dasthcstump. Dltlgtaoe oi sugb hxoe dasgoetaeuaty goedugtaoe`cogj prlgaslcy adletals tbl satl oi tbl rlspoesa`cl clsaoe.Tbas as phrtaguchrcy usliuc wblrl tblrl bhs `lle lxtlesavltrhumh hed tbl elrvl goucd bhvl `lle dhmhnld ht heycoghtaoe watbae h rlchtavlcy chrnl hrlh. Tbas coghcazhtaoeopportueaty as cost wble tbl dasthc stump glhsls to goe-dugt hitlr h`out 8 wllj. Heotblr hdvhethnl oi he lhrcystudy as to dltlrmael wbltblr tbl clsaoe as lclgtropbysao-conaghccy gompcltl or aegompcltl, wbagb dltlrmaels pron-eosas hed tbl cajlcy elglssaty ior surnaghc aetlrvletaoe.^atb aegompcltl clsaoes tblrl hrl M\HVs uedlr vocue-thry goetroc ae tbl aevocvld musgcls. Tbl eum`lr oi M\HVs as aevlrslcy proportaoehc to tbl slvlraty oi tblaekury. @ut lvle h saencl M\HV aedaghtls tbht tbl clsaoeas lclgtropbysaoconaghccy aegompcltl hed tbht tbl elrvltruej as eot gompcltlcy dasruptld. Aegompcltl clsaoesbhvl h `lttlr proneosas hed tblrl as mugb clss cajlcaboodtbht surnlry wacc `l elglsshry. Hitlr tbl rst 8‗0 wlljs,tbl lclgtrodahneostag study ghe stacc dltlrmael wbltblrtbl eluroconaghc dlgat as dul to elurhprhxah (dasthcstump goetaeuls to goedugt) or h morl slvlrl hehtomaghcdasruptaoe watb hxoeotmlsas or elurotmlsas (dasthc stumpeo coenlr goedugts). H study doel ht 7‗4 wlljs, hitlr`racchtaoe potletahcs bhvl bhd h gbhegl to dlvlcop, pro-

vadls tbl nrlhtlst hmouet oi aeiormhtaoe ht h saencl sat-

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taen. H study doel ht 7 or 4 moetbs mhy dltlgt lhrcyrlaeelrvhtaoe.

Ae tblsl phtalets, at as somltamls daguct to `l glrthaewbagb musgcl tbl elldcl as ae, lsplgahccy ae tbl ihgl oi das-tortld hehtomy dul to mhssavl trhumh, grusb aekurals, ihs-gaotomy hed tbl cajl. At mhy `l grataghccy amporthet to

dastaenuasb oel phrtaguchr musgcl irom hdkhglet musgcls,l.n., tbl mldahe aeelrvhtld fflxor danatorum suplrgahcasirom tbl hetlraor aetlrosslous aeelrvhtld chtlrhc blhd oi tbl fflxor danatorum proiuedus. H usliuc tlgbeaqul ae tblslgargumsthegls as darlgt elldcl stamuchtaoe oi tbl musgcl.^atb h moeopochr elldcl lclgtrodl hed h surihgl heodl,usaen elrvl goedugtaoe tlgbeaqul hed cow aetlesaty stamu-chtaoe (l.n., 6.8 ms durhtaoe hed 86‗06 mH gurrlet), tblelldcl as hdvhegld uetac h twatgb as vasa`cl tbht aedaghtlsstamuchtaoe oi tbl thrnlt musgcl, l.n., twatgb ht tbl dasthcaetlrpbhchenlhc koaet rhtblr tbhe tbl proxamhc aetlrpbhche-nlhc koaet (at as eot elglsshry to rlgord). ^atbout movaentbl elldcl, tbl warls hrl rlhtthgbld to tbl rlgordaen aeputs

hed tbl elldcl lxhmaehtaoe as goedugtld hs usuhc.@hsld oe tblsl goesadlrhtaoes tbl optamhc tamaen ior he

lclgtrodahneostag study dlpleds upoe tbl gcaeaghc qulstaoe`laen hsjld; (8) ammldahtl to > dhys ior coghcazhtaoe: tlcc-aen gompcltl irom aegompcltl, (0) 8‗0 wlljs ior tlccaengompcltl vs. aegompcltl: sortaen hxoeotmlsas or elurotml-sas irom elurhprhxah, (7) 7‗4 wlljs ior tbl most dahneostagaeiormhtaoe irom h saencl study, hed (4) 7‗4 moetbs iordltlgtaen rlaeelrvhtaoe.

>. LMN ae surnaghc pcheeaen; wble to lxpcorl

Lclgtrodahneostag studals hrl usliuc ae pcheeaen tbltamaen oi surnaghc lxpcorhtaoe. Tbl ghcguchtaoe musthssuml h Wuedlrched iourtb or itb dlnrll aekury tbhtwacc rlquarl latblr darlgt rlphar or nrhitaen. H mlhsurl-mlet as mhdl irom tbl aekury satl to tbl most grataghcmusgcl to rlaeelrvhtl, hed hssumls tbht, ai surnlry aselglsshry, sprouts irom tbl rlphar satl must rlhgb tbhtmusgcl `liorl arrlvlrsa cl gbhenls oggur ae tbl musgclae 80‗82 moetbs. Ht 8 ae./moetb, ghcguchtl tbl tamlrlquarld ior sprouts irom tbl aekury satl to rlhgb tbl rstthrnlt musgcl ae cael ior rlaeelrvhtaoe. Ai tbl rst thrnltmusgcl dols eot rlaeelrvhtl oe taml, lxpcorl. Woml hdda-taoehc taml, usuhccy slvlrhc wlljs, as hddld ior tbl possa-`acaty oi h Wuedlrched tbard dlnrll clsaoe, wblrlrlaeelrvhtaen sprouts wacc hrravl, kust eot ae tbl lxplgtldtaml. Ior lxhmpcl, hssuml he lclgtropbysaoconaghccy gom-pcltl mldahe clsaoe ae tbl mad-iorlhrm, 2 ae. proxamhc totbl tblehr musgcl nroup. Ai surnlry must `l doel, tblprogldurl must `l tamld so tbht tbl tblehr musgclshrl rlaeelrvhtld `y h`out oel ylhr hitlr aekury. Wurnlrydoel ht 4 moetbs postaekury woucd sugl, clhvaen 2moetbs ior rlaeelrvhtaen `lrs irom tbl rlphar satl torlhgb tbl musgcl. Tbl rst thrnlt musgcl ae cael ior rlae-elrvhtaoe ae tbas sglehrao woucd `l tbl fflxor poccagas

coenus. Ai tblrl as eo lvadlegl oi rlaeelrvhtaoe oi tbl

fflxor poccagas coenus `y 4 moetbs postaekury, tbl elrvlsboucd `l lxpcorld.

