КРИТЕРИИ ЗАЩИТЫ НАСЕЛЕНИЯ ПОСЛЕ РАДИАЦИОННОЙ АВАРИИ: ИСПОЛЬЗОВАНИЕ РАДИАЦИОННОГО РИСКА ДЛЯ АНАЛИЗА И ПРИНЯТИЯ ОПТИМАЛЬНЫХ РЕШЕНИЙ ПО ОГРАНИЧЕНИЮ ПОТРЕБЛЕНИЯ ПИЩЕВЫХ ПРОДУКТОВ, ЗАГРЯЗНЕННЫХ ТЕХНОГЕННЫМИ РАДИОНУКЛИДАМИ

The purpose of this paper is to assess the compliance of criterion A, adopted in NRB-99/2009 as emergency level of dose intervention, to permissible values of specific activity of 137Cs, 90Sr and 131I in food products in the first year after the accident. Assessments are made on the basis of comparison of the conservativeness coefficients by dose and the magnitude of the risk. The results of the evaluation showed that estimates of the doses and risks for 137Cs, 90Sr, calculated on the basis of weighting by the number of age groups, are equally conservative. For 131I, the conservative factors for dose and risk vary significantly, which indicates that it is not appropriate to use an effective dose to optimization of radiation protection for the given radionuclide. The ratios of the risk-weighted average weighted by the number of individual age groups to the weighted average effective dose values for 137Cs and 90Sr are close to the nominal risk of death from malignant neoplasms for the population of 5×10-5, which confirms that nominal risk factors can only be used for the general population. Two variants of the criteria for optimization of the radiation protection of the population are proposed: 1) by the value of the average weighted by the number of individual age groups, the value of the effective dose, or 2) the value of the average weighted by the number of individual age groups of risk. It is shown that to optimize the protection of individual age groups, the more preferable criterion is the risk value calculated for a given age group, since the maximum effective dose of some age group does not always correspond to the maximum risk.Целью данной работы является оценка соответствия критерия А, принятого в НРБ-99/2009 в качестве аварийного уровня вмешательства по дозе, допустимым значениям удельной активности 137Cs, 90Sr и 131I в пищевых продуктах в первый год после аварии. Оценки выполнены на основе сопоставления коэффициентов консервативности по дозе и величине риска. Результаты оценки показали, что в равной мере консервативными являются оценки доз и рисков для 137Cs и 90Sr, рассчитанных на основе взвешивания по численности возрастных групп. Для 131I коэффициенты консервативности по дозе и риску существенно отличаются, что свидетельствует о нецелесообразности использования эффективной дозы для оптимизации радиационной защиты в отношении данного радионуклида. Коэффициенты отношения средневзвешенных по численности отдельных возрастных групп значений риска к средневзвешенным значениям эффективных доз для 137Cs и 90Sr близки к номинальному коэффициенту риска смерти от злокачественных новообразований для населения 5×10-5, что подтверждает то, что номинальные коэффициенты риска могут использоваться только для населения в целом. Предложены два варианта критериев оптимизации радиационной защиты населения: 1) по величине средневзвешенного по численности отдельных возрастных групп значению эффективной дозы или 2) по величине средневзвешенного по численности отдельных возрастных групп риска. Показано, что для оптимизации защиты отдельных возрастных групп более предпочтительным критерием является величина риска, рассчитанная для данной возрастной группы, поскольку максимальная эффективная доза некоторой возрастной группы не всегда соответствует максимальному риску.сти 137Cs, 90Sr и 131I в пищевых продуктах в первый год после аварии. Оценки выполнены на

Gravitational Lensing by Black Holes

We review the theoretical aspects of gravitational lensing by black holes, and discuss the perspectives for realistic observations. We will first treat lensing by spherically symmetric black holes, in which the formation of infinite sequences of higher order images emerges in the clearest way. We will then consider the effects of the spin of the black hole, with the formation of giant higher order caustics and multiple images. Finally, we will consider the perspectives for observations of black hole lensing, from the detection of secondary images of stellar sources and spots on the accretion disk to the interpretation of iron K-lines and direct imaging of the shadow of the black hole.Comment: Invited article for the GRG special issue on lensing (P. Jetzer, Y. Mellier and V. Perlick Eds.). 31 pages, 12 figure

