Problemy radiatsiinoi medytsyny ta radiobiolohii最新文献

Loss of health and workability, as well as deaths due to harmful influence of the Chornobyl Catastrophe (including radiation exposure) during performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposure not through their own fault but due to a radiation accident, caused the development of a special form of medical expertise as part of the of medical social protection system for these suffered contingents.

Objective: To study and characterize the structure of the affected categories (clean-up workers and victims) of the Chernobyl Catastrophe based on the materials of expert cases of the Central Interdepartmental Expert Commission (CMEC) in the remote post-accidental period (2013-2022).

Material and methods: The work was performed in the design of a retrospective study that based on studying of 50,974 expert cases, which were considered by CIEC during 2013-2022 to establish a causal relationship between the disease and influence of radiation exposure and other harmful factors and conditions during ChNPP accident using a systematic analytical approach to assessing the medical and nonmedical parameters presented in medical expert documentation.

Results: The total number of affected adult citizens as on 01.01.2022, compared to 2008, decreased by 477,953 persons, or by 26.05 % (from 1,834,536 to 1,354,746 persons). The number of clean-up workers of the accident decreased from 276,327 (2013) to 171,725 (2022), or by 104,602 people (37.85 %), that means - during the last 10 years, almost every third clean-up worker who participated in the liquidation of the consequences of the accident at the Chernobyl NPP died. The number of adult victims decreased from 1,558,209 in 2008 to 1,183,021 in 2022, or by 24.08 % (375,188 persons). The average annual reduction in the absolute number of clean-up workers of ChNPP accident during 2013-2022 is about 7,770 people per year (9,424 during 2021), adult victims - 27,045 people per year (28,922 during 2021). In the structure of medical expert cases during 2013-2022 the leading place as the reason of disease, disability and death is occupied by oncological diseases - 52.72 %, cerebrovascular diseases and their complications make up 17.08 %, diseases of the cardiovascular system - 19.6 %.

Conclusion: In the remote post-accidental period (2013-2022) has increased the need of expertise of the causal relationship of disability and the causes of death with the influence of the Chornobyl NPP accident consequences for medical and social support. During 2013-2022 period quick reducing for all categories of affected due to the Chornobyl NPP accident taken place. In the structure of medical expert cases during 2013-2022 the leading place as the reason of disease, disability and death is occupied by oncological diseases.

Studies of the longterm oncological consequences after the Chornobyl accident show a significant impact of radiation exposure on the cancer incidence rate in affected population in Ukraine. This is supported by the increased radiation risk of leukaemia in liquidators, which exceeds national population rates, and its value is comparable to the data on hibakushi, who were subjected to Abombings. For the first time in the cleanup workers cohort the radiation dependence of chronic lymphoid leukaemia was established. There are radiation associated risks of leukemia in children who have been exposed to radiation from the Chornobyl accident. There has been registered an increase of thyroid cancer incidence in children and adults (liquidators, evacuees from the 30km exclusion zone and residents of the most contaminated territories). There is an excess of breast cancer in female liquidators. The frequency of all forms of malignant neoplasms decreases over time but still exceeds national rates. Further monitoring of malignant neoplasms in the groups of affected population will allow evaluating the radiation risks of cancer forms whose radiationassociated manifestation is already known from previous studies or can be expected in the future.

Objective: to establish cellular immunity in clean-up workers of the Chornobyl accident compared to patients with malignant neoplasms of the oral cavity, oral and laryngeal parts of the pharynx according to the subpopulation organization of peripheral blood leukocytes.

Materials and methods: We examined 112 males, age (56,92 ± 6,17) years (M ± SD), including 26 male clean-up workers exposed at the radiation dose 10-500 mSv; 20 male clean-up workers exposed at the dose range 504-990mSv; 33 patients with malignant neoplasms of the oral cavity, oral and laryngeal parts of the pharynx and 33 non-exposed subjects of the control group. Immune cell subsets analysis was performed by the expression of differential and activation antigens of peripheral blood leukocytes using flow cytometry.

Results: In assessing each group's cellular immunity, there was a decrease in the number of CD19+ B-lymphocytes, CD3+ HLA-DR+ T- and CD3- HLA-DR+ B-lymphocytes, CD3- 16+ 56+ natural killer cells, combined with an increase in the number of CD8+ T-lymphocytes. An increase in the relative number of CD4+ CD8+ T-lymphocytes was determined in clean-up workers (D < 500 mSv) and cancer patients. An increase in the number of CD8+ T-lymphocytes and a decrease in the number of CD4+ T-lymphocytes were observed in clean-up workers (D > 500 mSv), as well as in cancer patients. In addition, a decrease of monocytes, CD3+ 16+ 56+ , and CD3+ TCRαβ+ T-lymphocytes was determined in patients with oncological pathology.