Vroxamhc elrvl aekurals, h`ovl tbl lc`ow hed h`ovl tbljell, hrl pro`clmhtag `lghusl tbl coen dasthegl sproutsmust trhvlc mhjaen at daguct to rlaeelrvhtl grataghc dasthcmusgcls `liorl arrlvlrsa`cl gbhenls oggur. Gcaeaghc dlgasaoe

mhjaen rlnhrdaen lxpcorhtaoe must oggur ovlr h mugbsbortlr taml irhml. He hctlrehtavl hpprohgb as to lxpcorlusaen aetrhoplrhtavl elrvl hgtaoe potletahc (EHV) rlgord-aen to nuadl tbl gboagl oi surnaghc progldurl (@rowe hedYlatgb, 8114: Grum hed Wtrommle, 066>: Bocched, 0660:Jcael hed DlKoenl, 8192: Jcael hed Bhpplc, 8117: Wcamp,0666: Wpaeelr hed Jcael, 0666). Ai h EHV ghe `l rlgordldhgross tbl clsaoe, tble lxtlrehc elurocysas as plriormld. Ai eo EHV ghe `l rlgordld, led-to-led rlphar or nrhit astbl prlilrh`cl progldurl. Duraen spcat or phrtahc rlphar, atmhy `l elglsshry to rlgord EHVs irom splgag ihsgagcls(^accahms hed Tlrzas, 81>9). Ai h toureaqult as usld tohgbalvl h `coodclss lcd, at must `l dlffhtld ior ht clhst

76 mae `liorl httlmptaen to rlgord EHVs.

2. Outgomls oi surnlry ior trhumhtag elrvl aekury

Tblrl hrl slvlrhc rlgoneazld ihgtors tbht aeffulegl tbloutgoml hitlr rlphar oi h TVEA (@lcz`lrn, 066<). Twomhkor ihgtors ihvoraen h nood iuegtaoehc outgoml hrlyoutb hed dasthc aekury, `otb `lghusl oi tbl sbortlr das-thegl hed tbl morl dasgrltl slphrhtaoe oi motor hed sle-sory ihsgagcls tbht ghe `l mhtgbld ae tbl proxamhc heddasthc stumps. @lttlr iuegtaoehc rlgovlry oggurs watb led-to-led rlphar tbhe watb nrhitaen. Oplrhtaoes doel lhrcy

bhvl h `lttlr outgoml tbhe tbosl doel chtlr, hed he ueior-tuehtl eum`lr oi phtalets hrl ‒‒o`slrvld” uetac tbl taml ioroptamhc surnaghc aetlrvletaoe `y he lxplrt plrapblrhc elrvlsurnloe as coen phst. Chgj oi su`splgahcty trhaeaen aeplrapblrhc elrvl surnlry hed he aelxplralegld surnloehrl gclhr ampldamlets to h shtasihgtory outgoml. Hctbounbmusgcls hrl arrlvlrsa`cy dhmhnld hitlr h`out 82 moetbs,tbl slesory `lrs hed slesory rlglptors survavl ior h mugbcoenlr plraod, hed surnlry doel mugb chtlr, lvle ylhrschtlr, mhy rlstorl protlgtavl sleshtaoe to he aesleshtl phrt.Vrogldurls sugb hs tledoe trhesilrs hed vhsguchrazld irllmusgcl trhesilr, tbl nrhgacas as irlquletcy usld, ghe rlstorliuegtaoe lvle wble tbl praml movlr oi h phrt as arrlvlrs-a`cy dlelrvhtld.

Ae 8112, Jcael lt hc. rlportld h rltrosplgtavl gcaeaghcstudy oi h 04-ylhr lxplralegl watb tbl mhehnlmlet hedrlsucts oi sgahtag elrvl aekurals ae 726 phtalets (Jcaellt hc., 8112). Ae 96%, tbl aekury whs ht tbl `uttogj clvlc,hed aeklgtaoe aekurals mhdl up morl tbhe bhci oi tblslghsls. Tbanb-clvlc aekury oggurrld ae 46% hed whs usuhccyslgoedhry to nuesbot woued, ilmorhc irhgturl, chglrhtaoe,or goetusaoe. Vhtalets watb phrtahc dlgats uegompcaghtld`y slvlrl phae or watb saneaghet spoethelous rlgovlryor chtl rlilrrhc wlrl mhehnld mldaghccy. Wurnaghc lxpcorh-taoe whs eot aedaghtld ae 07% oi aekurals ht tbl tbanb clvlc

hed hcmost <6% oi tbosl ht tbl `uttogj clvlc. Most oi tblsl

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phtalets hgbalvld phrtahc `ut nood spoethelous rlgovlry,lsplgahccy ae tbl ta`ahc davasaoe dastra`utaoe. Wurnaghc aetlr-vletaoe whs doel ior gompcltl dlgats ae >>% oi tbl tbanbclvlc ghsls hed <6% oi tbl `uttogj ghsls. ^bltblr to plr-iorm elurocysas or rlslgtaoe whs nuadld `y EHV rlgord-aens. Waneaghet rlgovlry whs o`thaeld ae oecy 79% oi 

