Medicine of Extreme Situations
Scientific and Practical reviewed Journal
of FMBA of Russia

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№2, 2012 (June)

Improving the expertise of health and the relationship of radiation effects with diseases. 

Year: 2012 (June) Number: №2 Pages: 5-11

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: A.K. Guskova. 

Organization: Federal State Budgetary Institution Medical Biophysical center named after A.I. Burnazyan of FMBA of Russia, Moscow. 

Annotation: 

The article describes brief information about the main contingents, which health status is examined; connection with radiation influence is established. Rules of improvement of primary documentation and form of the expert opinion of council are formulated. Points to the continuing difficulties and possible measures to overcome them are indicated. 

Keywords: 

Expertise, long-term period, level of doses, the dynamics of their formation, completeness of information.

Analysis of the latest epidemiological trials of the effect of radon on the population incidence and mortality. 

Year: 2012 (June) Number: №2 Pages: 12-22

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors:  A.P. Tukov, G.I. Gneusheva, I.L. Shafranskiy, Yu.V. Suvorova. 

Organization: Federal State Budgetary Institution Medical Biophysical center named after A.I. Burnazyan of FMBA of Russia, Moscow. 

Annotation: 

The objective is to provide the analysis of literature on the methods of evaluation of lung cancer risk from radon in residential premises. 

Keywords: 

Radon, population, lung cancer, research methods, incidence and mortality rate.

Dynamics of health-related quality of life of sailors from Sakhalin region.

Year: 2012 (June) Number: №2 Pages: 23-27

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: V.A. Vagin. 

Organization: Federal State Institution Holmsk hospital "Far Eastern Medical Center of FMBA of Russia" Holmsk, Sakhalin region. 

Annotation: 

Material and methods: Health-related quality of life of sailors was evaluated with international questionnaire Euro Qul - 5D. Data collection was conducted by anonymous questionnaires. The questionnaire was filled by patient; subject answered the questions about health status for each of the five parameters and made a mark on the visual analogue scale, reflecting current quality of life.
525 sailors were inquired during annual medical examination (200 people in 2007 and 325 in 2009).
Intensive rates, average size, median, minimum and maximum values were calculated. Student's t-test was used to determine the reliability of differences.

Results: The analysis of variance in the quality of life associated with health in groups of 2007 and 2009 showed significant and reliable decrease in the total number of moderate deviation from 12,0 ± of 2,3% to 2,8 ± 0,9% (p<0.0001), and in the group of moderate anxiety/depression with 21,0 of + 2,9% to 3,7 ± 1,1 % (p < 0.001) was revealed. Statistically significant differences in health improvement indicators for the last year between groups of 2007 and 2009 was not identified (p > 0.05). Average assessment of health at the time of survey on a 100-point scale (thermometer) significantly increased for the two years from 90,5 ± 0,6 points to 93, 6 ± 0,4 points per 100 respondents (p < 0,001).

Conclusions:

  1. The survey questionnaire Euro Qul - 5D revealed significant improvement of health-related quality life of sailors from Sakhalin region in 2009 in comparison with 2007 in two of three parameters. The number of health deviations significantly reduced; scale-temperature average score of the health status at the time of survey significantly increased.
  2. The use of the questionnaire Euro Qul-5D during medical examination of sailors on professional suitability allows to complete picture about the state of their health.

Keywords: 

Sailors, health-related quality of life, questionnaire EQ-5D.

Pathogenesis of pulmonary pathology among miners of uranium mines. 

Year: 2012 (June) Number: №2 Pages: 28-34

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: A.V. Malashenko, A.A. Nakatis. 

Organization: Clinical hospital №122 named after L.G. Sokolova FMBA of Russia, Saint-Petersburg. 

Annotation: 

The objective is to study the peculiarities of the development of occupational lung diseases among miners of uranium mines in more than 35-year observation period (1965-2003) with the assessment of the etiologic role of the aggregate production of labour factors.

Methods: Comprehensive pathomorphological, emission-spectral, neutron activational examination of lung tissue of 326 dead miners with different levels of dust and radiation exposure was performed.