Conclusions: The obtained results show the unidirectionality of changes in cellular immunity in the participants of the liquidation of the consequences of the accident at the Chornobyl nuclear power plant and patients with the investigated oncological pathology, which indicates the formation of persistent violations of antitumor protection in the participants of the liquidation of the consequences of the accident as the basis of oncogenesis. Determining changes in the number of lymphocytes, monocytes, granulocytes, CD4+ T-lymphocytes, CD4+ CD8+ immature T-lymphocytes, the immunoregulatory ratio CD4+ / CD8+, CD3+TCRαβ+ T-lymphocytes and CD3+ 16+ 56+ CTL can have an additional effect on the effectiveness antitumor protection and the probability of oncogenesis risk in immunocompromised individuals.

Objective: to study relationship between the focal adsorbed doses (FAD) in the residual thyroid tissue (RTT) atradioiodine therapy (RIT) in patients with differentiated thyroid cancer (DTC) and efficacy of radioablation (RA).

Materials and methods: FAD in RTT in 221 patients aged 25-74 years were analyzed. Scintigraphic investigations were executed using gamma-camera «МВ 9200» and single photon emission tomograph «Е. САМ 180». FAD in RTT were determined according to recommendation of the Committee on Medical Internal Radiation Dose.

Results: Mean FAD in RTT was consisted (125.9 ± 8.6) Gy with range 1.8-1373.4 Gy. Positive effect after first course of RIT was in 77.4 % of patients complete RA of 78 % of RTT was achieved. Mean FAD in cases with complete RA was (147.0 ± 13.3) Gy with range 1.8-1373.4 Gy. Efficacy of RIT constantly increased from 68.2 to 93.7 % with increasing mean FAD from 30 to 370 Gy. Feather enlarging of FAD did not lead to any significant increasing of efficacy of RIT:enlarging mean FAD from 370 to 776 Gy increased efficacy of RA on 0.4 % only. Repeated RIT decreased FAD in RTTafter each course. Using regression analysis was established type of relationship between efficacy of RA and FAD in RTT, according it efficacy of first RA consists at 40 Gy 72.8 %, 150 Gy - 84.9 %, 300 Gy - 91.2 %, 400 Gy - 93.7 %,500 Gy - 95.7 %.

Conclusions: FAD in RTT at RIT differ in large range, it can be explained different anatomical and functional condition of iodine accumulate thyroid tissue after surgical treatment and its radioresistance. Efficacy of RA increases with enlarging of FAD, this relationship is nonlinear. Efficacy of RA has the upper dose threshold in range 350-400 Gy. The frequency of thyroid tissue with high radioresistance is approximately 6 %.

Objective: to provide a comparative characterization of the prevalence of polymorphic variants of cytokine genes in plasma cell myeloma (PCM) patients suffered after the Chornobyl disaster and patients who were in contact with ionizing radiation within the natural radiation background, based on comparison with population controls to determine their contribution as genetic markers of disease risk.

Materials and methods: Molecular genetic studies of polymorphism of cytokine genes (TNF-α, TGF-β1, IL-6, IL-10, IFN-γ) and complex frequency analysis of occurrence in three-, four-, and five-locus combinations of their allelic variants as prognostic markers of the risks of plasma cell myeloma was carried out in 102 patients - 56 victims of the Chornobyl nuclear power plant accident and 46 patients irradiated within the limits of the natural radiation background, in comparison with the control group (364 practically healthy people, residents of the Central geno-geographical region of Ukraine).

Results: The same probable increase in the prevalence of the TGF-β genotype codon10 T/T of the TGF-β1 gene was established in the groups of patients irradiated after the Chornobyl NPP accident and non-irradiated patients. In patients with plasma cell myeloma a protective effect for IL-10 -1082 A/G and an association with the risk of disease occurrence for IL-10 -1082 G/G were determined.

Conclusion: Probable difference in the frequency of the TGF-β1 genotype codon10 T/T of the TGF-β1 gene in the observed groups relative to the control group provides grounds for considering this single-nucleotide polymorphism of the TGF-β1 gene as an immunogenetic factor of predisposition to the development of PCM independent of exogenous factors. The study of the contribution of multigene combinations of «gene-gene» interaction indicates their role in the mechanisms of plasma cell myeloma occurrence and confirms the presence of an additive interaction.

Objective: to determine the causes of increased bone mineral density (BMD) based on case history, clinical and laboratory data, including the assay of hormones involved in ossification processes in children, living on radiologically contaminated territories (RCT) after the accident at the ChNPP, compared to the normative BMD patterns.