phtalets wbo bhd suturl or nrhit rlphars oi tbl plroelhcdavasaoe. Nood-to-lxglcclet outgoml whs gommoe ior tblta`ahc davasaoe, lvle wble rlphar whs proxamhc hed rlquarldclentby nrhits. Tbl rlchtavlcy ihvorh`cl rlgovlry oi ta`ahc hsopposld to plroelhc davasaoes oi tbl sgahtag elrvl oggurrldrlnhrdclss oi tbl clvlc or mlgbheasm oi aekury. Thbh hedThbh rlportld tbl outgoml oi 0> phtalets wbo bhd tbl sga-htag elrvl suturld h`ovl tbl jell 7‗84 wlljs hitlr massaclaekury (Thbh hed Thbh, 8112). Ae hducts, rlgovlry whs san-eaghetcy `lttlr hitlr suturl oi ta`ahc (27%) tbhe plroelhc(71%) elrvls, hitlr tbanb (>8%) tbhe `uttogj (78%) clvlcaekurals, hed hitlr led-to-led elurorrbhpby (>4%) tbhenrhitaen (71%). Ponheovag lt hc. rlportld h prosplgtavl

study oi 881 phtalets watb massacl-aedugld gompcltl clsaoesoi tbl ta ahc elrvl or ta ahc davasaoe (Ponheovag lt hc.,066<). Tblrl whs h sugglssiuc outgoml ae 76.7% oi banb-clvlc, <6% oi aetlrmldahtl-clvlc, hed 2<.>% oi cow-clvlcrlphars ( p 3 6.668). Oe hvlrhnl, tbl clentb oi tbl nhp hedtbl prloplrhtavl aetlrvhc wlrl saneaghetcy sbortlr aephtalets watb h nood outgoml. H worsl outgoml oggurrldwatb h elrvl dlilgt coenlr tbhe < gm hed h prloplrhtavlaetlrvhc coenlr tbhe 4 moetbs.

\sliuc rlgovlry oi slesory hed motor iuegtaoes whsstudald prosplgtavlcy hitlr 717 nrhit rlphars oi tbl mldahe,ucehr, rhdahc, ta`ahc, plroelhc, ilmorhc, hed musgucoguthel-

ous elrvls (Ponheovag hed Vhvcaglvag, 0669). Wlesoryrlgovlry potletahc whs samachr ior hcc elrvls tlstld( p 5 6.6<), `ut motor rlgovlry potletahc dastlrld sanea-ghetcy. Hitlr banb-clvlc rlphars, usliuc motor rlgovlrywhs `lttlr ior tbl rhdahc (99.>%) hed ta`ahc (<4.<%) elrvlstbhe ior tbl ucehr (8<.4%) hed plroelhc (87.2%) elrvls( p 3 6.6<). Hitlr aetlrmldahtl-clvlc rlphars, motor rlgovlrywhs `lttlr ior tbl musgucoguthelous (866%), rhdahc(12.7%), hed ilmorhc elrvls (2>.<%), tbhe ior tbl ta`ahc(97.1%), mldahe (<0%) hed ucehr (47.9%) elrvls( p 3 6.6<). Motor rlgovlry whs saneaghetcy worsl watbplroelhc elrvl rlphars (8<.0%) ( p 3 6.6<). Hitlr cow-clvlcrlphars, motor rlgovlry potletahc whs samachr ior hcc elrvlswatb usliuc rlgovlry ae tbl rhenl oi 22.1‗866% lxglpt iorplroelhc elrvl rlphars (<9.7%).

Jrltsgbmlr lt hc. studald ahtronleag elrvl aekurals ae >00surnaghccy trlhtld elrvl aekurals. Tbly ioued tbht 8>.4% oi tbl >00 ghsls wlrl ahtronleag, most irom h prlvaous oplrh-taoe. Mhey oi tbl phtalets watb ahtronleag clsaoes wlrl eotslle watbae h taml irhml goedugavl to surnaghc mhehnl-mlet: oi tbosl wbo dad bhvl surnlry, soml amprovlmletoggurrld ae >6%. Oel oi tbl mhkor ghusls oi poor outgomlae phtalets watb ahtronleag clsaoes as dlchyld rlilrrhc to hsurnloe watb plrapblrhc elrvl lxplrtasl (Jrltsgbmlrlt hc., 0668). Tblrl hrl mhey studals lxhmaeaen outgomls

ae ghrphc tueelc syedroml usaen dastlrlet surnaghc tlgb-

eaquls (Tbomh lt hc., 0664). Tblrl hrl hcso outgomls dhthhvhach`cl ae rlnhrd to h eum`lr oi splgag elrvls, aegcudaentbl postlraor aetlrosslous (Jam lt hc., 0669h), tbl hetlraoraetlrosslous (Jam lt hc., 0669`), mldahe (Jam lt hc.,0668h), ucehr (Jam lt hc., 0667h: Wlglr lt hc., 066>), rhdahc(Jam lt hc., 0668`), hed hxacchry (Jcael hed Jam, 0667).

Jam lt hc. studald tbl outgomls oi 8681 surnaghccy mhehnld`rhgbahc pclxus clsaoes. Plphars bhd tbl `lst outgoml watbaekurals coghtld ht tbl G-<, G-9, hed G-> clvlcs, tbl upplrhed maddcl truej, tbl chtlrhc gord to tbl musgucoguthelouselrvl, hed tbl mldahc hed postlraor gords to tbl hxacchryhed rhdahc elrvls. Plsucts wlrl poor watb G-2 hed T-8 aeku-rals hed ior cowlr truej hed mldahc gord clsaoes. Ghrliucslclgtaoe oi ghsls, lsplgahccy goesadlraen sugb ihgtors hsclsaoe typl, coghtaoe, slvlraty, hed taml saegl aekury wlrlhssogahtld watb `lttlr outgomls (Jam lt hc., 0667`).

Plilrlegls

Hbc`ore V, Wgbhgbelr M, Araetgblv H. Oel bour lclgtraghc stamuchtaoehgglclrhtls iuegtaoehc rlgovlry hitlr ilmorhc elrvl rlphar. Lxp Eluroc066>:062;87>‗44.

Hc Mhkld HH, Thm WC, Nordoe T. Lclgtraghc stamuchtaoe hgglclrhtls hedlebhegls lxprlssaoe oi rlnlelrhtaoe-hssogahtld nlels ae rlnlelrhtaenrht ilmorhc motoeluroes. Glcc Moc Eluro aoc 0664:04;7>1‗460.

Hmaeost MK. Lclgtropbysaoconag tlstaen ior tbl dahneosas oi plrapblrhcelrvl aekurals. Helstblsaocony 0664:866;8012‗767.

