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

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№4, 2019 (December)

MODERN TECHNIQUES FOR INTRACRANIAL PRESSURE MONITORING

Year: 2019 (March) Number: №1 Pages: 8-21

Article type: Scientific article.

Authors: Ostapenko B.V.,Voitenkov V.B., Marchenko N.V., Skripchenko N.V., Vasilieva Yu.P., Klimkin A.V., Bedova M.A.

Organization:

Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg, 197022, Russian Federation

Annotation:

Intracranial hypertension is a frequent cause of complications in critically affected patients, especially in childhood neuro-infections. Neuromonitoring methods can be divided into the following groups: methods of neuroimaging, assessment of cerebral blood flow, methods of control of intracranial hyper¬tension, methods of evaluation of brain metabolism, neurophysiological methods. Other classification of intracranial pressure (ICP) monitoring methods is also available, with their division into invasive and non-invasive methods. The "gold standard" for ICP measurement is the invasive monitoring of intraventricular pressure. However, this procedure has a number of contraindications, requires a neu¬rosurgical department and can lead to infectious, hemorrhagic complications. This article presents an overview of modern methods of non-invasive ICP monitoring. Non-invasive methods include radio¬logical methods, computed tomography, magnetic resonance imaging (CT, MRI), ultrasound techniques (ultrasound Doppler, ultrasound of the optic nerve with membranes), venous ophthalmo-dynamometry, pupillometry, as well as oto-acoustic methods, bio-impedansemetry, cerebral venous orthostatic re¬activity, variation cardio-intervalometry, infrared and short-wave thermography (radiometry) of the brain, monitoring of the pressure in the anterior part of the fontanelle, neuroophthalmological tech¬niques, neurophysiological techniques with evoked potentials. In our opinion, the screening method for ICP control, including pediatric practice, is the measurement of the diameter of the optic nerve disc with membranes, using it in combination with neuro-sonography and ultrasound of the brain vessels.

Keywords:

intracranial pressure; monitoring; ICP; non-invasive methods

DYNAMICS OF DENTAL STATUS INDICATORS AMONG MEMBERS OF THE COSMONAUTICS SQUAD

Year: 2019 (March) Number: №1 Pages: 22-26

Article type: Scientific article.

Authors: Olesov E.E.1, Glazkova E.V.1, Olesova V.N.2, Martynov D.V.1, Uzunyan N.A.2, Mirgazizov M.Z.3, Il'in A.A.2

Organization:

1Federal state budgetary institution of health care «Clinical center of dentistry of the Federal medical and biological Agency», Moscow, 123098, Russian Federation;
2Academy of postgraduate education of the Federal state budget institution «Federal scientific and clinical center specialized types of medical care and medical technologies Federal medical and biological Agency», Moscow, 125371, Russian Federation

Annotation:

Dental status indices for members of the cosmonaut corps were evaluated based on a survey using the WHO Dental Status Assessment Map in age groups under 35 years old, 35–44 years old, and over 45 years old. A lower intensity of caries, as well as the prevalence and intensity of periodontal diseases among members of the cosmonaut corps, insufficient quality of previous dental treatment regarding fillings and obstruction of the root canals; low need for caries treatment and dental prosthetics due to timely and high-quality treatment and replacement of removed teeth in specialized clinics in Moscow after enrollment in the cosmonaut corps, as well as in connection with real dispensary dental care for astronauts was established in comparison with Russian indices;

Keywords:

cosmonaut corps; dental status; indices.

ATTITUDE OF MEDICAL WORKERS TO VACCINE PREVENTION

Year: 2019 (March) Number: №1 Pages: 27-34

Article type: Scientific article.

Authors: Budnikova E.A., Kharit S.M., Fridman I.V.

