О ВЛИЯНИИ МАЛЫХ И СРЕДНИХ ДОЗ РАДИАЦИИ НА СТРУКТУРУ ПРОВОДЯЩИХ ПУТЕЙ ГОЛОВНОГО МОЗГА У ЛИКВИДАТОРОВ ПОСЛЕДСТВИЙ АВАРИИ НА ЧАЭС В ОТДАЛЕННОМ ПЕРИОДЕ (ПО ДАННЫМ ВЫСОКОПОЛЬНОЙ РУТИННОЙ И ДИФФУЗИОННО-ТЕНЗОРНОЙ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ)

To evaluate correlation between brain structural damages and radiation exposure level for the Chernobyl nuclear power plant accident liquidators, routine and diffusion tensor magnetic resonance imaging methods are efficient to visualize and evaluate those damages; it is also important to compare magnetic resonance imaging data of liquidators with results, received for people of the same age and the same stage of cerebral vascular disease (the discirculatory encephalopathy of I and II stage), but who did not participate in the Chernobyl accident liquidation and did not suffer from other liquidation factors and radiation catastrophe aftermaths. As a result, the Chernobyl accident liquidators group (49 subjects) and group of control (50 subjects) were examined with routine magnetic resonance imaging methods and standard protocols. In addition, the innovative method of diffusion tensor magnetic resonance imaging was applied to examine 11 cerebral tracts, bilaterally (22 tracts in both hemispheres) for every subject of the research. It was for the first time when diffusion tensor magnetic resonance imaging was applied to conduct visual analysis of polymorphic brain changes for the Chernobyl accident liquidators and special research conducted to find correlation between fractional anisotropy coefficient and radiation exposure for these patients. The results of diffusion tensor magnetic resonance imaging indicated no statistically significant (p > 0,05) difference in the level of cerebral morphological changes and between average fraction anisotropy coefficient value in any cerebral tract for both sub-groups of liquidators with different level of irradiation: 28 subjects, who were exposed by low and very low radiation doses (0–100 micro-Sv, sub-group A) and 21 subjects, who were exposed by mean radiation doses (100–1000 micro-Sv, sub-group B). However, comparing diffusion tensor magnetic resonance imaging results of control group and liquidators group, statistically significant (p < 0,05) reduction of average fraction anisotropy coefficient was detected in frontal and temporal lobes. It proves significant micro-structural damages of mentioned brain areas caused by different factors of the Chernobyl accident liquidation.Цель работы – определить зависимость структурных изменений головного мозга ликвидаторов последствий аварии на Чернобыльской АЭС от полученной ими дозы облучения с помощью рутинной и диффузионно-тензорной магнитно-резонансной томографии; сравнить полученные данные с данными исследования лиц, не участвовавших в ликвидации аварии на Чернобыльской АЭС.Результаты: пациентам-ликвидаторам последствий аварии на Чернобыльской АЭС (49 человек) и пациентам контрольной группы (50 человек), не имеющим в анамнезе факторов профессионального облучения, выполнена высокопольная магнитно-резонансная томография с применением стандартных протоколов. Группы были равнозначными по возрасту и количеству пациентов с I и II степенями дисциркуляторной энцефалопатии. С помощью инновационной методики – диффузионно-тензорной магнитно-резонансной томографии – обследованы проводящие пути головного мозга пациентов обеих групп, всего 11 трактов, взятых билатерально (всего по 22 тракта в обоих полушариях).Заключение: в настоящей работе при использовании высокопольной рутинной магнитно-резонансной томографии впервые проведен визуальный анализ полиморфных изменений головного мозга для ликвидаторов последствий аварии на Чернобыльской АЭС с добавлением методики диффузионнотензорной магнитно-резонансной томографии; изучена связь выявленных изменений с полученной дозой радиации. При сравнении пациентов-ликвидаторов подгруппы А (28 человек, получивших очень малые дозы (до 10 мЗв) и малые дозы радиации (10–100 мЗв)) и пациентов подгруппы Б (21 человек, получивших средние дозы 100 мЗв – 1Зв) не отмечалось различий в степени морфологических изменений головного мозга, выявляемых при рутинной магнитно-резонансной томографии. При выполнении методики диффузионно-тензорной магнитно-резонансной томографии статистически значимого (p > 0,05) снижения коэффициента фракционной анизотропии в основных структурах головного мозга у пациентов данных подгрупп также выявлено не было. Однако, по сравнению с контрольной группой, у ликвидаторов отмечено достоверное снижение фракционной анизотропии в лобных и височных долях, что свидетельствует о микроструктурных изменениях данных зон под воздействием различных факторов при ликвидации последствий аварии и более тяжелом течении дисциркуляторной энцефалопатии у данного контингента больных