ОБ ИСПОЛЬЗОВАНИИ КОЭФФИЦИЕНТОВ УЩЕРБА ДЛЯ КОЛИЧЕСТВЕННОЙ ОЦЕНКИ ПОСЛЕДСТВИЙ ВОЗДЕЙСТВИЯ ИОНИЗИРУЮЩЕГО ИЗЛУЧЕНИЯ

Article grows out of the comparative analysis of two publications of ICRP and is devoted features of practice of application of nominal detriment coefficients, a way of their calculation and a correctness of use of terminology in the field of a quantitative estimation of degree of radiating influence on human's health.Статья посвящена особенностям использования и вычисления коэффициентов ущерба и корректности использования терминолгии в области количественной оценки степени радиационного воздействия на здоровье человека

Scientific schools and directions of economic theory on the modern era of development

The modern expansion of subject areas of application in the development of economic theory, scientists, as a rule, distinguish four large eras of development, which are equal in their level of influence on the development of economic knowledge

Оценка радиационного ущерба для здоровья: о возможности использования эффективной дозы для расчета числа потерянных лет здоровой жизни

The Russian Law “On Radiation Safety of the Population” defines the effective dose as “the amount of exposure to ionizing radiation used as a measure of the risk of long-term consequences of human’s body exposure…” In turn, the Russian “Radiation Safety Standards” (RSS 99/2009) establish a procedure for assessing the health risk, associated with exposure to low doses, for two types of harmful effects (oncological diseases and hereditary effects) and two age and sex groups (“whole population” and “adults”) by multiplying corresponding linear risk coefficients per effective dose. At the same time, these documents do not impose restrictions on the risk assessment procedure, without excluding the use of any other risk indicators or risk assessment for other sex and age groups of the population. The value of radiation detriment to health, calculated by the method described in RSS 99/2009 to characterize the risk, as a unit of measurement, uses the fatal oncological disease caused by exposure to ionizing radiation, weighted by the number of years of life lost, or weighted by the severity of non-fatal cancer. Currently, mortality-based health measures are considered insufficiently informative characteristics of the impact of external factors on population health. Such indicators are poorly suited for a comparative analysis of risks, especially taking into account the different distribution of negative consequences over time. The paper presents an applied approach to expand the application of the radiation risk assessment methodology, without making significant changes to the established practice of radiation protection. The possibility of using the DALY value (disability-adjusted life years) as an measure of radiation risk is being considered; the expediency of changing approaches to calculating the effective dose (by using different values of weighting factors for tissues and organs during effective dose calculation for different age and sex groups of the population) and the possible scope of the proposed approaches to risk assessment in practice are discussed; an approach is proposed for calculating the DALY value using the effective dose and the corresponding risk factors (DALY×Sv-1).Закон «О радиационной безопасности населения» Российской Федерации определяет эффективную дозу как «величину воздействия ионизирующего излучения, используемую как меру риска возникновения отдаленных последствий облучения организма человека…». В свою очередь, «Нормы радиационной безопасности» устанавливают процедуру оценки риска для здоровья, связанного с облучением в малых дозах, для 2 видов вредных последствий (онкологические заболевания и наследственные эффекты) и 2 половозрастных групп («Все население» и «Взрослые») путем умножения соответствующих линейных коэффициентов риска на эффективную дозу. В то же время указанные документы не исключают использование иных процедур оценки риска, не исключая использование каких-либо других показателей риска или выполнения оценки риска для иных половозрастных групп населения. Величина радиационного ущерба для здоровья, вычисляемая описанным в НРБ99/2009 способом для характеристики риска, в качестве единицы измерения использует 1 случай вызванного воздействием ионизирующего излучения средневзвешенного по числу потерянных лет жизни смертельного онкологического заболевания или приравненного к нему взвешенного по степени тяжести онкологического заболевания, не приводящего к смерти. В настоящее время величины, вычисляемые на основе показателей смертности, считаются недостаточно информативными характеристиками влияния внешних факторов на популяционное здоровье. Такие показатели слабо пригодны при сравнительном анализе рисков различной природы, особенно с учетом различного распределения последствий негативного воздействия во времени. В работе представлен прикладной подход, с помощью которого без внесения существенных изменений в сложившуюся практику радиационной защиты возможно расширить применение методологии оценки риска для здоровья. Рассматривается возможность использования в качестве показателя радиационного риска для здоровья величины DALY (числа потерянных вследствие облучения лет здоровой жизни, взвешенных с учетом нетрудоспособности); обсуждаются целесообразность изменения подходов к расчету эффективной дозы (путем использования различных значений взвешивающих коэффициентов для тканей и органов при расчете эффективной дозы применительно к различным половозрастным группам населения) и возможная сфера применения предлагаемых подходов к оценке риска на практике; предлагается подход к расчету значения DALY с помощью эффективной дозы и соответствующих коэффициентов риска (DALY×Зв-1)

Complex cardiac malformation associated with pulmonary hypertension. Surgical treatment

