NEUROPHYSIOLOGICAL BASIS OF THE COMBINED EFFECTS OF ACUTE STRESS AND LOW DOSES OF IONIZING RADIATION ON HUMAN BRAIN. / НЕЙРОФІЗІОЛОГІЧНИЙ БАЗИС КОМБІНОВАНИХ ЕФЕКТІВ ГОСТРОГО СТРЕСУ ТА МАЛИХ ДОЗ ІОНІЗУЮЧОГО ВИПРОМІНЮВАННЯ НА ГОЛОВНИЙ МОЗОК ЛЮДИНИ.

OBJECTIVE: to study the clinical and neurophysiological features in the Chornobyl clean-up workers with a verified chronic cerebrovascular disease/cerebral small vessels disease (SVD) exposed to low doses of ionizing radiation (IR), employees of the Chornobyl Nuclear Power Plant (SSE ChNPP), who were exposed to the stress factor of a full-scale war as a result of being held captive by the Russian military at their workplaces, and individuals of the non-irradiated comparison group.Design, object and methods. A cross-sectional clinical study with parallel external control groups. We studied and carried out an expert statistical analysis of the clinical and neurophysiological characteristics of 62 male subjects, from which three examination groups were formed: 1) a randomized sample from the Clinical Epidemiological Register (CER) of the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) of 22 Chornobyl clean-up workers ('Chornobyl liquidators') in 1986-1990,examined during 2020-2021, aged 50-68 years at the time of examination (M ± SD: (58.1 ± 5.2) years) with a documented external radiation dose of 0.03-2.30 Sv; 2) 24 SSE ChNPP employees exposed to the stress factor impact of a full-scale war as a result of being held captive by the Russian military at their workplaces. The average age of the examined was (54.5 ± 5.8) years (range 46-71 years). 3) Comparison group - 16 non-exposed men with verified chronic cerebrovascular disease/cerebral small vessels disease (SVD). The average age of the examined was (57.8 ± 5.6) years (range 50-70 years). RESULTS: Neurophysiological studies confirm the presence of the pronounced dysfunction of the cortico-limbic system of the left dominant hemisphere of the brain with special involvement of the hippocampus in the Chornobyl clean-up workers. In the SSE ChNPP group, for the first time, the disorders of cerebral neurodynamics were detected in the form of functional hypofrontality and hyperfunction of the cortico-limbic system with lateralization to the right hemisphere. CONCLUSIONS: Today there exists a long-term thorough methodological and evidence base for a possible neurophysiological diagnosis and differential diagnosis of the combined cerebral effects of IR and psycho-emotional stress associated with the conditions of military conflicts. Neurophysiological technologies can be used in the objective professional and qualification selection of employees in a number of professions that require quick and responsible decision-making. Employees of SSE ChNPP need further medical and psychological support due to an increased risk of developing mental health disorders.

DIFFUSION TENSOR MAGNETIC RESONANCE IMAGING IN EARLY DIAGNOSIS OF STRUCTURAL CHANGES IN BRAIN WHITE MATTER IN SMALL VESSEL DISEASE ASSOCIATED WITH ARTERIAL HYPERTENSION AND IONIZING RADIATION. / DYFUZIINO-TENZORNA MRT U RANNII DIAGNOSTYTsI STRUKTURNYKh ZMIN BILOÏ REChOVYNY GOLOVNOGO MOZKU PRY ASOTsIIOVANII Z ARTERIAL'NOIu GIPERTENZIIeIu TA IONIZUIuChYM VYPROMINIuVANNIaM KhVOROBI MALYKh SUDYN.