Results: Direct dependence of severity and rate of pneumoconiosis development and incidence of lung cancer from cumulative levels of dust and radiation exposure was revealed. The development of silicosis in mine dustiness at the level of permissible (2 mg/m3), as well as doubling of output excess of lung cancer cases in the conditions recommended by the International Commission on radiation protection of cumulative radiation exposure decay products of radon in 100 working level of the month for 30 years of work in the mine indicates the need to standard improvement of dust and radiation safety.

Conclusion: Reduction of the current standard of the average annual mine dust to 1 mg/m3 and the level of cumulative radiation exposure up to 50 working level of the month for 30 years of work in mine, may exclude the likelihood of new cases of silicosis and to reduce the risk of death from occupational lung cancer to acceptable levels. 

Keywords: 

Uranium mines, miners, dust-radiation exposure, excessive mortality, probabilistic risk, multifactorial analysis.

The radiation situation in the surveillance zone of Rostov atomic station during operation of the power unit №1 on the power higher than the nominal. 

Year: 2012 (June) Number: №2 Pages: 35-42

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations. 

Article type: Scientific article.

Authors: I.G. Shumskiy, S.A. Romanova. 

Organization: Interregional Department №5 of FMBA of Russia, Volgodonsk. 

Annotation:

Objective: The objective is to assess the radiation situation in the monitoring area of the Rostov atomic station during operation of the power unit №1 with the power of 104%.

Materials and methods: Radiation and hygienic monitoring of the environment during operation of Rostov atomic station on the nominal power and power above nominal will be measured.

Results: The impact of aerosol emissions of Rostov atomic station on volumetric activity of radionuclides in the surface layer of atmospheric air and atmospheric precipitation is not revealed. Volume activity of man-caused radionuclides, registered in the surface layer of atmospheric air for the considered period was significantly below the permissible volume activity. Annual gas-aerosol emissions of Rostov atomic station in 2006 - 2009 were substantially lower than permitted, regulated SPAS- 03. Increase of the content of man-caused radionuclides in the components of terrestrial ecosystems of the area of atomic station was not revealed. The value of dose rate of gamma radiation during the observed period in all control stations were in the range from 0, 08 to 0, 11 micro sv/h, which corresponds to the radiation background in the region. The average annual intake of radionuclides into the water-cooler is at least twice lower values of permissible discharges approved for Rostov atomic station.

Conclusions: The radiation situation in the area of Volgodonsk atomic station has not changed since the commissioning of the 1st unit and its operation at power over nominal and it is safe for people and the environment.

Keywords: 

Surveillance area, sanitary protection zone, radiation monitoring, content of man-caused radionuclides, specific activity of radionuclides, dose rate of gamma radiation.

Monitoring of radionuclides in food products consumed by the population of Ozersk municipal district. 

Year: 2012 (June) Number: №2 Pages: 43-48

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations. 

Article type: Scientific article.

Authors: M.G. Shmatkov, E.B. Budushev, A.S. Bakurov, E.N. Krylova, E.V. Vitomskova. 

Organization: Regional office №71 of FMBA of Russia, Ozersk, Chelyabinsk region Federal State Unitary Enterprise Production Association "Mayak" Center of hygiene and epidemiology №71 of FMBA of Russia, Ozersk, Chelyabinsk region. 

Annotation:

Objective: The objective is to assess the intake of radionuclides of 90Sr and 137Cs by inhabitants of the surveillance zone of enterprise Federal State Unitary Enterprise "Production Association "Mayak" in agricultural production of Ozersk municipal district (OMD).

Material and methods: The data of radiation monitoring of 90Sr and 137Cs in milk and potatoes of the three settlements located in 15 km from the enterprise for the period from 2000 to 2009 were performed; description of the methods of definition of these radionuclides and characteristics of the measuring instruments were given.

Results: The analysis of dynamics of specific activity of radionuclides in agricultural products was done (milk, potatoes, and an assessment of the annual intake of 90Sr and 137Cs and internal exposure doses due to this factor).