Organization:

Children's Scientific and Clinical Center for Infectious Diseases, Saint Petersburg, 197922, Russian Federation

Annotation:

212 medical professionals conducted a survey to determine the level of knowledge and attitudes towards vaccine prevention of medical workers: doctors and nurses. The results of the analysis showed that 2.9% (4 out of 137) of adult health-care workers had a negative attitude towards vaccination in general. 26.7% of therapists (24 of 90) are wary or new about new vaccines included in the vaccination schedule, which is significantly higher (Chi2 = 4.552, p < 0.05) than among pediatricians 10.0% (4 of 40 ). The medical staff of children's polyclinics 2.6 times recommend vaccinations more often(69 of 75 - 92.0%) than employees of adult polyclinics (113 out of 137 -82.5%). Nurses of children's polyclinics vaccinated their children and grandchildren against pneumococcal infection significantly less frequently - (30.5%). Doctors-pediatricians reliably know that pneumococcosis causes meningitis (32 people - 80%), otitis (27 people - 67.5%), than therapists - meningitis (56 people - 62.2%), otitis media (27 people - thirty%). For all categories of medical workers, the refresher courses are a significantly important source of informa¬tion (62.2% -85.7%). The information that vaccinations are dangerous is the main reason for the refusal of vaccination, in the opinion of the majority of medical workers (76.6% -88.8%).

Keywords:

attitude to vaccination; a new vaccine; the level of awareness of health workers; training of health workers; the rejection of vaccination.

COMPARATIVE DATA ON PHARMACOKINETICS AND THE DURATION OF THE EXCRETION WITH BLOOD AND URINE OF MELDONIUM IN HEALTHY ATHLETES – VOLUNTEERS AND HEALTHY TESTS VOLUNTEERS

Year: 2019 (March) Number: №1 Pages: 35-52

Article type: Scientific article.

Authors: Rabin O.1, Uyba V.V.2, Miroshnikova Yu.V.2, Zabelin M.V.2, Samoilov A.C.3, Karkishchenko V.N.4, Semenov S.Yu.5, Astrelina T.A.3, Razinkin S.M.3

Organization:

1WADA, 800 Place Victoria, Suite 1700, Montreal, QC, H4Z 1B7, Canada;
2Federal Medical-Biological Agency of Russia, Moscow, 123182, Russian Federation;
3A.I. Burnazyan Federal Medical Biophysical Center of FMBA of Russia, Moscow, 123098, Russian Federation;
4Scientific Center of Bio-Medical Technologies of FMBA of Russia, Moscow, 143442, Russian Federation;
5Scientific and Technical Center of Radiation-Chemical Safety and Hygiene of FMBA of Russia, Moscow, 123103, Russian Federation;

Annotation:

Meldonium is a metabolic drug included in the “List of banned substances and methods” in 2016 on the base on results of the analysis of the Monitoring Program of the World Anti-Doping Agency, 2015. How¬ever, in early 2016, anti-doping laboratories reported an unusually large number of cases of the detection of Meldonium content in high concentrations in urine samples. Because of this, questions naturally arose about the features of the pharmacokinetics of the drug, its rate of excretion from the body, and the dura¬tion of the laboratory determination in the blood plasma and urine. Addressing these issues in the current situation was crucially important for the anti-doping community due to the need for the sound evaluation from the scientific and medical positions of the possibility of using Meldonium to manage the results of performances in competitions, and also in the interests of a fair, from a legal point of view, attitude to ath¬letes who used the drug . To date, only a few scientific papers on the pharmacokinetics of Meldonium are known. At the same time, there are no available data on the duration of the drug clearance time after its oral administration in high doses. The main purpose of this open study was to both investigate the pharma¬cokinetics of Meldonium in the body and determine the duration of its assessment in the urine and blood plasma in healthy volunteers who received the drug. The design of the study included functional exercise testing and the use of L-carnitine to assess its effect on the pharmacokinetics and excretion of Meldonium. Thirty-two volunteers were divided equally into two groups, in one of which each person received Meldo¬nia in a dose of 1.0 g, and in the other one - in a dose of 2 g was orally administered daily for 3 weeks. It has been shown that in order to achieve a stable concentration of Meldonium in the blood plasma, several days are required, and the elimination period is delayed up to several months after cessation of the use. The daily dose, frequency, and duration of Meldonium are the most important factors that must be consid¬ered when predicting the time of excretion of this substance until the body is completely cleansed.