Hedlrs KK, Nlueh W, Pogbjaed W. Vbototblrhpy promotls rlnlelrhtaoehed iuegtaoehc rlgovlry oi aekurld plrapblrhc elrvl. Eluroc Pls0664:09;077‗1.

@lcz`lrn HK. Hgutl elrvl aekurals. Ae; Plenhgbhry WW, Lccle`onle PN,ldators. Vraegapcls oi elurosurnlry. 0ed ld. Ldae`urn; Lcslvalr Mos`y:066<. p. 72>‗1<.

@lrtlcca KH, Nbazoea MI. \sl oi gcaeaghc sanes hed gomputld tomonrhpbymylconrhpby edaens ae dltlgtaen hed lxgcudaen elrvl root hvucsaoe aegompcltl `rhgbahc pclxus phcsy. K Elurosurn 0669:86<;27<‗40.

@argb P. Oplrhtaen oe plrapblrhc elrvls. Ae; Dygj VK, Tbomhs VJ,ldators. Vlrapblrhc elurophtby. 4tb ld. Vbachdlcpbah; Lcslvalr Whue-dlrs: 066<. p. 8<88‗70.

@ooestrh HM, vhe ^llrdle T^, Lasmh ^B, Vhbcpchtz Y@, OostlrbuasBK. Tbl lstlgt oi cow-irlqulegy lclgtraghc stamuchtaoe oe dlelrvhtaoehtropby ae mhe. Wghed K Plbh`ac Mld 812>:81;80>‗74.

@rowe ^I, Ylatgb K. HHLM maeamoeonrhpb #40; aetrhoplrhtavlmoeatoraen oi plrapblrhc hed grheahc elrvls. Musgcl Elrvl8114:8>;7>8‗>.

@ureltt MN, [hnlr LC. Vhtbopbysaocony oi plrapblrhc elrvl aekury; h`rali rlvalw. Elurosurn Iogus 0664:89;8‗>.

Ghmp`lcc ^^. DlKoen‑s tbl eluroconag lxhmaehtaoe. 9tb ld. Vbachdlc-

pbah; Cappaegott, ^accahms hed ^acjaes: 066<.Gbhudbry Y, Nchss KD, Nrae K^. ^hcclrahe dlnlelrhtaoe ae plrapblrhc

elrvl daslhsl. Eluroc Gcae 8110:86;987‗0>.Gbalrza W, Phtto NM, Ylrmh V, Ihwgltt K^. Tbl h`acaty oi hxoes to

rlnlelrhtl tblar nrowtb goels dlpleds oe hxoehc typl hed hnl, hed asrlnuchtld `y ghcgaum, gHMV hed LPJ. Lur K Elurosga066<:08;06<8‗90.

Gocl @N, Nhrdaelr VI. Dols lclgtraghc stamuchtaoe oi dlelrvhtld musgcl,goetaeuld hitlr rlaeelrvhtaoe, aeffulegl rlgovlry oi goetrhgtacl iueg-taoe?. Lxp Eluroc 8124:2<;<0‗90.

Gostanhe M, Mheeaoe PK, Jledhcc N, Clwas WL, Ghmphneh KH,Gonnlsbhcc PL, lt hc. Blht sbogj protlae 0>; dlvlcopmlethc rlnuchtaoehed lxprlssaoe hitlr plrapblrhc elrvl aekury. K Elurosga8112:82;<218‗166.

Grlhenl H, @hrcovhtz-Mlamoe N, Nblrhrda PJ. Gytojaels hed plrapb-

lrhc elrvl dasordlrs. Lur Gytojael Eltw 811>:2;84<‗<8.

8190   ^.^. Ghmp`lcc/ Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<

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Grum @H, Wtrommle KH. Vlrapblrhc elrvl stamuchtaoe hed moeatoraenduraen oplrhtavl progldurls. Musgcl Elrvl 066>:7<;8<1‗>6.

Dhbcae C@. Elrvl aekury hed rlphar; irom moclgucl to mhe. Ae; WcutsjyDK, Bletz YP, ldators. Vlrapblrhc elrvl surnlry; prhgtaghc hppcaghtaoesae tbl upplr lxtrlmaty. Vbachdlcpbah; Gburgbacc Cavaenstoel, Lcslvalr:0669. p. 8‗00.

Dhvas K@, Wtroo`het V. Vchtlclt-dlravld nrowtb ihgtors hed `ro`chstnrowtb ihgtors hrl matonles ior rht Wgbwhee glccs. K Glcc @aoc8116:886;87<7‗96.

Daho L, Yheeuyle T. Tlgbeaquls ior pramhry elrvl rlphar. Bhed Gcae0666:89;<7‗99, vaaa.

Dow DL, Ghrcsoe @M, Bhssltt GH, Dleeas PN, Ihucjelr KH. Lclgtraghcstamuchtaoe oi dlelrvhtld musgcls oi rhts mhaethaes mhss hed iorgl,`ut eot rlgovlry ioccowaen nrhitaen. Plstor Eluroc Elurosga0669:04;48‗<4.

DumatruD, [whrtsMK, Hmhto HH.Vlrapblrhcelrvous systlm‑s rlhgtaoe toaekury.Ae; DumatruD, Hmhto HH,[whrts M, ldators. Lclgtrodahneostagmldagael. 0ed ld. Vbachdlcpbah; Bhecly hed @lcius: 0668. p. 88<‗<9.

Dworjae PB, @hgjoekh M, Pow`otbhm MG, Hccle PP, Hrnost GP,@leeltt NK, lt hc. Hdvhegls ae elurophtbag phae; dahneosas, mlgbh-easms, hed trlhtmlet rlgommledhtaoes. Hrgb Eluroc0667:96;8<04‗74.

L`lrstlae H, L`lrstlae W. Lclgtraghc stamuchtaoe oi dlelrvhtld musgcl; as atwortbwbacl? Mld Wga Wports Lxlrg 8119:02;8497‗1.

Ileragb J, Nordoe T. Ghehdahe hssogahtaoe oi elurosgalegl rlvalw;hxoehc rlnlelrhtaoe ae tbl plrapblrhc hed gletrhc elrvous systlms‗ gurrlet assuls hed hdvhegls. Ghe K Eluroc Wga 0664:78;840‗<9.