Conclusions: The analysis of long-term monitoring data of radionuclides in food products consumed by population of Ozersk municipal district shows that in recent decade (2000 – 2009) the numerical values of the specific 90Sr and 137Cs activity in milk and the potatoes are an order of magnitude or more below the reference levels and two to three orders of magnitude below regulated SanPiN, but for the entire observation period there was a reduction in 10-100 times.

The annual intake of radionuclides with milk and potatoes in OMD in 2009 was the following: 90Sr - 1-2%, 137Cs - 0,3-0,4 % from the limit of annual intake (LAI) according to Radiation safety standards-99/2009. Maximum doses of internal exposure to the critical groups of OMD population from the exposure of 90Sr and 137Cs with milk and potatoes was not exceeded 0,025 mSv per year (Novogorny settlement).

Keywords: 

Radionuclides, surveillance area, diet, milk, potatoes, radiation monitoring, specific activity, the dose of internal irradiation.

The results of sanitary and hygienic certification of enterprises in Polyarniye Zory. 

Year: 2012 (June) Number: №2 Pages: 49-57

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations. 

Article type: Scientific article.

Authors: V.S. Znaenko, M.A. Kabakova.  

Organization: Regional office №118 of FMBA of Russia, Polyarniye Zory.

Annotation:

Objective: The objective is to demonstrate work experience of the Regional Department №118 of FMBA of Russia in sanitary and hygienic certification of carcinogenic enterprises according to chemical factors.

Material and methods: As the source of material that was used, the data was presented in six sanitary and hygienic certificates of carcinogenic organizations in Polyarniye Zory. Requirements of SanPiN 1.2. 2353-08 “Carcinogenic factors and basic requirements for the prevention of carcinogenic hazard” and methodological guidelines 2.2.9.2493-09 “Sanitary-hygienic certification of carcinogenic organizations and the data bases formation” were used as normative and methodical base.

Results: The number of staff, including women, who have occupational contact with carcinogens at workplace, was indicated. Recommendations on reduction of carcinogenic rate of enterprises were given. The main difficulties, arose during sanitary and hygienic certification of carcinogenic organizations, were revealed.

Conclusions: The findings suggest that the work in sanitary and hygienic certification of carcinogenic organizations should be continued with strict criteria for classification of the whole enterprise or its structural subdivision to the category of carcinogenic.

Keywords:

Sanitary and hygienic certificate, carcinogen, cancer, working conditions, workplace, environment.

Remote medical consequences of radiation accidents among veterans of nuclear submarines. 

Year: 2012 (June) Number: №2 Pages: 58-70

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: N.V. Alishev, B.A. Drabkin, V.M. Shubik, N.A. Nikolaeva, E.I. Puchkova. 

Organization: The scientific and therapeutic center for veterans of special risk subdivisions Federal State Healthcare Institution Medical and Sanitary Unit №144 FMBA of Russia, St. Petersburg.

Annotation:

Objective: The objective is to characterize the immunity and health among veterans of special risk subdivisions in remote period after radiation accidents on nuclear submarines (NS).

Materials and methods: The analysis of incidence of various diseases among veterans of nuclear submarines, who are examined in the scientific and therapeutic center for veterans of special risk subdivisions, will be performed by taking into account all diagnoses.

Profound clinical examination of veterans of nuclear submarines will be hold using psychophysiological, EEG, ECG methods, immunological examination of veterans of nuclear submarines identifying the status of nonspecific protection, humoral u cellular immunity, autoimmune changes.

Results: In the remote period after radiation accidents there is increased morbidity of veterans of nuclear submarines associated with radiation exposure (thyroid pathology, cataracts), chronic stress and more severe forms of the diseases of nervous, cardiovascular and other systems.

Conclusion: There are increased morbidity and more severe forms of the diseases among veterans of nuclear submarines in the remote period after radiation accidents.

Long-term health disorders were associated with radiation exposure and stress. Among veterans of nuclear submarines immunological changes play important role in the pathogenesis of diseases.

Keywords:

Immunity, veterans, nuclear submarines.

Contemporary stage of blood service development in Russia.

Year: 2012 (June) Number: №2 Pages: 71-81

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: E.A. Selivanov, T.N. Danilova, I.N. Degterev, M.S. Grigoryan, L.G. Vorobey. 

