[Medical discourse as a social activity: formation, priorities, dynamics (based on the material of the Russian popular science magazine «Zdorovie¼)].

Increasing interest in society in topics related to medicine and health is due to the current trend to consider physical, mental and social well-being as a basic human need. In the context of modern life, health is perceived as one of the most important values of an individual and society as a whole, therefore, medical discourse today plays a special role in culture, covering not only the professional expert and scientific community, but also the widest audience - the audience of the media. The media play a key role as a source of medical information and its targeted and targeted distribution. In this article, the medical discourse is analyzed in terms of its formation as a social activity and the role of modern mass media in it. The aim of the study is to analyze the demand for medical discourse in society and the features of its mediatization, which is the most important factor in the value-semantic dynamics of society and its way of life. The main empirical material is publications in the magazine "Zdorovie", the most popular Russian publication about a healthy lifestyle, medicine, practices for the treatment and prevention of diseases, the art of preserving beauty and vitality. The discourse of the popular scientific magazine "Zdorovie" as a very important segment of the value-semantic space of modern media is represented by a set of genres aimed at disseminating theoretical and practical medical knowledge, experience and providing medical services, taking into account the characteristics of medical subjects. dis-course, their information needs and problem-thematic requests, goal-setting attitudes, the degree and nature of interest, as well as the level of professional, general cultural and communicative competencies.

[The burden of progression of psoriatic arthritis. All-Russian register data].

BACKGROUND: Psoriatic arthritis (PsA) is a complex immune-mediated disease in which a third of patients with psoriasis (PsO) have a inflammatory lesion of both the musculoskeletal system (peripheral joints and axial structures) and extra-articular manifestations (dactylitis, enthesitis, nail PsO, uveitis and inflammatory bowel disease). AIM: To assess the burden of PsA progression in real practice according to the Russian register of PsA patients. MATERIALS AND METHODS: Seven hundred thirty seven M/F=350 (47.5%)/387 (52.5%) patients with PsA from the Russian register of PsA patients were included. Mean age 47.412.7 yrs., duration of PsO 200.6158.9 mo., PsA 79.681.9 mo. All patients were divided into 2 groups by PsA duration: 1st gr 36 mo 288 (39.1%) and 2nd gr 36 mo 449 (60.9%). All patients underwent standard clinical examination of PsA activity. Tender (68) and swelling (66) joint count (TJC, SJC), DAPSA, LEI, tenderness of the plantar fascia, PsO BSA (%), PASI, HAQ-DI, PsAID-12, BMI (kg/m2), ESR (mm/h), CRP (mg/l) and comorbidities by ICD-10 were evaluated. Parametric and non-parametric methods of statistical analysis were used. All p0.05 were considered to indicate statistical significance. RESULTS: In patients with PsA duration 36 mo we found significant prevalence of erosions by X-Ray, axial PsA, BMI30 kg/m2, HAQ-DI1, PsAID-124, arterial hypertension, metabolic syndrome and overall comorbidity (p0.05). There were no significant differences between groups in PsO severity by BSA3%, PASI1, LEI1, TJC, SJC, dactylitis, ESR30 mm/h, CRP10 mg/l, DAPSA, diabetes mellitus, hyperlipidemia, coronary heart disease and liver damage (p0.05). Сonclusion. Long-standing stage PsA is associated with erosions, axial PsA, worst health related quality of life, functional disability and increased cardio-metabolic disorders and overall comorbidity. Our results support the idea to start bDMARDs at early stage of PsA, it can improve better outcomes.

[Management of the patient with renal artery fibromuscular dysplasia: clinical case].

Fibromuscular dysplasia (FMD) is a rare disease that affects small and medium-sized arteries. Clinical manifestations of FMD depend on its localization. In many cases, FMD of renal arteries (RA) is associated with arterial hypertension. Young age, particularly of female patients, suspected RA dissection or kidney infarction, absence of atherosclerosis or presence of FMD in other arteries of such patients evidence for RA FMD. In invasive treatment of hemodynamically significant stenoses, transluminal balloon angioplasty (TBA) of renal arteries is preferrable. Taking into account initial alterations of the vascular wall and unevenness of the lumen of the affected blood vessel, stent implantation is associated with an increased risk of complications and is recommended only if ballooning complications develop. An open reconstructive surgery is indicated in complicated narrowing anatomy, a high risk of the endovascular treatment, or after failure of the endovascular intervention. This article presents a clinical case of a young female patient with RA FMD and renovascular arterial hypertension who successfully underwent renal TBA with a drug-coated balloon.