Spitalul Clinic Republican “Timofei Moșneaga”, Secția Chirurgia Malformațiilor cardiace congenitale, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Malformații cardiace congenitale (MCC) complexe cu șuntare intracardiacă, sunt asociate cu hipertensiune pulmonară (HTP) severă. Iar în lipsa tratamentului chirurgical pot dezvolta rapid Sindromul Eisenmeger. Scopul studiului: Analiza experienței tratamentului chirurgical al anomaliilor MCC complexe. Materiale și metode: În secția chirurgia MCC a SCR din anii 2015 pînă în 2018 au fost operați 51 copii. Grupul de patologii incluse în studiu au fost: Canal atrioventriclar coplet (CAVC) - 30(58,8%) pacienți, Ventricol drept cu cale dubla de iesire (VDCDE)-11(21,5%), Ventricol Unic (VU) - 8(15,%) și Transpoziția de vase magistrale cu DSV (TVM+DSV) - 2(3,9%). Rezultate: Tratamentul chirurgical a inclus corecție etapizată, prima operație fiind cea paleativă “banding de AP” și apoi corecția radicală. Au fost supuși tratamentului chirurgical pe etape 25 (49%), iar corecție radical au suportat din prima 26(51%). Toți copiii cu media PSVD = 54,5mmHg în preoperator. Complicațiile postoperatorii: Pneumonie în 27 cazuri (52,9%), pleurezii în 7 cazuri (13,7%), bloc AV gr.III-2 cazuri. Iar 5(9,8%) cazuri soldate cu deces. Concluzii: Rezultatele operațiilor sunt în strînsă corelație cu vîrsta bolnavului, greutatea acestuia, dereglările hemodinamice, gradul de HTAP și fonul clinic general. Bandingul arterei pulmonare este o metodă cu risc relativ sporit (mortalitate de 5,8%), dar este etapă importantă în managementul pacienţilor cu insuficienţă cardiacă progresivă, hipotrofie şi anomalii asociate. În grupul cu MCC complexe mortalitatea a fost de 9,8%(5 copii) cu toții fiind sub 6kg și vîrsta medie de 4,1l.Introduction: Complex congenital cardiac malformations with intracardiac shunt are associated with advanced of the surgical can rapidly develop Eisenmeger s syndrome. The purpose of the study: was to analyze the experience of surgical treatment of complex congenital heart abnormalities. Materials and Methods: 51 children were operated in the CCM section of SCR in the years 2015 to 2018.The group of pathologies included in the study were: Atrioventricular septal defect (AV-canal)-30 patients, Double Outlet Right Ventricle (DORV)-11 patients, Single Ventricle (SV) - 8 patients, and Transposition of the Great Arteries (TGA) associated with ventricular septal defect-2 patients. Results: Surgical treatment included correction in stages, first was palliative operation ”PA banding” and then radical correction. Twenty-five patients were surgically staget, and 26 patients underwend primary-correction. All children with PSVD mean=54,5mmHg (pressure) in preoperative time. Postoperative complications: Pneumonia in 27 cases (52,9%), pleurisy in 7 cases(13,7%), A-V block in 2 cases and 5 cases(9,8%) of death. Conclusion: The results of the operations are closely correlated with the patient s age, body weight, hemodynamic disturbances, grade of pulmonary hypertension, and general clinical condition. Pulmonary artery banding is a relatively high risk method (5,8% mortality), but is au important step in the managements of patients with progressive heart failure, hypertrophy and associated abnormalities. In the group with complex congenital malformations the mortality was 9,8%,all being below 6kg and the mean age of 4,1 years

Strategies to preserve autologous blood in patients operated on heart under extracorporeal circulation