СПЕЦИАЛИЗИРОВАННАЯ И ВЫСОКОТЕХНОЛОГИЧНАЯ МЕДИЦИНСКАЯ ПОМОЩЬ ПОСТРАДАВШИМ В АВАРИИ НА ЧЕРНОБЫЛЬСКОЙ АЭС В РАМКАХ МЕРОПРИЯТИЙ СОЮЗНОГО ГОСУДАРСТВА

This paper presents the experience and features of the organization and provision of specialized and hightech medical care to victims of the Chernobyl accident in the framework of the activities of the Union State in the Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia. It reveals the features of the morbidity, disability and mortality of the injured in the accident at the Chernobyl nuclear power plant. The paper presents the data on the types and amount of medical assistance provided to victims of the Chernobyl accident for the period from 2007 to 2018 as well as the features of the organization of rendering specialized, including hi-tech, medical assistance and medical rehabilitation to participants of liquidation of consequences of the Chernobyl accident and inhabitants of the radioactively contaminated territories.Представлен опыт и особенности организации и оказания специализированной и высокотехнологичной медицинской помощи пострадавшим в аварии на Чернобыльской АЭС в рамках мероприятий Союзного государства на базе Всероссийского центра экстренной и радиационной медицины им. А.М. Никифорова МЧС России. Показаны особенности заболеваемости, инвалидизации и смертности пострадавших в аварии на Чернобыльской АЭС. Представлены виды и объемы оказанной медицинской помощи пострадавшим в аварии на Чернобыльской АЭС за период с 2007 по 2018 г. Выявлены особенности организации оказания специализированной, в том числе высокотехнологичной, медицинской помощи и медицинской реабилитации участникам ликвидации последствий аварии на Чернобыльской АЭС и жителям радиоактивно загрязненных территорий

Опыт работы мобильного компьютерного томографа в составе аэромобильного госпиталя МЧС России в полевых условиях Крайнего Севера для борьбы со вспышкой новой коронавирусной инфекции

Background. Large-scale construction of industrial and transport facilities is underway in the Far North of Russia. The process involves more than 10,000 shift workers, and there was a Covid19 outbreak in this population. In order to contain the outbreak and prevent the spread of infection in this area the Russian Emergencies Ministry deployed an airmobile hospital.Purpose. The purpose is to present an experience of work with the mobile CT scanner as part of an airmobile field hospital deployed in the Far North of Russia to combat the Covid-19 outbreak.Materials and methods. On April 6, 2020, the construction site reported a “zero patient” who sought medical aid; the PCR test showed positive results of coronavirus. In the first half of April, over 300 rotation employees applied for medical care, most of them had a positive PCR test. On April 11, a state of emergency was declared in the construction site and, on April 17, 2020, airmobile hospital started operations. Its mission lasted 54 days. The mobile CT scanner (Brightspeed Elite Mobile, GE) was transported by land. The field hospital closely cooperated with the nearest medical institutions and the regional clinical hospital.Results. During its work the airmobile hospital examined 1,678 rotational workers and 408 employees of the Ministry of Emergency Situations of the Murmansk region, with 2,086 CT scans performed. The average age of the patients was 37.8 years, men predominated. In 91.2% of patients, fever was the first symptom of the disease. Blood saturation results ranged from 92% to 99%. The degree of lung involvement ranged from CT 0 to CT 4. During the work of the airmobile hospital, COVID-19 was diagnosed in 500 people, including 328 cases of mild form, 98 – moderate, 74 – severe, no mortalities.Conclusion. A positive experience of application of the mobile CT scanner as part of the AMH field hospital in unfavorable epidemiological conditions of the Far North of the Russian Federation was obtained. CT plays a key role in early detection of infection, differential diagnosis, and identification of complications. Determination of the severity of the disease based on CT data is crucial for patient routing.Введение. На территории Крайнего Севера Российской Федерации ведется масштабное строительство промышленных и транспортных объектов. В этом процессе участвуют более 10 000 вахтовых рабочих и в этой популяции произошла вспышка COVID-19. В целях сдерживания вспышки и предотвращения распространения инфекции в этом районе МЧС России развернуло аэромобильный госпиталь (АМГ).Цель исследования: представить опыт работы мобильного компьютерного томографа в составе полевого АМГ, развернутого на Крайнем Севере России для борьбы со вспышкой COVID-19.Материал и методы. 6 апреля 2020 г. на территории строительного объекта был зафиксирован “нулевой пациент”, ПЦР-тест которого оказался положительным на наличие коронавируса. В первой половине апреля за медицинской помощью обратилось более 300 вахтовиков. 11 апреля на территории строительного объекта была объявлена “чрезвычайная ситуация” и уже 17 апреля 2020 г. начал свою работу АМГ, длительность миссии которого составила 54 дня. Передвижной мобильный компьютерный томограф (Brightspeed Elite Mobile, GE) был транспортирован сухопутным путем. Полевой госпиталь работал в тесном взаимодействии с ближайшими медицинскими учреждениями и краевой клинической больницей.Результаты. За 54 дня работы АМГ было обследовано 1678 вахтовиков, 408 сотрудников ведомства МЧС Мурманской области, выполнено 2086 КТ-исследований. Средний возраст пациентов 37,8 года, преобладали мужчины. У 91,2% пациентов лихорадка была первым признаком заболевания. Результаты сатурации крови колебались от 92 до 99%. Степень поражения легких варьировала от КТ-0 до КТ-4. За время работы АМГ заболевание COVID-19 диагностировано у 500 человек, из них у 328 – легкая форма, у 98 – среднетяжелая, у 74 – тяжелая, летальных исходов нет.Заключение. Получен положительный опыт применения мобильного компьютерного томографа в составе полевого АМГ в неблагоприятных эпидемиологических условиях Крайнего Севера Российской Федерации. КТ играет ключевую роль в раннем выявлении инфекции, дифференциальной диагностике и выявлении осложнений. Определение степени тяжести заболевания на основе данных компьютерной томографии имеет решающее значение для маршрутизации пациентов