Iu WQ, Nordoe T. Tbl glccuchr hed moclguchr `hsas oi plrapblrhc elrvlrlnlelrhtaoe. Moc Eluro`aoc 811>:84;9>‗889.

Iuehjosba B, Irasle K, @hr`hey N, Tammusj T, [hgbrassoe O, YlrnlYM, lt hc. Dastlrletahc lxprlssaoe oi mPEHs ior elurotropbaes hedtblar rlglptors hitlr hxotomy oi tbl sgahtag elrvl. K Glcc @aoc8117:807;4<<‗9<.

Nhcco N, Cltourelhu V. Hxoe nuadhegl; protlaes tureovlr ae tureaennrowtb goels. Gurr @aoc 0660:80;P<96‗0.

Nhcco N, Cltourelhu VG. Plnuchtaoe oi nrowtb goel hgtae chmlets `ynuadhegl guls. K Eluro`aoc 0664:<2;10‗860.

Nlrlmah EM, Nordoe T, @rusbhrt TM, Hc Mhkld HH, Ylrnl YM.Lclgtraghc stamuchtaoe promotls slesory eluroe rlnlelrhtaoe hednrowtb-hssogahtld nlel lxprlssaoe. Lxp Eluroc 066>:06<;74>‗<1.

Nano-@lehto D, Nlueh W, Pogbjaed W. Vbototblrhpy ior lebhegaenplrapblrhc elrvl rlphar; h rlvalw oi tbl catlrhturl. Musgcl Elrvl066<:78;914‗>68.

Noodmhe GW. Mlgbheasms hed moclgucls tbht goetroc nrowtb goelnuadhegl. Heeu Plv Elurosga 8119:81;748‗>>.

Nordoe T, Wuchamhe O, @oyd KN. Lxplramlethc strhtlnals to promotliuegtaoehc rlgovlry hitlr plrapblrhc elrvl aekurals. K Vlrapblr ElrvWyst 0667:2;079‗<6.

Nordoe T, @rusbhrt TM, Hmarkhea E, Gbhe JM. Tbl potletahc oi lclgtraghc stamuchtaoe to promotl iuegtaoehc rlgovlry hitlr plrapblrhcelrvl aekury‗gomphrasoes `ltwlle rhts hed bumhes. Hgth ElurogbarWuppc 066>:866;7‗88.

Nudlmlz L, Ozlr J, Gueeaenbhm @, Walmaoeow J, @rowel L,Walmaoeow M. Dlbydrolpahedrostlroel hs he lebheglr oi iuegtaoehcrlgovlry ioccowaen grusb aekury to rht sgahtag elrvl. Magrosurnlry0660:00;074‗48.

Nuttmhee L, Qouen K[. Plaeelrvhtaoe oi musgcl hitlr vhraous plraods oi htropby. K Heht 8144:>2;8<‗47.

Bhcc WM. Plnlelrhtaoe ae tbl plrapblrhc elrvous systlm. ElurophtbocHppc Eluro`aoc 8121:8<;<87‗01.

Bhcc WM. Tbl `aocony oi gbroeaghccy dlelrvhtld Wgbwhee glccs. Hee E QHghd Wga 8111:227;08<‗77.

Bhcc W. Mlgbheasms oi rlphar hitlr trhumhtag aekury. Ae; Dygj VK, TbomhsVJ, ldators. Vlrapblrhc elurophtby. Vbachdlcpbah; Lcslvalr, Whuedlrs:066<. p. 8467‗77.

Bhrtmhee KL. Elurocony ae oplrhtaoe arhqa irlldom; rasj ihgtors iorrlilrrhc, gcaeaghc prlslethtaoes hed aegadlegl oi daslhsl. K Eluroc Wga

0669:048;27‗16.

Blcnhsoe T, Nhrnauco V, Kobheelsdottar I, lt hc. Moeatoraen musgclnrowtb hed tassul gbhenls aedugld `y lclgtraghc stamuchtaoe oi dlelrvhtld dlnlelrhtld musgcls watb GT hed stlrlocatbonrhpbag 7Dmodlcaen. Hrtai Ornhes 066<:01;446‗7.

Blr`asoe NK, Khwlld MM, Datueeo Kr KI. Hgltycgbocael slesatavaty hed`racchtaoe potletahcs ae lclgtraghccy stamuchtld grusb-dlelrvhtld rhtsjlclthc musgcl. Hrgb Vbys Mld Plbh`ac 8127:94;08>‗06.

Barhshwh Q, Whjhjadh J. Wports hed plrapblrhc elrvl aekury. Hm K WportsMld 8127:88;406‗9.

Bojl H. Mlgbheasms oi daslhsl; wbht ihgtors camat tbl sugglss oi plrapblrhc elrvl rlnlelrhtaoe ae bumhes? Eht Gcae Vrhgt Eluroc0669:0;442‗<4.

Bocched EP. Aetrhoplrhtavl lclgtromyonrhpby. K Gcae Eluropbysaoc0660:81;444‗<7.

Ato Q, Qhmhmoto M, Ca M, Doyu M, Thehjh I, Mutgb T, lt hc.Dastlrletahc tlmporhc lxprlssaoe oi mPEHs ior gacahry elurotropbagihgtor (GETI), clujlmah aeba`atory ihgtor (CAI), aetlrclujae-9 (AC-9),hed tblar rlglptors (GETIP hcpbh, CAIP `lth, AC-9P hcpbh hednp876) ae aekurld plrapblrhc elrvls. @rhae Pls 8112:>17;708‗>.

Jhen B, Tahe C, Tbompsoe ^. Tlrmaehc Wgbwhee glccs nuadl tblrlaeelrvhtaoe oi musgcl hitlr elrvl aekury. K Elurogytoc0667:70;1><‗2<.

Jhtlr W@, Plbdlr Y. Tbl slesory-motor rocl oi nrowtb goel copodah.Gurr Opae Eluro`aoc 811<:<;92‗>4.

Jam DB, Jhm HG, Gbhedajh V, Talc PC, Jcael DN. Wurnaghcmhehnlmlet hed outgomls ae phtalets watb mldahe elrvl clsaoes. KElurosurn 0668h:1<;<24‗14.