Departamentul Chirurgie Cardiacă, IMSP Spitalul Clinic Republican, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Atât chirurgie cardiaca cît si caracteristicile tehnice ale circulație extracorporală (CEC) necesita transfuzie de sânge de la donatori, care implică o serie de riscuri pentru pacienți. Scop. explorarea posibilităților de reducere a volumului de transfuzii sângelui homolog, la diferite grupe de vârstă de pacienți care necesită intervenții chirurgicale cardiace. Materiale și metode. Primul lot de studiu a inclus 250 de copii (131 băieți, 119 fete), cu greutatea mai mică de 10 kg (10 .45 ± 3.15) și 1,4 ± 0.7 ani - vârsta medie, cu vicii cardiace congenitale, care au suportat intevenții chirurgicale în condiţii de CEC. În cadrul lotului II, au fost incluși 223 adulți (122 barbati, 101 femei) cu vicii cardiace dobândite, operați în condiții de CEC. Rezultate. La toti copii a fost utilizat metoda de restituire a volumului de umplere cu sânge propriu a pacienților, datorit acestei metode a fost recuperate până 45 % din “priming” . În primul lot de studiu nu a fost nevoie de hemostaza chirurgicală repetată. Pierderea de sânge a reprezentat 6,2 ml / kg / 24h. Transfuzie postoperatorie de sânge homolog (masa eritrocitara) au necesitat 73 de copii, 48,66% din întregul grup. În grupul II au necesitat hemostaza chirurgicală repetată 5 pacienți. Letalitatea a fost de 1,8%(4 pacienți). Concluzii. Minimalizarea perderilor, restituirea primingului cu sânge autolog,utilizarea “ Cell saver “, ultrafiltrare și autotransfuzia intraoperatorie ar putea diminua necesitatea de transfuzie de sânge homolog la pacienții cu intervenții chirurgicale pe cord deschis.Introduction. Both severity of cardiac surgery and technical features of extracorporeal circulation (CEC) circuit demands blood transfusion from donors, which involves a number of risks for the patient. Purpose. To explore the possibilities of reducing the volume of homologous blood transfusion in different age groups of cardiac surgery patients. Material and methods. The study group I included 250 children (131 boys, 119 girls) weighting less than 10kg (10 .45 ± 3.15) and 1.4 ± 0.7 years average age with congenital heart disease, operated on heart under CPB. In group II patients were included 223 adults (122 men, 101women) with acquired heart disease, operated under CPB conditions. Results. No hospital lethality occurred in 1st group and no surgical hemostasis was performed. Blood loss accounted 6.2 ml/kg /24h. Postoperative transfusion of homologous blood (erythrocyte mass) were needed in 73 children, which consists only 48,66% of whole group. Retrograde autologus blood priming was used with recuperation till 45 “ of priming.In 2nd group surgical hemostasis demanded 5 patients. Lethality was 1,8% (4 patients). Conclusions. Priming minimalisation and autologous blood priming, Cell Saver usage, ultrafiltration, preand intraoperative auto transfusion could diminish the necessity of homologous blood transfusion in cardiac surgery patients

Surgical treatment for aortic coarctation and associated anomalies

Departamentul Cardiochirurgie, Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Scopul studiului a fost analiza experienţei de mai mult de 20 ani (1991-2014) a unui singur centru în chirurgia coarctaţiei de aortă (CA). Material şi metode: Două sute şaizeci şi doi pacienţi au fost supuşi intervenţiei pentru CA: 49 sugari, 175 copii şi 38 adulţi. Leziuni asociate au fost găsite la 194 (74%) pacienţi. Rezultate: S-au înregistrat 10 (3,8%) decese intraspitaliceşti. La supravegherea de durată s-a înregistrat un deces cauzat de proceduri chirurgicale simultane. Re-coarctația s-a dezvoltat la 19 supravieţuitori de durată din grupul pediatric (7,25%), proceduri chirurgicale simultane au fost executate în 54 cazuri. Cinci adulți (1,9%) din supravieţuitorii de durată au fost operaţi pentru anevrismele anastomozelor. Concluzii: Frecvenţa anomaliilor asociate cu CA este de aproximativ 74%. Operaţiile precoce în CA pot salva viaţa copiilor şi preveni complicaţiile la distanţă. Pacienţii cu anomalii asociate necesită un monitoring sistematic din partea cardiologului şi cardiochirurgului pentru depistarea precoce şi corecția complicaţiilor în curs de dezvoltare. CA în perioda adultă este uneori asociată cu patologii cardiovasculare adiţionale, care necesită intervenţii.The aim of study was the retrospective analysis of single center experience in surgery for aortic coarctation (AC) over a period of 20 years (1991-2013). Material and methods: Two hundred sixty two patients underwent surgery for AC: 49 infants, 175 children and 38 adults. Associated lesions were found in 194 (74%) patients. Results: There were 10 (3.8%) hospital deaths. During the follow-up there was one late death after simultaneous surgical procedures. Re-coarctation occurred in 19 late survivors of the pediatric group (7.25%); simultaneous surgical procedures were performed in 54 cases. Five adults (1.9%) late survivors were operated on for false aneurisms of anastomosis. Conclusions: The frequency of associated anomalies in AC is about 74%. Early operations in case of AC can save the life of child and prevent the development of long-term complications. Patients with associated anomalies require regular monitoring by a cardiologist and cardiac surgeon for early detection and correction of developing complications. AC in the adulthood is sometimes associated with additional cardiovascular pathologies that require intervention