The results of using lean technologies in assessing the cardiovascular risk based on ultrasound markers of atherosclerosis

Aim. To establish the practical value of studying ultrasound markers of atherosclerosis for assessing cardiovascular risk as a part of screening of the population based on lean technologies.Material and methods. The study included 305 patients. The age of participants ranged from 31 to 84 years, the median age was 61,0 years. The object of study was 1830 extracranial vessels, including common carotid arteries, internal carotid arteries, subclavian arteries. Duplex ultrasound was using an Acuson 2000 ultrasound system with a frequency of 3-9 MHz. An abbreviated ultrasound protocol was used. The obtained data were processed using the software package Statistica 12.0 (StatSoft, USA).Results. As a result of lean technology application, the duration of procedure was significantly reduced, and the process was improved by 6 times. Changes in intimamedia thickness (IMT) were detected in 42,6% of cases, and significantly more changes in IMT were found in women (48,1%) than in men (25,0%), p=0,0005. Atherosclerotic plaques (ASP) were detected in 53,4% of cases (men — 68,1%; women — 48,9%), p=0,0043. In men <50 years of age, a more intense increase in ASP prevalence than in women was recorded. Starting from 50 years old, ASP prevalence has leveled off. The prevalence of carotid atherosclerosis at any age was higher in men. From the age of 50, sex differences had no significance, p=0,133. In 87,1% of cases, ASP was located within the bifurcation. In the studied groups, obstruction to 50% were more common (46,2%, p=0,0005). Questioning revealed that over the past three years, duplex ultrasound was performed in 21% of patients. Satisfaction with the quality of the procedure was 57,0% (174/305).Conclusion. The results of the study indicate the high practical value of ultrasonic markers of atherosclerosis using abbreviated ultrasound protocol as a part of screening of the population. The inclusion of noninvasive vascular imaging data in screening programs will help to achieve targets for reducing cardiovascular mortality and personalize the assessment of cardiovascular risk

PHYSIOLOGICAL MONITORING OPERATORS ACS IN AUDIO-VISUAL SIMULATION OF AN EMERGENCY

In terms of ship simulator automated control systems we have investigated the information content of physiological monitoring cardiac rhythm to assess the reliability and noise immunity of operators of various specializations with audio-visual simulation of an emergency. In parallel, studied the effectiveness of protection against the adverse effects of electromagnetic fields. Monitoring of cardiac rhythm in a virtual crash it is possible to differentiate the degree of voltage regulation systems of body functions of operators on specialization and note the positive effect of the use of means of protection from exposure of electromagnetic fields