[The relationship between obesity, cardiometabolic disorders and disease activity in psoriatic arthritis patients: data from the Russian register].

AIM: To study the relationship between obesity, cardiometabolic disorders and disease activity in patients with psoriatic arthritis (PsA) in real practice. MATERIALS AND METHODS: The Russian register included 614 PsA patients [female 331 (54%)/283 (46%)]. Average age 45.20.52 years, PsA duration 5.70.27 years, psoriasis 15.710.56 years. Patients underwent examination, body mass index (BMI), PsA activity according to DAPSA, cDAPSA, analysis of concomitant diseases were assessed. The patients were divided into 3 groups depending on BMI (kg/m2): normal 25 (group 1), increased 2530 (group 2), obesity 30 (group 3). RESULTS: The average BMI was 27.70.23 kg/m2, normal BMI in 213 (34.7%), increased in 214 (34.8%) and obesity in 187 (30.5%). Concomitant diseases in 297 (48%). In group 3, arterial hypertension was observed significantly more often than in groups 1 and 2 (p0.0001); more often than in group 2 diabetes mellitus (p0.0001), metabolic syndrome (p0.0001); more often than in group 1 ischemic heart disease (p=0.026). PsA activity at Baseline, after 6/12 months was significantly higher in group 3 (p0.031). In obese patients, the chance of a decrease in disease activity to a moderate/low level and remission during therapy for 6/12 months is 2.484 times lower than in group 1, and 2.346 times lower than in group 2: odds ratio 2.346 (95% сonfidence interval 1.075.143) and 2.484 (95% сonfidence interval 1.1355.439), respectively. CONCLUSION: In the majority (65.3%) of PsA patients, BMI exceeded the norm. Obesity is associated with a high incidence of cardiometabolic disorders, with higher PsA activity and lower treatment efficacy.

The radiological environment at the Mayak PA site and radiation doses to individuals involved in emergency and remediation operations after the 'Kyshtym Accident' in 1957.

This article assesses the radiological environment at the nuclear site of the Mayak PA, Russian Federation, during and after the accident in 1957, the so-called 'Kyshtym Accident', and the radiation doses to those who participated in the eradication of its consequences. Based on numerous archival documents, this paper presents the radiation data for 1957-1960, including individual dosimetry monitoring data and estimated doses to the Mayak workers, as well as the to personnel in supporting organisations and the military involved in the remediation operations. From 1957-1959 some 38 500 individuals took part in the clean-up actions and remediation of contaminated areas of the Mayak PA industrial site after the accident, including individuals exposed at the time of the accident: Mayak PA employees, militarypersonnel, and civil construction workers. External equivalent doses to 10 500 individuals were estimated in the range of 220 to 265 mSv, while there were cases of doses up to 950 mSv and higher. The collective dose received during the accident and its aftermath was in the region of 7300 person-Sv. By October-December 1957, the collective dose was about 4500 person-Sv. Collective doses recorded in 1958 and 1959 amounted to 2250 person-Sv and 480 person-Sv, respectively.

[Bispecific Antibodies: Formats and Areas of Application].

Bispecific antibodies capable of simultaneously binding two targets have been studied for many years with a view to their implementation in clinical practice. Unique biological and pharmacological properties, as well as the diversity of their formats, make it possible to consider bispecific antibodies as promising agents for use in various procedures: from visualization of intracellular processes to targeted anticancer therapy. Bispecific antibodies help to determine more precisely the therapeutic target, thereby increasing the efficiency of therapy and reducing the probability of side effects. The present review describes the main formats of bispecific antibodies, methods for their generation, and possibilities for practical application.

[Biological Dosimetry Technique for Estimation of Doses from Accidental Exposure to External γ-Rays].

