ПРОБЛЕМИ ВПРОВАДЖЕННЯ МЕДИЧНИХ ІНФОРМАЦІЙНИХ СИСТЕМ В УКРАЇНІ

The analysis of basic descriptions of the medical information systems which are offered nowadays at the market is conducted. Key factors which influence on efficiency of the use of medical information systems in practice of healthcare are selected. The most perspective approaches to introduction and realization of functioning the basic subsystems of application software in the field of informatization of diagnostic and therapeutic process are represented. Advantages of domestic medical information systems “TherDep” are considered as the means of automatization management of medical document for doctors.Проведен анализ основных характеристик медицинских информационных систем, представленных сегодня на рынке Украины. Выделены ключевые факторы, влияющие на эффективность использования медицинских информационных систем в практике здравоохранения. Приведены наиболее перспективные подходы к внедрению и реализации функционирования основных подсистем прикладного программного обеспечения в сфере информатизации лечебно-диагностического процесса. Рассмотрены преимущества авторской медицинской информационной системы «TherDep» как средства автоматизированного ведения медицинской документации для врачей.Проведено аналіз головних характеристик медичних інформаційних систем, що представлені сьогодні на ринку України. Визначені ключові фактори, що впливають на ефективність використання медичних інформаційних систем у практиці охорони здоров’я. Наведено найбільш перспективні підходи до впровадження та реалізації функціонування основних підсистем прикладного програмного забезпечення в галузі інформатизації лікувально-діагностичного процесу. Розглянуті переваги авторської медичної інформаційної системи «TherDep» як засобу автоматизованого ведення медичної документації для лікарів.

Radiation induced thyroid cancer: fundamental and applied aspects

Aim: To describe the epidemiology and pathology of thyroid cancer in Ukraine, and to perform the molecular analysis of genetic alterations more frequently found to be associated to papillary carcinomas (PTC) in a selected group of PTC. Materials and Methods: Relationship between the thyroid cancer incidence and gender, age, and place of residence of subjects aged 0–18 years at the time of the Chernobyl accident (5427 subjects of thyroid cancer, among which 3996 (73.6%) were children aged 0 to 14 years at the time of the accident, and 1431 (26.3%) were adolescents aged 15 to 18 years was studied. Pathologically analyzed thyroid carcinomas were obtained from 640 patients (20–40 years old at the time of surgery and born before the Chernobyl accident), and from 90 patients (11–22 years old at the time of surgery and born after the accident). All patients were operated during 2006–2008. RET/PTC rearrangements and BRAFV600E mutation were analyzed in 35 cases of PTC. Results: A comparison between the thyroid cancer incidence rates in the 6 highest contaminated regions of Ukraine and in the other 21 regions shows the most significant difference between the rates for the last three years of follow-up, which confirms that a direct relationship is still present between the rise in thyroid cancer incidence and the post Chernobyl radiation exposure. Much lower incidence of thyroid cancer in subjects, who were born after the accident, additionally confirmed a direct relationship between the Chernobyl accident and thyroid cancer development at least in those who were aged up to 18 years at the time of the nuclear accident. Pathological results showed that with increasing latency the decrease has been noted in the percentage of PTC with solid structure, a decrease in invasive properties of tumors, as well as an increase in the percentage of PTC with papillary-follicular structure, encapsulated forms, and «small» carcinomas measuring up to 1 cm. Molecular-biological studies of PTC revealed more common RET/PTC1 and RET/PTC3 rearrangements (34.3% of cases), than BRAFV600E mutation (24%cases). Conclusion: After 22 years from the Chernobyl nuclear accident the number and incidence of thyroid cancer cases in Ukraine was steadily increased in the cohort of those who were children and adolescents at the time of the accident. Most common thyroid tumors (PTC) were characterized by significant changes in histological structure with increasing latency. PTC with any RET/PTC rearrangements had more aggressive behavior than BRAFV600E-positive tumors or PTC without gene alterations

Barriers for the reduction of transport due to the EXB drift in magnetized plasmas

We consider a 1 1/2degrees of freedom Hamiltonian dynamical system, which models the chaotic dynamics of charged test-particles in a turbulent electric field, across the confining magnetic field in controlled thermonuclear fusion devices. The external electric field E = \nabla\bigvee is modeled by a phenomenological potential V and the magnetic field B is considered uniform. It is shown that, by introducing a small additive control term to the external electric field, it is possible to create a transport barrier for this dynamical system. The robustness of this control method is also investigated. This theoretical study indicates that alternative transport barriers can be triggered without requiring a control action on the device scale as in present Internal Transport Barriers (ITB).Comment: 1