LOW AND MEAN RADIATION DOSES IMPACT ON THE CEREBRAL TRACTS STRUCTURE OF THE CHERNOBYL ACCIDENT LIQUIDATORS IN THE REMOTE PERIOD (BASED ON ROUTINE AND DIFFUSION-TENSOR MAGNETIC RESONANCE IMAGING DATA)

To evaluate correlation between brain structural damages and radiation exposure level for the Chernobyl nuclear power plant accident liquidators, routine and diffusion tensor magnetic resonance imaging methods are efficient to visualize and evaluate those damages; it is also important to compare magnetic resonance imaging data of liquidators with results, received for people of the same age and the same stage of cerebral vascular disease (the discirculatory encephalopathy of I and II stage), but who did not participate in the Chernobyl accident liquidation and did not suffer from other liquidation factors and radiation catastrophe aftermaths. As a result, the Chernobyl accident liquidators group (49 subjects) and group of control (50 subjects) were examined with routine magnetic resonance imaging methods and standard protocols. In addition, the innovative method of diffusion tensor magnetic resonance imaging was applied to examine 11 cerebral tracts, bilaterally (22 tracts in both hemispheres) for every subject of the research. It was for the first time when diffusion tensor magnetic resonance imaging was applied to conduct visual analysis of polymorphic brain changes for the Chernobyl accident liquidators and special research conducted to find correlation between fractional anisotropy coefficient and radiation exposure for these patients. The results of diffusion tensor magnetic resonance imaging indicated no statistically significant (p > 0,05) difference in the level of cerebral morphological changes and between average fraction anisotropy coefficient value in any cerebral tract for both sub-groups of liquidators with different level of irradiation: 28 subjects, who were exposed by low and very low radiation doses (0–100 micro-Sv, sub-group A) and 21 subjects, who were exposed by mean radiation doses (100–1000 micro-Sv, sub-group B). However, comparing diffusion tensor magnetic resonance imaging results of control group and liquidators group, statistically significant (p < 0,05) reduction of average fraction anisotropy coefficient was detected in frontal and temporal lobes. It proves significant micro-structural damages of mentioned brain areas caused by different factors of the Chernobyl accident liquidation

SPECIALIZED AND HIGH-TECH MEDICAL ASSISTANCE TO THE VICTIMS OF THE ACCIDENT AT THE CHERNOBYL NPP IN THE FRAMEWORK OF THE UNION STATE

This paper presents the experience and features of the organization and provision of specialized and hightech medical care to victims of the Chernobyl accident in the framework of the activities of the Union State in the Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia. It reveals the features of the morbidity, disability and mortality of the injured in the accident at the Chernobyl nuclear power plant. The paper presents the data on the types and amount of medical assistance provided to victims of the Chernobyl accident for the period from 2007 to 2018 as well as the features of the organization of rendering specialized, including hi-tech, medical assistance and medical rehabilitation to participants of liquidation of consequences of the Chernobyl accident and inhabitants of the radioactively contaminated territories

ФИЗИОЛОГИЧЕСКИЙ МОНИТОРИНГ ОПЕРАТОРОВ АСУ ПРИ АУДИО-ВИЗУАЛЬНОЙ ИМИТАЦИИ АВАРИЙНОЙ СИТУАЦИИ

In terms of ship simulator automated control systems we have investigated the information content of physiological monitoring cardiac rhythm to assess the reliability and noise immunity of operators of various specializations with audio-visual simulation of an emergency. In parallel, studied the effectiveness of protection against the adverse effects of electromagnetic fields. Monitoring of cardiac rhythm in a virtual crash it is possible to differentiate the degree of voltage regulation systems of body functions of operators on specialization and note the positive effect of the use of means of protection from exposure of electromagnetic fields.В условиях тренажера судовых автоматизированных систем управления выполнены исследования информативности физиологического мониторинга кардиоритма для оценки надежности и помехоустойчивости операторов различных специализаций при аудио-визуальной имитации аварийной ситуации. Параллельно изучалась эффективность средств защиты от негативного воздействия электромагнитного поля. Мониторинг кардиоритма в условиях виртуальной аварии позволил дифференцировать степень напряжения систем регуляции функций организма операторов по специализации и констатировать положительный эффект от применения средств защиты от воздействия электромагнитного поля