Keywords:

Meldonium; excretion; pharmacokinetics; blood plasma; urine.

DEVELOPMENT OF A TECHNOLOGY FOR PRODUCING A FERMENTED MILK PRODUCT ON SPACE SHIP BOARD AND EVALUATION OF ITS PROBIOTIC AND POTENTIAL RADIOPROTECTIVE PROPERTIES

Year: 2019 (March) Number: №1 Pages: 53-63

Article type: Scientific article.

Authors: Kobatov A.I., Verbitskaya N.B., Polotsky A.E., Savin I.I., Grebenyuk A.N.

Organization:

State Research Institute of Highly Pure Biopreparations, Federal Agency for Medicine and Biology, Saint Petersburg, 197110, Russian Federation

Annotation:

Development and testing of the technology for producing a fermented milk product based on Lactoba¬cillus acidophilus on board a spacecraft during an orbital flight and its probiotic and potential radio¬protective properties were evaluated. As an experimental material, we used a fermented milk probiotic product obtained by the crew of the International Space Station (ISS) using a low-stage technology from a dry preparation delivered on ship board containing two symbiotic strains of Lactobacillus acidophi¬lus. The fermented milk product obtained as a result of thermostatic cultivation on the spacecraft board was cooled in the on-board refrigerator and then sent by astronauts to Earth to determine its probiotic properties. The analysis of the composition of the product was carried out by gas-liquid chromatogra¬phy with mass spectrometry. It was established fermented milk product samples delivered from the ISS to have a high probiotic potential: biological activity, antagonism against opportunistic and pathogenic microorganisms, acid forming ability and antibiotic resistance. When analyzing the chromatograms of the product received on the ISS board, there were found to be determined 25 substances that either are not detected at all when studying the fractional composition of the milk solution used as a nutrient medium, or are determined in significantly lower concentrations. 15 out of 25 substances were shown to be a part of the products of the metabolism of lactobacilli in the fermented milk product obtained on the ISS, in one way or another, contribute to the enhancement of the radioresistance of the human body. The possibility of using a fermented milk product based on Lactobacillus acidophilus to increase the astronaut’s resistance to extreme space flight factors is being discussed.

Keywords:

space experiment “Probiovit”; International Space Station (ISS);fermented milk pro¬biotic product; Lactobacillus acidophilus; technology for producing; probioticand radioprotectiveproperties.

ON THE PROBLEM OF PROTECTION OF THE RUSSIAN POPULATION FROM NATURAL SOURCES OF IONIZING RADIATION PART 2. THE DEVELOPMENT OF APPROACHES AND PRACTICAL ACTIVITIES

Year: 2019 (March) Number: №1 Pages: 63-75

Article type: Scientific article.

Authors: Kobatov A.I., Verbitskaya N.B., Polotsky A.E., Savin I.I., Grebenyuk A.N.

Organization:

1Scientific and Technical Center of Radiation Chemical Safety and Hygiene under FMBA of Russia, Moscow, 123182, Russian Federation;
2State Research Center – Burnasyan Medical Biophysical Center FMBA of Russia, Moscow, 123098, Russian Federation

Annotation:

This article consisted of two parts, is devoted to the main aspects of the public radiation protection against natural radiation sources. In Part 1 there were briefly considered all the main types of natural sources, there was given their component composition, energy and dose characteristics. In addition, the approaches and recommendations of international organizations WHO, ICRP and IAEA concerning the regulation of natural sources are analyzed. The Russian regulatory requirements for radiation safety under the influence of natural sources are presented. In Part 2, attention is paid to the consideration of the "historical" sequence of approaches to solving the problem of the impact of natural sources of ionizing radiation on the public and personnel in Russia, it is reported about the functioning system of collecting information about the exposure of the population to natural sources and relevant information resources. The data on the values of the average indices characterizing the irradiation by natural sources of the Russian population as a whole, and in its regions are presented. A brief overview of the results of the radon surveys in dwellings in a number of regions of Russia is presented.

Keywords:

radon; Federal purpose program; public exposure; databases; radon surveys; integral method.