Individual doses from external γ-rays were estimated using biological dosimetry based on limited samplings (n1= 15 and n2 12 individuals) which comprised the Mayak workers group with acute radiation sickness (ARS). The following primary data were used for calculation as initial parameters: estimated dose from ex- ternal γ-rays based on physical dosimetry methods - D (Gy); time before first vomiting - T (h); number of lymphocytes in peripheral blood on a second day after acute radiation exposure - L (109/1); number of neutrophils in blood during first hours after accidental radiation exposure - N(109/). A number of mathe- matical models used for dose estimation were verified: power-law dependence of the absorbed dose from ex- ternal γ-rays (D) on time before first vomiting (7), exponential dependence of D on the number of lympho- cytes in peripheral blood (L), dependence of D on the number of neutrophils in peripheral blood (N) and complex models forD association with Tand L parameters as well as-with Tand Nparameters. The biological dosimetry technique based on a complex approach was shown to provide the best agreement with physical dosimetry methods for individual assessment of doses from external γ-rays.

Microbiota Induces Expression of Tumor Necrosis Factor in Postnatal Mouse Skin.

Tumor necrosis factor (TNF) is a pleiotropic cytokine that regulates many important processes in the body. TNF production in a physiological state supports the structure of lymphoid organs and determines the development of lymphoid cells in hematopoiesis. However, chronic TNF overexpression leads to the development of various autoimmune disorders. Sites of TNF production in the naïve state remain unclear due to the lack of in vivo models. In the present study, we used TNF-2A-Kat reporter mice to monitor the expression of TNF in different tissues. Comparative analysis of tissue fluorescence in TNF-2A-Kat reporter mice and wild type mice revealed constitutive expression of TNF in the skin of naïve adult mice. In the skin of TNF-2A-Kat reporter mouse embryos, no statistically significant differences in the expression of TNF compared to wild type animals were observed. Furthermore, we established that local depletion of microflora with topical antibiotics leads to a reduction in the fluorescence signal. Thus, we assume that the skin microflora is responsible for the expression of TNF in the skin of mice.

Electron paramagnetic resonance measurements of absorbed dose in teeth from citizens of Ozyorsk.

In 1945, within the frame of the Uranium Project for the production of nuclear weapons, the Mayak nuclear facilities were constructed at the Lake Irtyash in the Southern Urals, Russia. The nuclear workers of the Mayak Production Association (MPA), who lived in the city of Ozyorsk, are the focus of epidemiological studies for the assessment of health risks due to protracted exposure to ionising radiation. Electron paramagnetic resonance measurements of absorbed dose in tooth enamel have already been used in the past, in an effort to validate occupational external doses that were evaluated in the Mayak Worker Dosimetry System. In the present study, 229 teeth of Ozyorsk citizens not employed at MPA were investigated for the assessment of external background exposure in Ozyorsk. The annually absorbed dose in tooth enamel from natural background radiation was estimated to be (0.7 ± 0.3) mGy. For citizens living in Ozyorsk during the time of routine noble gas releases of the MPA, which peaked in 1953, the average excess absorbed dose in enamel above natural background was (36 ± 29) mGy, which is consistent with the gamma dose obtained by model calculations. In addition, there were indications of possible accidental gaseous MPA releases that affected the population of Ozyorsk, during the early and late MPA operation periods, before 1951 and after 1960.

Lung cancer risks from plutonium: an updated analysis of data from the Mayak worker cohort.

Workers at the Mayak nuclear facility in the Russian Federation offer a unique opportunity to evaluate health risks from exposure to inhaled plutonium. Risks of mortality from lung cancer, the most serious carcinogenic effect of plutonium, were evaluated in 14,621 Mayak workers who were hired in the period from 1948-1982, followed for at least 5 years, and either monitored for plutonium or never worked with plutonium. Over the follow-up period from 1953-2008, there were 486 deaths from lung cancer, 446 of them in men. In analyses that were adjusted for external radiation dose and smoking, the plutonium excess relative risk (ERR) per Gy declined with attained age and was higher for females than for males. The ERR per Gy for males at age 60 was 7.4 (95% CI: 5.0-11) while that for females was 24 (95% CI: 11-56). When analyses were restricted to plutonium doses <0.2 Gy, the ERR per Gy for males at age 60 was similar: 7.0 (95% CI: 2.5-13). Of the 486 lung cancer deaths, 105 (22%) were attributed to plutonium exposure and 29 (6%) to external exposure. Analyses of the 12,708 workers with information on smoking indicated that the relationship of plutonium exposure and smoking was likely sub-multiplicative (P = 0.011) and strongly indicated that it was super-additive (P < 0.001). Although extensive efforts have been made to improve plutonium dose estimates in this cohort, they are nevertheless subject to large uncertainties. Large bioassay measurement errors alone are likely to have resulted in serious underestimation of risks, whereas other sources of uncertainty may have biased results in ways that are difficult to predict.