Jam DB, Jhm HG, Gbhedajh V, Talc PC, Jcael DN. Wurnaghcmhehnlmlet hed outgoml ae phtalets watb rhdahc elrvl clsaoes. KElurosurn 0668`:1<;<>7‗27.

Jam DB, Bhe J, Talc PC, Murovag KH, Jcael DN. Wurnaghc outgomls oi 9<4 ucehr elrvl clsaoes. K Elurosurn 0667h:12;117‗8664.

Jam DB, Gbo QK, Talc PC, Jcael DN. Outgomls oi surnlry ae 8681`rhgbahc pclxus clsaoes trlhtld ht Couasaheh Wthtl \eavlrsaty BlhctbWgalegls Gletlr. K Elurosurn 0667`:12;866<‗89.

Jam DB, Murovag KH, Jam QQ, Jcael DN. Wurnaghc trlhtmlet hedoutgomls ae 4< ghsls oi postlraor aetlrosslous elrvl letrhpmlets hedaekurals. K Elurosurn 0669h:864;>99‗>>.

Jam DB, Murovag KH, Jam QQ, Jcael DN. Wurnaghc trlhtmlet hedoutgomls ae 8< phtalets watb hetlraor aetlrosslous elrvl letrhpmletshed aekurals. K Elurosurn 0669`:864;><>‗9<.

Jaenlry ^W. H grataghc rlvalw oi goetroccld gcaeaghc trahcs ior plrapblrhcelurophtbag phae hed gompclx rlnaoehc phae syedromls. Vhae811>:>7;807‗71.

Jcael DN. Wlclgtld `hsag goesadlrhtaoes. Ae; Jam DB, Madbh P, MurovagKH, Wpaeelr PK, ldators. Jcael & Budsoe‑s elrvl aekurals. 0edld. Vbachdlcpbah; Lcslvalr Whuedlrs: 0662h. p. 8‗08.

Jcael DN. Gcaeaghc hed lclgtraghc lvhcuhtaoe. Ae; Jam DB, Madbh P,Murovag KH, Wpaeelr PK, ldators. Jcael & Budsoe‑s elrvl aekurals. 0edld. Vbachdlcpbah; Lcslvalr, Whuedlrs: 0662`. p. 47‗97.

Jcael DN, DlKoenl @P. Lvojld potletahcs to lvhcuhtl plrapblrhc elrvlaekurals. Wurn Nyelgoc O`stlt 8192:80>;8071‗42.

Jcael DN, Bhpplc CT. Vlelcd clgturl. H quhrtlr gletury‑s lxplraleglwatb aetrhoplrhtavl elrvl hgtaoe potletahc rlgordaen. Ghe K Eluroc Wga8117:06;7‗86.

Jcael DN, Jam DB. Hxacchry elrvl rlphar ae 11 phtalets watb 868 strltgbaekurals. K Elurosurn 0667:11;976‗9.

Jcael DN, Jam D, Madbh P, Bhrsb G, Talc P. Mhehnlmlet hed rlsucts oi sgahtag elrvl aekurals; h 04-ylhr lxplralegl. K Elurosurn 8112:21;87‗07.

Jolpple HB. ^hcclrahe dlnlelrhtaoe; bastory hed gcaeaghc saneaghegl. KEluroc Wga 0664:006;88<‗>.

Jocahtsos YL, Vragl ^C, Vhrdo GH, Vragl DC. Yletrhc root hvucsaoe; helxplramlethc modlc oi dlhtb oi hduct motor eluroes. K Gomp Eluroc8114:740;7<‗44.

Jocodjae HC. Nrowtb goels hed tbl guls tbht rlplc tblm. TrledsElurosga 8119:81;<6>‗87.

Jouyoumdkahe KH. Vlrapblrhc elrvl aekurals; h rltrosplgtavl survly oi 4<9

ghsls. Musgcl Elrvl 0669:74;>2<‗2.

^.^. Ghmp`lcc/ Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<   8197

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Jrltsgbmlr T, Hetoeahdas N, @rhue Y, Phtb WH, Pagbtlr BV. Lvhcuhtaoeoi ahtronleag clsaoes ae >00 surnaghccy trlhtld ghsls oi plrapblrhc elrvltrhumh. K Elurosurn 0668:14;16<‗80.

Jrystoslj H, Wllds E^. Vchsmaeonle hgtavhtor rlclhsl ht tbl eluroehcnrowtb goel. Wgalegl 8128:087;8<70‗4.

Juffllr DV. Vromotaen hed darlgtaen hxoe outnrowtb. Moc Eluro`aoc8114:1;077‗47.

Clwas WL, Mheeaoe PK, ^batl IH, Gonnlsbhcc PL, @lnns W, Gostanhe M,lt hc. H rocl ior BWV0> ae slesory eluroe survavhc. K Elurosga8111:81;214<‗<7.

Ca C, Bouleou CK, ^u ^, Cla M, Vrlvlttl DM, Oppleblam P .Gbhrhgtlrazhtaoe oi spaehc motoeluroe dlnlelrhtaoe ioccowaen dastlr-let typls oi plrapblrhc elrvl aekury ae eloehthc hed hduct magl. K GompEluroc 8112:719;8<2‗92.

Cauzza IK, Tldlsgba @. Vlrapblrhc elrvl rlnlelrhtaoe. Elurosurn Gcae EHm 8118:0;78‗40.

Cuee LP, @rowe MG, Vlrry YB. Tbl phttlre oi hxoehc dlnlelrhtaoe aetbl plrapblrhc elrvous systlm vhrals watb dastlrlet typls oi clsaoe.Elurosgalegl 8116:7<;8<>‗9<.

Mhgjaeeoe WL, Dlccoe HC. Wurnlry oi tbl plrapblrhc elrvl. ElwQorj; Tbalml: 8122.

Mhgjaeeoe WL, Dooch`b Y@, Eovhj G@, Trucogj LV. Gcaeaghc outgomlioccowaen elrvl hcconrhit trhespchethtaoe. Vchst Plgoestr Wurn0668:86>;8481‗01.

Mhnna WV, Cowl AAA K@, Mhgjaeeoe WL. Vhtbopbysaocony oi elrvl aekury.Gcae Vchst Wurn 0667:76;861‗09.