BIOINDICATION OF INTERNAL RADIATION EXPOSURE FOLLOWING ACCIDENTAL RADIONUCLIDE INTAKE

Year: 2019 (March) Number: №1 Pages: 76-83

Article type: Scientific article.

Authors: Sotnik N.V., Azizova T.V., Zhuntova G.V.

Organization:

Southern Urals Biophysics Institute at the Federal Medical and Biological Agency of Russia, 456780, Ozyorsk, Russian Federation

Annotation:

The present-day industrial conditions practically exclude chronic intakes of alpha-emitting radionuclides by nuclear workers. To date occupational exposure to alpha-emitting radionuclides at doses exceeding allowable limits might take place only in cases of radiation incidents or emergencies during production, storage and reprocessing of radioactive materials as well as repair operations. Cytogenetic study was performed for two cases of alpha-emitting nuclide incidental intake into Mayak worker’s body. Chromosome slides were stained by the classical method by Romanowski-Giemsa (case 1) and by the modification of the FISH method – mBAND (case 2). Cytogenetic analysis (case 1) performed 96 hours, 7 days and 1 month after radionuclide’s intake showed a decrease in the frequency of chromosomal aberrations from 10 to 1 per 100 cells. Markers of internal alpha-radiation exposure, i.e. intrachromosomal rearrangements and complex chromosome aberrations, were detected in case 2. The paper assesses potential of using the biological indication technique to identify incidental alpha-emitting radionuclide intakes based on cytogenetic findings.

Keywords:

bioindication, radionuclides, internal alpha-particle exposure, biomarker, cromosomal aberrations, accidental and emergency situations.

DETECTION OF HEPATIC STEATOSIS WITH USING CONTROLLED ATTENUATION PARAMETER OF ULTRASOUND IN SCREENING PATIENT IN THE AMBULATORY PRACTICE

Year: 2019 (March) Number: №1 Pages: 84-91

Article type: Scientific article.

Authors: Melnikova L.I.1, Ilchenko L.Yu.2,3, Pevtsova I.Yu.1, Shelyagina I.M.1, Bondarenko N.L.1, Korolev A.P.1

Organization:

1Clinical hospital № 85 FMBA of Russia, Moscow, 115409, Russian Federation; 2Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products of the Russian Academy of Sciences, Moscow, 108819, Russian Federation; 3Pirogov Russian National Research Medical University, Moscow, 117997, Russian Federation

Annotation:

Aim of the study. To identify and assess the degree of hepatic steatosis according to elastometry with the controlled attenuation parameter (CAP) function in patients in ambulatory practice. Study Design. Perspective open single-site cross-sectional (single-step) clinical study. Material and Methods. We examined 36 patients suffered from chronic liver disease (CLD) with vari¬ous etiologies and 16 individuals from a group of the conditionally healthy population. The severity of fibrosis was evaluated by fibro-elastometry, and the degree of hepatic steatosis in the liver was mea¬sured by the value of the index of CAP ultrasound. To identify intergroup differences, a median (IU) was calculated [25th and 75th percentiles]. Results. The signs of liver fibrosis were found in 6/36 (16,7%) of CLD patients; steatosis - in 32 (88,9%), a combination of fibrosis and steatosis - in 5 (13,9%). 9/16 (56,3%) among conditionally healthy individu¬als showed minimal or moderate degrees of liver steatosis. The identified abdominal obesity, dyslipidemia and impaired glucose tolerance in some cases excluded patients from the group of "healthy metabolics". Conclusion. Liver elastometry with CAP function is a sensitive method for the early diagnosis of he¬patic steatosis both in CLD cases and in conditionally healthy individuals. It is advisable to expand the diagnostic algorithm in case of the high prevalence of hepatic steatosis to exclude the components of the metabolic syndrome, as well as other conditions associated with abdominal obesity.

Keywords:

elastometry; controlled attenuation parameter; hepatic steatosis; nonalcoholic fatty liver disease.