Organization: Federal State Institution of Russian Research Institute of Hematology and Transfusiology of FMBA of Russia, Saint-Petersburg.

Annotation:

Objective: The objective is to study the current state of the blood service in Russia.

Material and method: The materials were presented by official information of statistics (form №39) from institutions of blood service, subordinated to the Ministry of Health and Social Development of Russia. For generalization and analysis of available information the computer program developed at the Russian Research Institute of Hematology and Transfusiology will be used.

Results: It was established that in 2009 the preparation of blood and its components was made in 146 stations and blood centers, 482 departments of blood transfusion, 100 hospitals. The donors before donation according to national standards have passed the examination, which included the determination of the level of hemoglobin, blood group, rhesus-factor, antibodies for hepatitis B and C, syphilis and HIV tests and alanine aminotransferase tests. The number of donors in 2009 reached 1 908 350 people, including the number of donors without compensation was 1 738 977, the number of primary donors was 719 940. In a disposable plastic containers were prepared 1 957 401, 8 liters of whole blood. Erythrocyte containing environment, plasma native and frozen, albumin, immunoglobulins, cryoprecipitate were prepared. However, the need for blood is virtually constant. New technological methods are developed. The aim is to provide safe blood transfusions with the help of the following measures: quarantine for plasma, leucocytes’ filtration, viral inactivation.

Conclusions: Comparison with those data of 2002 and 2008 showed increase in 2009 the number of donors and the volume of blood. According to the National programme of the development of blood service it is expected further improvement of work of institutions. It is important to prevent post - transfusion complications and improve safety of blood transfusion.

Keywords:

Blood service, transfusiology, blood transfusion.

The role of hyperhomocysteinemia in the development of thromboembolic complications.

Year: 2012 (June) Number: №2 Pages: 82-92

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: V.M. Shmeleva, S.I. Kapustin, M.N. Blinov, A.P. Polyakova, N.B. Saltykova, L.P. Papayan. 

Organization: Federal State Institution Russian Research Institute of Hematology and Transfusiology FMBA of Russia, Saint-Petersburg.

Annotation:

Objective: The objectives are to determine the role of hyperhomocysteinemia (GHZ) in the development of thromboembolic complications and to detect association of GHZ with other hereditary and acquired risk factors for blood clots.

Materials and methods: 447 patients with venous thrombosis (VT) in anamnesis were examined and 260 people in the control group. Homocysteine level (GL) was determined by the liquid chromatography method on the column under high pressure.
The polymerase chain reaction was used for the following tests: molecular genetic testing factors I, II, V, XII of blood coagulation, tissue activator of plasminogen - t-RA, inhibitor of plasminogen activator type I - PAI - 1, the glycoproteins Ia, Iba, IIIa, platelet ADP receptor - P2Y12, methylenetetrahydrofolate reductase (MTHFR), apolipoprotein E - ApoE, endothelial synthase of nitric oxide- eNOS, angiotensinogen, angiotensin converting enzyme, angiotensin II receptor type first.

Results and conclusions: It is shown that hyperhomocysteinemia is a frequent and independent risk factor for development and recurrence of venous thrombosis. Excessive level of HZ in plasma is able to increase the influence of other prothrombotic factors on the risk of thrombosis. The relative risk of VT combination with GHZ and V Leiden factor mutation is significantly exceeds the indicators for isolated carriage of these risk factors and demonstrates synergistic effect in the induction of BT. In patients with GHZ there are more significantly marked genotypes I/I in the gene t-RA (45% vs. 25%, p = 0,04), C/C in the gene eNOS (18% compared with 9,5%, p = 0,04) and T/T in the gene MTHFR (20,8 % vs. 6%, p= 0,01). In patients with GHZ there is a trend towards a higher incidence of carriage of genotype 4G/4G in the gene PAI-1 (42% vs. 30%, p= 0,07) and D/D in the gene ACE (30% vs. 20,6%, p = 0,08). GHZ is effectively eliminated with folic acid in therapeutic doses. The level of homocysteine should be always examined in patients with thromboembolic complications.

Keywords:  

Homocysteine, hyperhomocysteinemia, venous thrombosis and thrombophilia.