Mhraglvag H, Lrgln M. ^hr aekurals to tbl lxtrlmatals. Mac Mld811>:890;262‗88.

Mhrtaea P. Lxprlssaoe hed iuegtaoehc rocls oi elurhc glcc surihgl moclguclshed lxtrhglccuchr mhtrax gompoelets duraen dlvlcopmlet hed rlnle-lrhtaoe oi plrapblrhc elrvls. K Elurogytoc 8114:07;8‗02.

Mhssly KM, Whedlrs D@. Waencl-`lr LMN dlmoestrhtls rlaeelrvhtaoedyehmags hitlr elrvl aekury. Elurocony 8118:48;88<6‗8.

Mhtsuyhmh T, Mhgjhy M, Madbh P. Vlrapblrhc elrvl rlphar hednrhitaen tlgbeaquls; h rlvalw. Eluroc Mld Gbar (Tojyo)0666:46;82>‗11.

Mourhd VD, Chzhr DH, Gurrh IV, Mobr @G, Hedrus JG, Hvlccaeo HM,lt hc. \ctrhsoued hgglclrhtls iuegtaoehc rlgovlry hitlr plrapblrhc elrvldhmhnl. Elurosurnlry 0668:42;8879‗46.

Mulcclr @J. Nrowtb goel nuadhegl; rst stlps towhrds h dllplruedlrsthedaen. Heeu Plv Elurosga 8111:00;7<8‗22.

Murpby VN, @ortbwagj CW, Kobestoe PW, Jugblc N, PagbhrdsoeVM. Ehturl oi tbl rltronrhdl sanehc irom aekurld elrvls tbhtaedugls aetlrclujae-9 mPEH ae eluroes. K Elurosga8111:81;7>18‗266.

Eagbocsoe D^, Tbore`lrry EH. Ghsphsls; jacclr protlhsls. Trleds@aogblm Wga 811>:00;011‗769.

Eohmhe BB, Wbabh HL, @hbm K. O`lrcae‑s ucehr elrvl trhesilr to tbl`aglps motor elrvl ae o`stltrag `rhgbahc pclxus phcsy; aedaghtaoes, hednood hed `hd rlsucts. Magrosurnlry 0664:04;820‗>.

Vhphcah A, Ghrdhga H, d‑Hcgoetrls IW, Cll KM, Tos V, Nlueh W. Wlclgtaoeoi tbl doeor elrvl ior led-to-sadl elurorrbhpby. K Elurosurn

066>h:86>;7>2‗20.Vhphcah A, Nlueh W, d‑Hcgoetrls IW, Tos V. Oranae hed bastory oi led-to-sadl elurorrbhpby. Magrosurnlry 066>`:0>;<9‗98.

Vhrthele KY, Dheelr P. Ia`racchtaoe potletahcs hitlr musgcl aekury aebumhes. Musgcl Elrvl 8120:<;W>6‗7.

Voccogj M. Elrvl rlnlelrhtaoe. Gurr Opae Eluroc 811<:2;7<4‗2.Phst MG, ^batmorl HY, Iaee KT. Hxoehc slci-dlstrugtaoe hed elurodl-

nlelrhtaoe. Wgalegl 0660:019;292‗>8.Pagbhrdsoe VM, Cu R. Aeffhmmhtaoe hed hxoehc rlnlelrhtaoe. K Eluroc

8114:040;W<>‗96.Po aesoe CP. Trhumhtag aekury to plrapblrhc elrvls. Musgcl Elrvl

0666:07;297‗>7.Po`aesoe CP. Trhumhtag aekury to plrapblrhc elrvls. Wuppc Gcae

Eluropbysaoc 0664:<>;8>7‗29.Ponheovag [, Vhvcaglvag N. Dastlrlegl ae rlgovlry potletahc oi plrapblrhc

elrvls hitlr nrhit rlphars. Elurosurnlry 0669:<1;908‗77.

Ponheovag [, Vhvcaglvag N, Vltjovag W. Massacl-aedugld gompcltl clsaoesoi tbl ta`ahc elrvl hed ta`ahc davasaoe oi tbl sgahtag elrvl; rlsucts oi 881rlphars. K Elurosurn 066<:867;900‗1.

Powhe VP, Gble CL, \r`heahj KP. Led-to-sadl elrvl rlphar. H rlvalw.Bhed Gcae 0666:89;8<8‗1, x.

Pudnl V, Ogboh K, Naccahtt P^. Hgutl plrapblrhc elrvl gomprlssaoe ae tbl`h`ooe. K Eluroc Wga 81>4:07;467‗06.

Pydlvaj @, Cued`orn N. Vlrmlh`acaty oi aetrhelurhc magrovlsslcs hedplraeluraum ioccowaen hgutl, nrhdld lxplramlethc elrvl gomprlssaoe.Wghed K Vchst Plgoestr Wurn 81>>:88;8>1‗2>.

Whrajgaoncu C, Onuz E. Lxlrgasl trhaeaen hed hxoehc rlnlelrhtaoe hitlrsgahtag elrvl aekury. Aet K Elurosga 0668:861;8>7‗>.

Wlglr BA, Dhelylmlz M, Noeuc L, Azga Q. Wurnaghc rlphar oi ucehr elrvlclsaoes ghusld `y nuesbot hed sbrhpelc; rlsucts ae 46> clsaoes. KElurosurn 066>:86>;>>9‗27.

Wlgjlc @P. Lebheglmlet oi plrapblrhc elrvl rlnlelrhtaoe. Musgcl Elrvl8116:87;>2<‗266.

Wlddoe B. Tbrll typls oi elrvl aekury. @rhae 8147:99;07>‗22.Wlclgja @P, Paen AT, Wampsoe DH, Yhedlrlcd NJ, Wlwlcc MI. Trhumh

to tbl gletrhc hed plrapblrhc elrvous systlms. Vhrt A; he ovlrvalw oi morthcaty, mor adaty hed gosts: E.W. . 81>>. Hust E [ K Wurn8120:<0;17‗860.

Walmaoeow M, Whra H. H goetlmporhry ovlrvalw oi plrapblrhc elrvlrlslhrgb irom tbl Gclvlched Gcaeag magrosurnlry ch`orhtory. ElurocPls 0664:09;082‗0<.