Materials and methods: There were 289 children involved in the study. The 1st group included persons with a BMD above 100 IU, 2nd group - with normative BMD (100-85 IU). Family history of diseases was assessed featuring cancer and endocrine diseases, cholelithiasis, and urolithiasis. Weight of the child at birth, frequency of bone fractures, complaints about osalgia, jaw abnormalities, dental caries, presence or absence of obesity, peripheral blood count, blood biochemical parameters (total protein, creatinine, iron, alkaline phosphatase, calcium), serum pituitary thyroid-stimulating hormone and cortisol were accounted. Children's radiation doses were calculated according to the materials of the «General dosimetric certification of settlements of Ukraine that were exposed to radioactive contamination after the Chornobyl accident».

Results: Higher than normative BMD values were found in children after puberty, while normative ones - in puberty (р < 0.001), regardless of gender. A direct correlation between the bone fractures frequency was established in children with increased BMD (р < 0.01). Jaw anomalies and dental caries occurred at that significantly less often than in normative BMD (р > 0.05). A direct correlation was established between the obesity and BMD (р < 0.001).Increased alkaline phosphatase activity was inversely correlated with BMD (rs = -0.21; р < 0.05). In children with elevated BMD a direct correlation was established between the level of iron and endocrine disorders in the family history (р > 0.001). Serum level of cortisol was directly correlated with dental caries (р < 0.05). In children, regardless of BMD value, a direct correlation was established between the radiation dose, age and obesity (р < 0.001).

Conclusions: Higher than normative BMD is accompanied by an increased frequency of bone fractures, jaw abnormalities, metabolic changes in bone tissue and bone tissue hormonal regulation in children, which requires application of pathogenetic therapy for the osteogenesis.

Prerequisite. Since the advent of nuclear energy, industry and weapons, a possibility of radiation events i.e. incidents and accidents had emerged. Given the presence of radioactive iodine as part of environmental contamination, the response of authorities and medical services consists, in particular, in carrying out the emergency iodine prophylaxis among specialists and general population. And along with the fact that emergency iodine prophylaxis is a generally accepted measure in radiation events accompanied by the release of radioactive iodine, some methods of its implementation were and remain in certain sources and instructions/recommendations contradictory and even false. Such inconsistency increases the potential risks of health effects of radioactive iodine and exacerbates the sense of fear and uncertainty among the population involved in the incident.

Objective: to consider and review the essence of emergency iodine prophylaxis during radiation events, physiological aspects of iodine metabolism in the body, properties of individual iodine prophylaxis agents that are recommended, and to justify the rationality of using some of them along with absurdity/inadmissibility of others; substantiate the creation of a unified preventive information strategy regarding the event in order to reduce anxiety and other negative psychological consequences among the affected population.

Materials and methods: The review was performed by searching the abstract and scientometric databases and printed publications.

Results: In the event of serious radiation events at nuclear power plants and industry facilities, radioactive iodine is highly likely to enter the environment. With the threat of radioactive iodine incorporation or with its incorporation that has already begun, it is absolutely necessary to carry out the emergency iodine prophylaxis. Such prevention should be carried out with stable iodine preparations such as potassium iodide or potassium iodate in special pharmaceutical formulas. Dosing of drugs in age and population groups should be carried out by specialists in radiation medicine and radiation safety in accordance with internationally recognized guidelines. The use of iodinecontaining food additives, iodine solution for external use and Lugol's solution is categorically unacceptable due to complete ineffectiveness, impracticality of implementation, and sometimes due to the threat of serious harm to health.

Conclusions: Clear preparedness plans for possible radiation accidents and incidents, as well as successfullyimplemented appropriate preventive measures, including emergency iodine prophylaxis, are crucial for the effective and successful response to such events. Emergency iodine prophylaxis during radiation events should be carried out exclusively under the guidance of specialists in radiation medicine and radiation safety using special pharma

Any collection of objects of study needs some arrangement, i. e. classification. The existing numerous classifications of antiradiation agents are built on the basis of their antiradiation effects of an integrated or differentiated nature. The work presents the chronology of the main classifications of chemical compounds that are able to protect against the shortterm and longterm effects of ionizing radiation when they are introduced into the body both before and after exposure. The change of views, trends and paradigms regarding radioprotective compounds is shown. These classifications of antiradiation medicines include radioprotectors, means of stimulating the radioresistance of the body, means of prevention and suppression of the primary reaction to irradiation, means of prevention and treatment of lesions from exposure to incorporated radionuclides, means of treatment of acute bone marrow syndrome, means of treatment of local radiation lesions. It is shown that modern concepts of radiation protection are based on fundamentally different «points of application» of groups of radioprotective agents and depend on the stage of radiation damage.