ENSURING SANITARY AND EPIDEMIOLOGICAL SECURITY OF INFRASTRUCTURE OF THE CHEMICAL WEAPONS DESTRUCTION FACILITY "POCHEP" PLANNED TO BE INVOLVED IN THE ECONOMIC TRAFFIC

Year: 2019 (March) Number: №1 Pages: 84-91

Article type: Scientific article.

Authors: Gulyaev D.V., Kombarova M.Yu., Radilov A.S., Rembovsky V.R., Savelieva E.I., Koryagina N.L., Ukolov A.I.

Organization:

Research Institute of Hygiene, Occupational Pathology and Human Ecology, Federal Medical Biological Agency, Kapitolovo St., G/P Kuz’molovsky, 188663, Russian Federation

Annotation:

The sampling and analysis of wipes from the surfaces of process equipment and samples of fragments of buildings and engineering infrastructure of buildings and related structures of the chemical weapons destruction facility (CWDF) in the city of Pochep, the Bryansk Region, were performed in order to identify possible contamination of the process equipment and infrastructure elements by residual toxic organophosphorus compounds (OPs) and their destruction products. The sampling sites were determined taking into account the possible contamination with OPs during the destruction of chemical weapons (probable spills, gas release), and included not only process equipment, but also all infrastructure elements (floors, walls, and forced ventilation, power supply, lighting, fire extinguishing, and video surveillance systems). A protocol for the analysis of samples for OP destruction products by high-performance liquid chromatography with tandem mass-selective detection (HPLC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) was developed. The article presents a brief description of the Pochep CWDF and the list of toxic substances destroyed at the facility. The results of the survey physicochemical analysis and quantitative chemical analysis of the wipe samples from the surfaces of process equipment, as well as samples of fragments of buildings and engineering infrastructure, are described. The flow chart of the sanitary and hygienic support of the conversion activities at the Pochep CWDF, including the sampling methodology, is presented. The analysis revealed no toxic chemicals in the studied samples, which allowed making the conclusion the infrastructure elements to meet the sanitary and epidemiologic safety standards, and the Pochep CWDF can be involved in economic turnover.

Keywords:

manufacturing infrastructure components; technological equipment; chemical-analytical control; degradation products; poisonous substances; physical-chemical analysis; sample selection.

TO THE 65TH ANNIVERSARY OF MILITARY EXERCISES WITH THE USE OF NUCLEAR WEAPONS (THE “TOTSKY EXERCISE” OF 1954): RETROSPECTIVE ASSESSMENTS OF RADIATION BIOMEDICAL CONSEQUENCES – MYTHS AND REALITY

Year: 2019 (March) Number: №1 Pages: 84-91

Article type: Scientific article.

Authors: Ivanchenko А.В.1, Evseev А.С.2, Gavrish N.N.3, Rezontov В.А.3, Sudakov V.В.3

Organization:

1Research Institute of Industrial and Marine Medicine of the Federal Medical-Biological Agency, St. Petersburg, 196143, Russian Federation;
2Veteran Committee of Special Risk Units, St. Petersburg, 198152, Russian Federation
312 Central Research Institute of the Ministry of Defense of the Russian Federation, Moscow region, Sergiev Posad-7, 141307, Russian Federation

Annotation:

In 2019, it marks the 65th anniversary of the military tactical exercises with the use of nuclear weapons in the USSR (the “Totsky exercise” of 1954). In the years following this event, much attention has been paid to the teaching in the media. At the same time, a significant part of the publications came from people who were either distant from the topic, or ignorant, or deliberately dramatizing or distorting a named historical event and the “consequences” of nuclear weapon testing. This situation is the result of both insufficient public awareness, including the scientific community, due to the secrecy of information until the end of the 1980s, limited trustworthy data (for example, professional memories, as well as of¬ficial departmental publications of the Ministry of Defense), and the dominance of politicized, specula¬tive opinions and non-scientific generalizations. The article is intended to give an objective presentation of the event and consequences in a medical-biological aspect wth a strict (non-judgmental) assessment of what could be, what was or was not.

Keywords:

military exercises; nuclear explosion; radiation safety; doses and risks; regulatory framework; long-term effects.

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