VACCINATION: STATE-IMPLEMENTED MEDICO-SOCIAL AND LEGAL MEASURES.

The article reviews the medical and social vaccination-related initiatives in different countries of the world aimed at maintaining the balance between the public interest and respect for rights. A separate emphasis is put on exceptions to general rules of compulsory vaccination of children based on religious, philosophic and other personal beliefs of their parents. The connection between the medical and social initiatives applied in different countries, exemption from vaccination for non-medical reasons and reduction of herd immunity is determine. The methods of the research include the comparative method, i.e. the comparison of Ukrainian and international medical and social initiatives related to vaccination of children; the statistical method which is used for generalization of vaccination-related information of the World Health Organization and the European Centre for Disease Prevention and Control; the systematic analysis aimed at identification of existing shortcomings and positive experience of state policies of children vaccination in different countries of the world; the linguo-cognitive analysis, i.e the analysis of reasons for judgements with relation to the role of vaccination in modern countries and those social and medical initiatives that are allowed to be used in certain states to ensure exercise of human rights. Even a slight reduction in numbers of vaccinated children caused by parents' hesitancy due to certain non-medical reasons, religious and philosophic beliefs will have negative consequences for the public health and country's economy. Looking for a balance of human rights and public interest when it comes to vaccination resulted in establishing by the supranational judicial institutions of the prevalence of social necessity over individual rights. These findings should play a key role in the selection by different states of vaccination-related medical and social initiatives.

The Necessity of an ICD-Therapy in Patients with Indications for Primary Prevention of Sudden Cardiac Death. One Center Experience.

Aim      Analysis of responses of cardioverter-defibrillators implanted in patients with cardiomyopathies (CMPs) of various origins and a high risk of sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for primary prevention of SCD.Material and methods  In the Federal Center for High Medical Technologies in Kaliningrad from 2014 through 2018, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) were installed in 165 patients. Major indications for device implantation in these patients included left ventricular (LV) systolic dysfunction with ejection fraction (EF) ≤35 %; chronic heart failure (CHF) consistent with the New York Heart Association (NYHA) functional class (FC) II-III (IV for CRT-D) without previous episodes of life-threatening ventricular arrhythmias, circulatory arrest and resuscitation, which was consistent with the current international strategy for primary prevention of SCD. The study patients were divided into two groups based on the CMP origin; group 1 included 101 (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about arrhythmic episodes and device activation was retrieved from the device electronic memory during visits of patients to the clinic and was also transmitted to the clinic by a remote monitoring system. This information was studied and evaluated for the validity and effectiveness of the device triggering. If necessary, the parameters of detection and treatment were adjusted taking into account the obtained information. Information was analyzed and statistically processed with the SPSS Statistics 20.0 software.Results The patients were followed up for 28.3 ± 15.6 months, during which the devices delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, the devices were activated in 44 (26.7 %) patients and in the NCMP group, the devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate triggering was observed in 33 (20.0%) patients and inappropriate triggering was observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 (5.5 %) patients. The main cause of inappropriate triggering was atrial fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular tachycardia (VT), which did not reach the detection frequency for ICD therapy; these VTs were only detected by devices and terminated spontaneously. Intragroup differences in the number of patients who received an appropriate treatment were statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the NCMP group (р<0.006). Differences in the number of patients who received an inappropriate treatment were not statistically significant although their number was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), р>0.05).Conclusion      A higher requirement for the ICD treatment was revealed in patients with ICMP compared to patients with NCMP. The low demand for the ICD treatment in patients with NCMP and the more frequent inappropriate actuation of the devices in this patient group due to AF allow a conclusion that the criteria for primary prevention of SCD with ICD (LV EF ≤35% and clinically significant CHF) are not equally effective indications for ICD implantation in patients with ICMP and NCMP. It can be assumed that life-threatening ventricular arrhythmias are evident in patients with NCMP before the development of hemodynamically significant LV dysfunction and CHF, which warrants further research in this direction.

Macrophages - a perspective target for antineoplastic immunotherapy.

The review discusses the data on the functional/phenotypic M1/M2 types of macrophages and their chimeric forms, the molecular mechanisms of polarization of these cells, and their role in the development of malignant tumors. Information on the prognostic value of the presence (density and location) of M1/M2 cells in tumor tissue is analyzed. Our own results evidence on the necessity of determination of the functional/phenotypic state of M1/M2 macrophages from different biological niches in the dynamics of tumor growth, in particular in terms of NO level and arginase activity.

[Influence of work factors on health state in personnel servicing military nuclear technical objects].