Wcamp KG. Aetrhoplrhtavl moeatoraen oi elrvl rlphars. Bhed Gcae0666:89;0<‗79.

Wpaeelr PK, Jcael DN. Wurnlry ior plrapblrhc elrvl hed `rhgbahc pclxusaekurals or otblr elrvl clsaoes. Musgcl Elrvl 0666:07;926‗1<.

Wthelg W, Toejovag A, Wthelg [, Toejovag D, Dzlpaeh A. Trlhtmlet oi upplr cam` elrvl whr aekurals hssogahtld watb vhsguchr trhumh. Aekury811>:02;497‗2.

Wtocc N, Mucclr B^. Elrvl aekury, hxoehc dlnlelrhtaoe hed elurhcrlnlelrhtaoe; `hsag aesanbts. @rhae Vhtboc 8111:1;787‗0<.

Wuchamhe OH, Nordoe T. Lstlgts oi sbort- hed coen-tlrm Wgbwhee glccdlelrvhtaoe oe plrapblrhc elrvl rlnlelrhtaoe, mylcaehtaoe, hed sazl.Ncah 0666:70;074‗49.

Wumelr HK. H`lrrhet rlaeelrvhtaoe. Musgcl Elrvl 8116:87;268‗7.Wuedlrched W. Elrvls hed elrvl aekurals. 0ed ld. @hctamorl; ^accahms hed

^acjaes: 81>2.Wuedlrched W. Tbl hehtomy hed pbysaocony oi elrvl aekury. Musgcl Elrvl

8116:87;>>8‗24.Thbh H, Thbh K. Plsucts oi suturl oi tbl sgahtag elrvl hitlr massacl aekury. K

Trhumh 8112:4<;746‗4.Theh`l J, @oeacch A, ^aejcls KH, Wtrattmhttlr WM. Ia`ro`chst nrowtb

ihgtor-aeduga`cl-84 as aedugld ae hxotomazld eluroes hed promotlseluratl outnrowtb. K Elurosga 0667:07;19><‗29.

Theaugba M, Gchrj B@, Kobesoe Kr LM. Aedugtaoe oi elrvl nrowtb ihgtorrlglptor ae Wgbwhee glccs hitlr hxotomy. Vrog Ehtc Hghd Wga \WH8129:27;4614‗2.

Tlrzas KJ, Jostopoucos YJ. Tbl surnaghc trlhtmlet oi `rhgbahc pclxusaekurals ae hducts. Vchst Plgoestr Wurn 066>:881;l>7‗10.

Tlssalr-Chvanel M, Noodmhe GW. Tbl moclguchr `aocony oi hxoenuadhegl. Wgalegl 8119:0>4;8807‗77.Tbomh H, Ylctra J, Bhaels T, Duju L. H mlth-hehcysas oi rhedomazld

goetroccld trahcs gomphraen ledosgopag hed ople ghrphc tueelcdlgomprlssaoe. Vchst Plgoestr Wurn 0664:884;887>‗49.

Tbomhs VJ. Aevatld rlvalw; ioghc elrvl aekury; nuadhegl ihgtors duraenhxoehc rlnlelrhtaoe. Musgcl Elrvl 8121:80;>19‗260.

Tbomhs VJ, Bocdorst @. Elurophtby dul to pbysaghc hnlets. Ae; Dygj VK,Tbomhs VJ, Nrae K^, ldators. Vlrapblrhc elurophtby. 7rd ld. Vbac-hdlcpbah; ^.@. Whuedlrs: 8117. p. 116.

Tuttcl P, O‑Clhry DD. Elurotropbaes rhpadcy moduchtl nrowtb goelrlspoesl to tbl hxoe nuadhegl moclgucl, gocchpsae-8. Moc GlccElurosga 8112:88;8‗2.

\daeh L, Gl`hccos D, Ylrdu L, Nocd @N, Ehvhrro R. @amodhc dosl-dlpledlegl oi IJ<69 oe tbl rhtl oi hxoehc rlnlelrhtaoe ae mousl

plrapblrhc elrvl. Musgcl Elrvl 0660:09;742‗<<.

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^l lr PY, Mhgjaeeoe WL. @radnaen tbl elurhc nhp. Gcae Vchst Wurn066<:70;96<‗89.

^ac`oure HK. Vlrapblrhc elurophtbals hssogahtld watb vhsguchr daslhslshed tbl vhsgucatadls. Ae; @rowe ^I, @octoe GI, Hmaeost MK, ldators.Eluromusguchr iuegtaoe hed daslhsl. Vbachdlcpbah; Whuedlrs: 0660. p.8001‗90.

^accahms B@, Tlrzas KJ. Waencl ihsgaguchr rlgordaens; he aetrhoplrhtavldahneostag tooc ior tbl mhehnlmlet oi plrapblrhc elrvl clsaoes. VchstPlgoestr Wurn 81>9:<>;<90‗1.

Qhwo B, Jueo M. Ghcgaum dlpledlegl oi mlm`rhel slhcaen ht tbl gutled oi tbl gogjrohgb nahet hxoe. K Elurosga 812<:<;8909‗70.

Qnnl K. Eluroehc coss ae cum`hr dorshc root nhencah hitlr proxamhcgomphrld to dasthc sgahtag elrvl rlslgtaoe; h quhetathtavl study ae tblrht. @rhae Pls 8121:4>2;817‗<.

[blen M, Juffllr DV. Nuadhegl oi rlnlelrhtaen motor hxoes ae vavo `ynrhdalets oi dastusa`cl plrapblrhc elrvl-dlravld ihgtors. K Eluro aoc0666:40;080‗1.

[bavotovsjy @. Ghsphsls; tbl lezymls oi dlhtb. Lsshys @aogblm0667:71;0<‗46.

[ogbodel D^, Clvy D. Eatrag oxadl ae dhmhnl, daslhsl hed rlphar oi tblplrapblrhc elrvous systlm. Glcc Moc @aoc (Eoasy-cl-nrhed)066<:<8;0<<‗9>.

^.^. Ghmp`lcc/ Gcaeaghc Eluropbysaocony 881 (0662) 81<8‗819<   819<