Measurements and Monte Carlo calculations of photon energy distributions in MAYAK PA workplaces.

Photon energy distributions were measured in different workplaces of the Mayak Production Association (MPA), which was the first plutonium production plant in the former Soviet Union. In situ gamma spectrometry measurements were performed with a portable germanium detector. The spectral stripping method is used for the conversion of the in situ gamma-ray spectra to photon fluence rate energy distribution. This method requires the simulation of the portable germanium detector, which has been performed based on the MCNP code of Los Alamos. Measured photon fluence rate energy distributions were compared with calculated photon energy distributions (with the MCNP code) in two different workplaces: in the first workplace the geometry exposure was known. On the contrary, in the second workplace, as in most workplaces of MPA, the exposure geometry was unknown. The results obtained from the comparison between the experimental and calculated photon fluence rate energy distributions are presented and discussed.

The Radiation Injury Severity Classification system: an early injury assessment tool for the frontline health-care provider.

Our goal was to adapt current diagnostic methods for radiation overexposure patients into a practical system that can be implemented rapidly and reliably by responders unfamiliar with the effects of radiation. Our Radiation Injury Severity Classification (RISC) system uses clinical and haematological parameters from the prodromal phase of the acute radiation syndrome (ARS) to classify acute radiation injury for purposes of managing treatment disposition. Data from well-documented ARS cases were used to test the RISC system. Three-day summaries were generated for each case. These were individually reviewed by the three physicians most involved with the development of the system to establish both a consensus case score (CCS) and disposition category ranges. 30 volunteer raters from varying health disciplines using the RISC system then each independently rated a random selection of 12 cases for injury severity in a self-trained field-simulation exercise. The CCS identified discrete cut-off ranges for the three disposition categories in both manageable and mass casualty events. The group of raters, after a modest period of self-training, achieved overall levels of pairwise agreement with the CCS category of 0.944 for manageable events and 0.947 for mass casualty situations. In conclusion, an early assessment of the severity of the ARS injury is required for an appropriate disposition determination. The RISC system should produce reasonably accurate and reliable assessments of radiation injury severity within 6-12 hours post exposure despite the probable absence of physical dosimetric data.

Mayak worker dosimetry study: an overview.

The Mayak Production Association (MPA) was the first plutonium production plant in the former Soviet Union. Workers at the MPA were exposed to relatively large internal radiation intakes and external radiation exposures, particularly in the early years of plant operations. This paper describes the updated dosimetry database, "Doses-2005." Doses-2005 represents a significant improvement in the determination of absorbed organ dose from external radiation and plutonium intake for the original cohort of 18,831 Mayak workers. The methods of dose reconstruction of absorbed organ doses from external radiation uses: 1) archive records of measured dose and worker exposure history, 2) measured energy and directional response characteristics of historical Mayak film dosimeters, and 3) calculated dose conversion factors for Mayak Study-defined exposure scenarios using Monte Carlo techniques. The methods of dose reconstruction for plutonium intake uses two revised models developed from empirical data derived from bioassay and autopsy cases and/or updates from prevailing or emerging International Commission on Radiological Protection models. Other sources of potential significant exposure to workers such as medical diagnostic x-rays, ambient onsite external radiation, neutron radiation, intake of airborne effluent, and intake of nuclides other than plutonium were evaluated to determine their impact on the dose estimates.

Mayak film dosimeter response studies, part I: measurements.