Токсичність МАРК у карциномах щитоподібної залози. Механізми пригнічення сигнального каскаду (огляд літератури та власних даних)

The aim of the work: to study the activity and expression of the main effector protein kinase cascade in tumors of thyroid gland. There is a strong evidence that the Ras/Raf/MEK/ERK (МАРК) signaling cascade promotes cell proliferation and malignancy by stimulating cell growth and division, as well as inhibiting apoptosis. The mitogenic MAPK cascade associates growth factor signals at cell surface receptors with the transcription factors AP-1, NF-κB, Ets, leading to the induction of c-Fos, cyclin D1 and c-Myc. These factors regulate the expression of genes that control survival, angiogenesis, growth, proliferation, and cell motility. However, the hyperactivity of this cascade in tumor tissues can lead to sensescence, growth retardation, apoptosis or increased autophagy. This phenomenon was called "oncogenic toxicity".Цель работы: исследование в опухолях щитовидной железы активности и экспрессии главной эффекторной протеинкиназы каскада – ERK1/2. Получены убедительные доказательства того, что сигнальный каскад Ras/Raf/MEK/ERK (МАРК) способствует пролиферации и злокачественной трансформации клеток путем стимуляции клеточного роста и деления, а также подавления апоптоза. Митогенный МАРК-каскад связывает сигналы факторов роста на рецепторах клеточной поверхности с транскрипционными факторами АР-1, NF-κB, Ets, что приводит к индукции с-Fos, циклина D1 и с-Мус. Эти факторы регулируют экспрессию генов, контролирующих выживание, ангиогенез, рост, пролиферацию и подвижность клеток. Однако гиперактивность этого каскада в опухолевых тканях может привести к сенесценции, задержке роста, апоптозу или усилению аутофагии. Этот феномен назвали “токсичностью онкогенов”.Мета роботи: дослідження в пухлинах щитоподібної залози (ЩЗ) активності та експресії головної ефекторної протеїнкінази каскаду – ERK1/2. Отримано переконливі докази того, що сигнальний каскад Ras/Raf/MEK/ERK (МАРК) сприяє проліферації і злоякісній трансформації клітин шляхом стимуляції клітинного росту і ділення, а також пригнічення апоптозу. Мітогенний МАРК-каскад пов’язує сигнали факторів росту на рецепторах клітинної поверхні з транскрипційними факторами АР-1, NF-κB, Ets, що приводить до індукції с-Fos, цикліну D1 і с-Мус. Ці фактори регулюють експресію генів, що контролюють виживання, ангіогенез, ріст, проліферацію і мобільність клітин. Однак гіперактивність цього каскаду в пухлинних тканинах може привести до сенесценції, затримки росту, апоптозу або посилення автофагії. Цей феномен назвали “токсичністю онкогенів”

Impact of uncertainties in exposure assessment on estimates of thyroid cancer risk among Ukrainian children and adolescents exposed from the chernobyl accident

The 1986 accident at the Chernobyl nuclear power plant remains the most serious nuclear accident in history, and excess thyroid cancers, particularly among those exposed to releases of iodine-131 remain the best-documented sequelae. Failure to take dose-measurement error into account can lead to bias in assessments of dose-response slope. Although risks in the Ukrainian-US thyroid screening study have been previously evaluated, errors in dose assessments have not been addressed hitherto. Dose-response patterns were examined in a thyroid screening prevalence cohort of 13,127 persons aged <18 at the time of the accident who were resident in the most radioactively contaminated regions of Ukraine. We extended earlier analyses in this cohort by adjusting for dose error in the recently developed TD-10 dosimetry. Three methods of statistical correction, via two types of regression calibration, and Monte Carlo maximum-likelihood, were applied to the doses that can be derived from the ratio of thyroid activity to thyroid mass. The two components that make up this ratio have different types of error, Berkson error for thyroid mass and classical error for thyroid activity. The first regression-calibration method yielded estimates of excess odds ratio of 5.78 Gy-1 (95% CI 1.92, 27.04), about 7% higher than estimates unadjusted for dose error. The second regression-calibration method gave an excess odds ratio of 4.78 Gy-1 (95% CI 1.64, 19.69), about 11% lower than unadjusted analysis. The Monte Carlo maximum-likelihood method produced an excess odds ratio of 4.93 Gy-1 (95% CI 1.67, 19.90), about 8% lower than unadjusted analysis. There are borderline-significant (p= 0.101-0.112) indications of downward curvature in the dose response, allowing for which nearly doubled the low-dose linear coefficient. In conclusion, dose-error adjustment has comparatively modest effects on regression parameters, a consequence of the relatively small errors, of a mixture of Berkson and classical form, associated with thyroid dose assessment