OBJECTIVE: to determine the early signs of structural changes in brain white matter in small vessel disease associated with arterial hypertension and exposure to ionizing radiation using DTI-MRI. MATERIALS AND METHODS: 45 patients (mean age (57.56 ± 6.34) years) with small vessel disease (SVD) associatedwith arterial hypertension (AH) were examined: group I - 20 patients, participants of liquidation of the accident atthe Chornobyl nuclear power plant (Chornobyl clean-up workers); group II - 25 patients not exposed to ionizingradiation. MRI was performed on an Ingenia 3T tomograph («Philips¼). The fractional anisotropy (FA) was determined in the main associative and commissural pathways, periventricular prefrontal areas (fasciculus fronto-occipitalis superior / anterior - f. FO ant., corona radiata anterior - CR ant.) and semioval centers (SC). RESULTS: No signs of cerebral cortex or brain white matter (WM) atrophy, intracerebral microhemorrhages, and widespread areas of leukoaraiosis consolidation were observed in the examined patients. In the Chornobyl clean-up workers a larger number of foci of subcortical leukoaraiosis was visualized (80 %) on MRI images including multiple -8 (40 %), > 0.5 cm - 10 (50 %), with signs of consolidation - 5 (25 %). The results of the FA analysis in semiovalcenters showed its significant decrease in the patients of groups I and II (p < 0,007), regardless of the presence orabsence of visual signs of subcortical leukoaraiosis (ScLA) (III gr.: 253-317, p < 0.00001; IV gr.: 287- 375,p < 0.001). FA indicators in f. FO ant. and CR ant. in the patients of groups I and II differed insignificantly but weresubstantially lower than controls (p < 0.05). FA was significantly lower, compared to reference levels, in visuallyunchanged f. FO ant. (0.389-0.425; p = 0.015) and CR ant. (0.335-0.403; p = 0.05). In patients with AH-associated SVD of middle age, regardless of the effects of ionizing radiation, no significant changes in FA in the mainWM associative and commissural pathways were found (p > 0.05). CONCLUSIONS: DTI-MRI allows to detect early signs of structural changes in the white matter of the brain - a significant decrease in fractional anisotropy indicators in visually unchanged periventricular and subcortical areas. Themain associative and commissural pathways of the brain remain intact in the absence of widespread consolidatedfoci of leukoaraiosis and lacunar infarctions. The negative impact of ionizing radiation on the course of SVD associated with arterial hypertension is manifested by more active processes of WM disorganization: the prevalence andtendency to the consolidation of periventricular and subcortical leukoaraiosis foci, a significant FA decrease in semioval centers.

Detection of breast cancer presenting as a mass in women with dense breasts - digital breast tomosynthesis versus full-field digital mammography.

AIM: To evaluate the sensitivity and specificity of digital breast tomosynthesis compared with full-field digital mammography in detection of breast cancer presenting as a mass in women with dense breasts. Маterials and Methods: This study included 347 asymptomatic and symptomatic patients with dense breasts who underwent full-field digital mammography, digital breast tomosynthesis and hand-held full breast ultrasound. 57 core-needle biopsies were performed. Pathology included 31 invasive cancers and 26 non-cancerous lesions. RESULTS: Sensitivity of full-field digital mammography was 61.3% [0.422-0.789] and sensitivity of digital breast tomosynthesis was 77.4% [0.589-0.904]. Specificity of full-field digital mammography was 92.7% [0.893-0.953] that was 2.2% lower than the specificity of digital breast tomosynthesis - 94.9% [0.919-0.971]. CONCLUSION: Results of our study showed superior sensitivity and specificity of digital breast tomosynthesis compared to full-field digital mammography for detection of malignant masses in women with dense breasts.

[The structural-functional changes in the hepatobiliary system of patients with colorectal cancer]. / Strukturno-funktsional'ni zminy hepatobiliarnoï systemy u khvorykh na kolorektal'nyi rak.

On the grounds of clinical and experimental data on hepatobiliary system obtained by hepatobiliscintigraphy (HBSG) and morphological study of hepatic parenchyma deterioration of hepatocytes and suppression of concentrating abilities of gallbladder were found in 68 patients with colorectal cancer and no clinical and laboratory manifestation. Any antitumor treatment, especially combined with chemotherapy, aggravates the disorders. Surgical intervention provokes transient ciliary dyskinesia. Unspecific reactive hepatitis associated with intrahepatic cholestasis and aggravated by antitumor therapy should be considered as a morphological ground for the functional changes. HBSG is recommended to be performed from time to time during post-operative rehabilitation of patients who underwent radical surgery for colorectal cancer. Correction of revealed disorders should be carried out in gastroenterological departments.