The Mayak Worker Dosimetry study is a joint Russian/U.S. project to evaluate doses received by workers at the Mayak Production Association facilities from 1948-1972. A key investigation in this project is the characterization of responses of the three types of film dosimeters used to monitor workers during this time period. Experimental irradiations of the dosimeters were performed in the radiation calibration laboratories at the National Research Center for Environment and Health (GSF) in Munich, Germany. The irradiations used photon sources from x-ray beams with ten different energy distributions and with Co and Cs isotopic gamma sources. Irradiations were performed with the dosimeters on phantoms and free-in-air. The dosimeters and phantoms were also positioned at varying angles to the radiation beam. The result of the experiments was a thorough characterization of the dosimeter response as a function of photon energy and as a function of angle for energy and angular ranges that cover the conditions encountered in the Mayak workplaces. The characterization data were then available for use in developing correction factors, which could be applied to worker dosimeter readings to provide a more accurate assessment of worker dose and estimates of doses to organs.

Mayak film dosimeter response studies, part II: response models.

A study was performed of energy and angular responses of the film dosimeters that were used for worker monitoring at the Mayak Production Association (Mayak PA) in 1948-1992. The study used experimental data from tests with three types of individual film dosimeters, and the data were used to determine the dosimeters' energy and angular response characteristics in the range from 9 keV to Co energies, with the dosimeters exposed both free-in-air and on-phantom at horizontal and vertical rotation. Mathematical models of the dosimeters were developed to calculate the response characteristics of the dosimeters. The models of the film dosimeters were validated by comparing calculations to measurements. The models were then used as the basis for individual dose reconstruction in realistic photon spectra and worker exposure geometries at the Mayak PA workplaces. Reconstructed individual doses have been included in the Mayak worker database "Doses-2005" that is used for epidemiological studies of the Mayak workers' radiation exposures and subsequent health effects.

Mayak film dosimeter response studies, part iii: application to worker dose assessment.

This paper describes the methods used to correct individual dosimeter readings for workers to obtain estimates of worker doses received at the Mayak Production Association (Mayak PA). Film dosimeters were used at Mayak PA for worker monitoring from 1948 until 1992. The method requires a determination of the relationship between the absorbed dose in film emulsion and the dose in air under calibration conditions, which is then extended to exposures in the actual radiation fields of the workplace. Corrections needed to account for actual workplace exposure conditions were determined by modeling with the Monte Carlo radiation transport computer code MCNP. Correction factors were developed to convert from dosimeter reading to a realistic worker dose. The method was applied as a basis for individual dose reconstruction using film dosimeters in realistic photon spectra and geometries at Mayak PA work areas.

Lung cancer risk of Mayak workers: modelling of carcinogenesis and bystander effect.

Lung cancer mortality in the period of 1948-2002 has been analysed for 6,293 male workers of the Mayak Production Association, for whose information on smoking, annual external doses and annual lung doses due to plutonium exposures was available. Individual likelihoods were maximized for the two-stage clonal expansion (TSCE) model of carcinogenesis and for an empirical risk model. Possible detrimental and protective bystander effects on mutation and malignant transformation rates were taken into account in the TSCE model. Criteria for non-nested models were used to evaluate the quality of fit. Data were found to be incompatible with the model including a detrimental bystander effect. The model with a protective bystander effect did not improve the quality of fit over models without a bystander effect. The preferred TSCE model was sub-multiplicative in the risks due to smoking and internal radiation, and more than additive. Smoking contributed 57% to the lung cancer deaths, the interaction of smoking and radiation 27%, radiation 10%, and others cause 6%. An assessment of the relative biological effectiveness of plutonium was consistent with the ICRP recommended value of 20. At age 60 years, the excess relative risk (ERR) per lung dose was 0.20 (95% CI: 0.13; 0.40) Sv(-1), while the excess absolute risk (EAR) per lung dose was 3.2 (2.0; 6.2) per 10(4) PY Sv. With increasing age attained the ERR decreased and the EAR increased. In contrast to the atomic bomb survivors, a significant elevated lung cancer risk was also found for age attained younger than 55 years. For cumulative lung doses below 5 Sv, the excess risk depended linearly on dose. The excess relative risk was significantly lower in the TSCE model for ages attained younger than 55 than that in the empirical model. This reflects a model uncertainty in the results, which is not expressed by the standard statistical uncertainty bands.