Radiation signatures in childhood thyroid cancers after the Chernobyl accident: Possible roles of radiation in carcinogenesis

After the Tokyo Electric Power Company Fukushima Daiichi nuclear power plant accident, cancer risk from low-dose radiation exposure has been deeply concerning. The linear no-threshold model is applied for the purpose of radiation protection, but it is a model based on the concept that ionizing radiation induces stochastic oncogenic alterations in the target cells. As the elucidation of the mechanism of radiation-induced carcinogenesis is indispensable to justify the concept, studies aimed at the determination of molecular changes associated with thyroid cancers among children who suffered effects from the Chernobyl nuclear accident will be overviewed. We intend to discuss whether any radiation signatures are associated with radiation-induced childhood thyroid cancers

Histological validation of diagnoses of thyroid cancer among adults in the registries of Belarus and the Ukraine

In order to evaluate the diagnostic reliability of the thyroid cancers listed in adult registries from the Ukraine and Belarus, a histological review was organised of 327 randomly selected thyroid carcinoma cases diagnosed between 1960 and 1999. A final diagnosis was reached at a 5-day consensus conference by six pathologists who met around a multiheaded microscope. The study concluded with a comparison between the final diagnosis and the initial diagnosis. The pathologists agreed with the initial diagnosis of malignancy in 286 cases (88%). A final diagnosis of papillary, follicular or medullary thyroid carcinoma was reached in 86, 4, and 6% of the cases respectively. In 2.8% of the cases reviewed, diagnostic discrepancies persisted. The percentage of agreement between the final diagnosis and the initial diagnosis was 93%, with a weighted κ-statistic of 0.61 (confidence interval 95% (CI 95%): [0.45-0.77]). In all, 89% of the 286 confirmed cancer cases were in agreement for the type of cancer, with a κ-statistic of 0.56 (CI95%: [0.43-0.69]). The level of agreement differed according to cancer categories, with concordance rates of 94, 40 and 33% for papillary, follicular and medullary thyroid carcinomas respectively. The low prevalence of follicular thyroid carcinomas in the adult population studied calls for further exploration. The discrepancies and classification difficulties encountered were analysed. © 2003 Cancer Research UK

I-131 Dose Response for Incident Thyroid Cancers in Ukraine Related to the Chornobyl Accident

Background: Current knowledge about Chornobyl-related thyroid cancer risks comes from ecological studies based on grouped doses, case–control studies, and studies of prevalent cancers

Subjective health legacy of the Chornobyl accident: a comparative study of 19-year olds in Kyiv

<p>Abstract</p> <p>Background</p> <p>Since the Chornobyl accident in 1986, the physical health of exposed children in Ukraine has been monitored, but their perceived health has not been studied. This study examines health perceptions of Ukrainian adolescents exposed to radioactive fallout <it>in utero </it>or as infants, and the epidemiologic and Chornobyl-related influences on self-reported health.</p> <p>Method</p> <p>We assessed three groups of 19-year olds in Kyiv: 262 evacuees from contaminated areas near the plant; 261 classmate controls; and 325 population-based controls. The evacuees and classmates were previously assessed at age 11. Structured interviews were conducted with the adolescents and their mothers (N = 766), followed by general physical examinations (N = 722) and blood tests (N = 707). Proportional odds logistic regression and multi-group path analysis were the major statistical tests.</p> <p>Results</p> <p>The examination and blood test results were similar across groups except for a significantly elevated rate of thyroid enlargement found by palpation in evacuees (17.8%) compared former classmates (8.7%) and population-based controls (8.0%). In addition, four evacuees and one population control had had a thyroidectomy. Compared to controls, the evacuees rated their health the least positively and reported more medically diagnosed illnesses during the 5 years preceding the interview, particularly thyroid disease, migraine headache, and vascular dystony. The consistent risk factors (p < 0.001) for these subjective health reports were evacuee status, female gender, multiple hospitalizations, and health risk perception regarding Chornobyl. All three groups of mothers rated their children's health more negatively than the adolescents themselves, and maternal ratings were uniquely associated with the adolescents' health reports in the adjusted models. In the longitudinal evacuee and classmate subsamples, path analysis showed that mothers' health ratings when the children were age 11 predicted their later evaluations which in turn were associated with the adolescent self-reports.</p> <p>Conclusion</p> <p>The more negative self-evaluations of the evacuees were linked to a number of risk factors, including multiple hospitalizations, health risk perceptions, and epidemiologic risk factors. The increased rate of thyroid cancer and other diagnoses no doubt contributed to the evacuees' less positive subjective health. The strong effect of the mothers' perceptions argues in favor of developing risk communication programs for families rather than for mothers or adolescents as separate target groups.</p