Complex of occupational studies and medical, statistical research helped to reveal climate, geographic and other factors influencing health state of personnel servicing military nuclear technical objects. Considering peculiarities of occupational activities in various specialists, the authors specified measures to improve medical service for nuclear technical military officers directly working with nuclear ammunition. Practical application of the measures helped to gain 1.5-1.7 times improvement in morbidity parameters among nuclear technical military officers.

[Prognostic assessment for formation of a group of cardiovascular high risk among personnel participating in atomic submarines utilization].

Ultrasound scanning of main vessels (common carotid, internal carotid, common and superficial femoral, posterior tibial arteries) in staffers of shipyard "Nerpa"--branch of JSC "Shipbuilding center Zvezdochka" (Snezhnogorsk city Murmansk region)--engaged into atomic submarines utilization. Findings are atherosclerotic changes in common carotid and common femoral arteries--increased thickness of intima-media complex over the reference values or atherosclerotic plaque formation. The changes were maximal in a group of males aged over 50 with length of service over 25 years. Discriminant analysis helped to suggest a mathematic model to forecast cardiovascular diseases in personnel of "Nerpa" shipyard.

Comparison of GEANT4 very low energy cross section models with experimental data in water.

PURPOSE: The GEANT4 general-purpose Monte Carlo simulation toolkit is able to simulate physical interaction processes of electrons, hydrogen and helium atoms with charge states (H0, H+) and (He0, He+, He2+), respectively, in liquid water, the main component of biological systems, down to the electron volt regime and the submicrometer scale, providing GEANT4 users with the so-called "GEANT4-DNA" physics models suitable for microdosimetry simulation applications. The corresponding software has been recently re-engineered in order to provide GEANT4 users with a coherent and unique approach to the simulation of electromagnetic interactions within the GEANT4 toolkit framework (since GEANT4 version 9.3 beta). This work presents a quantitative comparison of these physics models with a collection of experimental data in water collected from the literature. METHODS: An evaluation of the closeness between the total and differential cross section models available in the GEANT4 toolkit for microdosimetry and experimental reference data is performed using a dedicated statistical toolkit that includes the Kolmogorov-Smirnov statistical test. The authors used experimental data acquired in water vapor as direct measurements in the liquid phase are not yet available in the literature. Comparisons with several recommendations are also presented. RESULTS: The authors have assessed the compatibility of experimental data with GEANT4 microdosimetry models by means of quantitative methods. The results show that microdosimetric measurements in liquid water are necessary to assess quantitatively the validity of the software implementation for the liquid water phase. Nevertheless, a comparison with existing experimental data in water vapor provides a qualitative appreciation of the plausibility of the simulation models. The existing reference data themselves should undergo a critical interpretation and selection, as some of the series exhibit significant deviations from each other. CONCLUSIONS: The GEANT4-DNA physics models available in the GEANT4 toolkit have been compared in this article to available experimental data in the water vapor phase as well as to several published recommendations on the mass stopping power. These models represent a first step in the extension of the GEANT4 Monte Carlo toolkit to the simulation of biological effects of ionizing radiation.

[Modern concepts and methodology of means, methods of protection, and safety measures for servicemen affected by nonionizing radiation]. / Sovremennye konseptsiia i metodologiia razrabotki sredstv, metodov zashchity i obespecheniia bezopasnosti voennosluzhashchikh pri deistvii neioniziruiushchikh izluchenii.

The given information classifies the protection means and methods containing the known for today and prospective decisions, as well as process elements of development, creation and testing of these means Presented as whole, these protection group comprise all the possible aspects of the service-men safety problem in operation of military equipment objects, being the source of non-ionizing radiation.

[The systems of prophylactic and ecological support for the Armed Forces: their status and interrelationships]. / Sistemy profilakticheskogo i ékologicheskogo obespecheniia Vooruzhennykh Sil: sostoianie i vzaimosviazi.

In the article the theoretical bases of preventive and ecological maintenance of the armed forces are discussed. It is specified, that the main reason for preventive maintenance is preservation and strengthening of health and performance of the personnel, and for the ecological maintenance-achievement of ecological safety: preservation and restoration of the environment. As a result, protection of the personnel from the effect of the adverse factors is offered as a sub-gain of the ecological maintenance, and a sub-gain of preventive maintenance is the control of the environment protection, which defines the health state of the personnel.

[The effect of pulsed noise on acquired behavior in rats and cats]. / Vliianie impul'snogo shuma na priobretennoe povedenie krys i koshek.

Low-frequency pulsing noise exerted an adverse effect upon acquired behaviour in rats and cats. The cerebral function of behavioural integration seems to suffer under the effect.