Nonspecific protective factors and humoral immunity in patients with multiple myeloma.

Year: 2012 (June) Number: №2 Pages: 93-98

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: J.V. Chubukina, L.N. Bubnova, C.C. Bessmeltsev, G.V. Glazanova, O.E. Rozanova, I.E. Pavlova. 

Organization: Federal State Institution Russian Research Institute of Hematology and Transfusiology FMBA of Russia, Saint-Petersburg.

Annotation:

The objective of the research is to study the anti-infective factors of protection (phagocyte and humoral immunity) in patients with multiple myeloma (MM).

Materials and methods: 65 patients with MM were examined among whom were patients with newly diagnosed MM, with relapse and remission. The study of the functional activity of neutrophils was performed by the modified Wright method using the daily culture of dead cells Staphylococcus aureus strains P-209. The number of serum immunoglobulin (Ig) was defined by standard turbidimetric method. The level of medium and low molecular weight of circulating immune complexes (IC) was determined by their precipitation in 5% and 7% solution of glycol 6000.

Results: Examination of phagocytic activity of granulocytes in patients with MM revealed violations of the process of phagocytosis at all stages of its development; the number of phagocytic neutrophils was reduced and their main functions of absorption microbial particles and their digestion were suppressed. In patients with newly diagnosed MM and with relapse of the disease these violations were more pronounced than in patients with remission, where there was a trend towards recovery process of phagocytosis. The increase of level of all circulating immune complexes was determined in patients with the active phase of the disease, whereas the content of serum immunoglobulins of all classes was sharply reduced in patients with MM all groups.

Conclusions: Obtained findings about the decrease activity of phagocytic process and the depletion of humoral immunity in patients with MM indicate a low protection against an infectious disease.

Keywords:

Multiple myeloma, phagocytosis, humoral immunity, immunoglobulins, circulating immune complexes.

The state of postvaccinal immunity and anti-infective resistance of mucous oropharynx in severe whooping cough in children. 

Year: 2012 (June) Number: №2 Pages: 99-104

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: A.S. Kvetnaya, O.S Kalinogorskaya. 

Organization: Federal State Institution Russian Research Institute of children's infections FMBA of Russia, Saint-Petersburg.

Annotation:

A complex clinical and anamnestic analysis of 1005 cases of whooping cough among children from 1 month to 16 years, who received treatment in hospital and attended the outpatient department of the Research Institute of children's infections (Saint - Petersburg) in the period 2001-2004 was performed. The main feature of whooping cough was confirmed. Children who were vaccinated are also involved in the epidemic process (46,7%), mainly children of older age groups with no or low postvaccinal immunity. Criteria of prediction of the nature and severity of the whooping cough in vaccinated and unvaccinated children are scientifically proved; these criteria are based on a comprehensive assessment of colonization activity of the pathogen, anti-infective drug resistance, morphofunctional state of oropharyngeal mucosa and the level of IgA.

Objective: The objective is to identify etiopathogenetic features of treatment of whooping cough in children based on the assessment of the morphofunctional state and anti- infective drug resistance mucous nasopharynx.

Material and methods: 1005 whooping cough patients aged l-month to 16 years were examined. Materials for the study were laryngo-pharyngeal and biopsy specimens from the back of the throat and blood serum.
The following methods were used: bacterioscopy (staining of smears according to Gram and Romanovsky-Giemsa), indirect immunofluorescence reaction, evaluation of electrokinetic activity of nuclei of epithelial cells (ELA), the agglutination reaction.

Results: The main reasons of whooping cough in vaccinated children were established. Criteria of the forecast and severity of the treatment of whooping cough in "grafted in history" and unvaccinated children scientifically justified. This was based on a comprehensive assessment of colonization activity of the pathogen, anti-infective drug resistance, morphofunctional state of oropharyngeal mucosa and the level of IgA.

Conclusions: The assessment algorithm of morphofunctional state and anti-infective resistance of mucous nasopharynx was developed. This allows to predict the nature, severity and duration of infection process in whooping cough.

Keywords: 

Whooping cough, colonization, immunity, immunoglobulins.

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