STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE¼ - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2022. / РЕЗУЛЬТАТИ РОБОТИ ДУ «ÐÐÐ¦Ð†ÐžÐÐÐ›Ð¬ÐÐ˜Ð™ НАУКОВИЙ ЦЕНТРРАДІАЦІЙНОЇ МЕДИЦИНИ НАЦІОНАЛЬНОЇ АКАДЕМІЇ МЕДИЧНИХ НАУК УКРАЇНИ¼ У 2022 РОЦІ.

Research activities and scientific advance achieved in 2022 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident. The report also shows the results of scientificorganizational and health care work, staff training. The Scientific Council meeting of NAMS approved the NRCRM Annual Report.

STATUS OF THE CURRENT DOMESTIC REGULATORY BASE FOR ENSURING RADIATION SAFETY AND ANTI-RADIATION PROTECTION OF MILITARY PERSONNEL DURING THE PERIOD OF MARTIAL STATUS. / СТАН ЧИННОЇ ВІТЧИЗНЯНОЇ НОРМАТИВНОЇ БАЗИ ЩОДО ЗАБЕЗПЕЧЕННЯ РАДІАЦІЙНОЇ БЕЗПЕКИ ТА ПРОТИРАДІАЦІЙНОГО ЗАХИСТУ ВІЙСЬКОВОСЛУЖБОВЦІВ НА ПЕРІОД ВОЄННОГО СТАНУ.

Prerequisite. In the conditions of a full-scale invasion, the issue of radiation safety and anti-radiation protection in the Armed Forces of Ukraine (AFU) occupies a special place, since the aggressor country violated global geopolitical international decisions, occupied civilian nuclear facilities, in the process of their liberation servicemen mayhave to act in conditions of increased radiation risk, the possibility of using tactical nuclear weapons also is not excluded. OBJECTIVE: to investigate the state of the current national regulatory framework for ensuring radiation safety and anti-radiation protection of military personnel during the period of martial law. METHODS: bibliographic, analytical, historical, systematic approach. RESULTS: The main normative document on the organization of radiation safety and anti-radiation protection of both personnel and the population in Ukraine, as well as military personnel, currently in everyday conditions and in case of radiation accidents since 1998 and until now, are the State Hygienic Standards «Radiation Safety Standards of Ukraine (NRBU-97)¼. But neither in this document, nor in the transition to NRBU-2021-P, the issue of exposure to such a category as military personnel during the performance of combat (special) tasks is considered. The system of monitoring the radiation situation in Ukraine, documents on the organization of medical support for military personnel, including the Guidelines on the Medical Support of the Armed Forces of Ukraine for a Special Period (2019)and the Guidelines on the Organization of Radiation Safety in the Armed Forces of Ukraine (2020), were analyzed.modules of radiation safety principles in the Armed Forces of Ukraine were proposed. CONCLUSION: The unsolved problem of normalization of the radiation factor in the case of man-made and socio-political emergencies can create significant problems in the organization of anti-radiation protection of troops and the population in the case of the use of nuclear weapons or radiation accidents in a special period and requires anurgent solution. It is obvious that there is a need to develop regulatory documents regarding the response and planning of continuous activities to respond to potential nuclear and radiation threats during martial law, including relationships at all levels of the management vertical and methods of communication in the event of a threat.

ON THE METHODOLOGY OF PASSPORT DOSES CALCULATION FOR UKRAINIAN SETTLEMENTS RADIOACTIVELY CONTAMINATED DUE TO THE CHORNOBYL NPP ACCIDENT. / ЩОДО МЕТОДИКИ РОЗРАХУНКУ ПАСПОРТНИХ ДОЗ НАСЕЛЕНИХ ПУНКТІВ УКРАЇНИ, ЯКІ ЗАЗНАЛИ РАДІОАКТИВНОГО ЗАБРУДНЕННЯ В РЕЗУЛЬТАТІ АВАРІЇ НА ЧАЕС.

OBJECTIVE: scientific substantiation of the new methodology for estimation of passport doses of the settlementswhich belong to Zone of Unconditional (obligatory) Resettlement, or 2nd zone and Zone of Granted VoluntaryResettlement, or 3rd zone in the framework of dosimetric passportization in accordance with the legislation ofUkraine. MATERIALS AND METHODS: 37 years after the accident, radioactive contamination of the environment has significantly decreased. However, it is still necessary to carry out ecological and dosimetric monitoring and apply countermeasures in certain territories of Ukraine affected by the accident at the Chornobyl Nuclear Power Plant: restriction of the consumption of locally produced milk, forest products, etc. The methodology, which was since 1996 used to estimate the passport doses of Ukrainian settlements, no longer corresponds to the current level of scientific knowledge about radioactive contamination of environment. The new methods of passport doses calculating presented in the work involves the use of a model whose parameters are determined by the types, quality and completeness of radio-ecological and dosimetric monitoring carried out on the radioactively contaminated territories in 1986-2013. The methodology takes into account the specific of radioactive contamination of each settlement. The passport dose of external exposure is reconstructed only from 137Cs radionuclide, because the contributions of other Chornobyl radionuclides influence the radiation dose only in the first years after the accident. The passport dose of internal exposure is formed as a result of the consumption of 137Cs contaminated food products. It is calculated depending on the availability in the settlement in the current year of the results of measurements of the 137Cs radionuclide activity incorporated in the human body using a whole body counter (WBC) and the activity of 137Cs in the private milk. At the same time, priority is given precisely to the results of WBC measurements of 137Cs. RESULTS AND CONCLUSIONS: A new methodology (Methodology-2023) for passport doses calculation of Ukrainian settlements was substantiated. A comparison of passport doses based on the results of radioecological and dosimetric monitoring in 2011 calculated by Methodology-2023 and passport doses calculated by Methodology-96 was made.Passport doses calculated by Methodology-2023 increased by 40 % on average compared to doses calculated by Methodology-96. At the same time, passport doses of internal radiation calculated by the new methodologyincreased by 1.5 times, and passport doses of external radiation increased by 1.7 times. The passport dose of 2011, calculated by Methodology-2023, exceeds the legally established limit of 1 mSv in 71 settlements, most of which are located in Korostenkyi raion of Zhytomyr Oblast.

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.

COMORBID PATHOLOGY IN FATAL CASES DUE TO CORONAVIRUS DISEASE (COVID-19) IN VICTIMS OF THE CHORNOBYL NPP ACCIDENT. / КОМОРБІДНА ПАТОЛОГІЯ ПРИ ЛЕТАЛЬНИХ ВИПАДКАХ ВНАСЛІДОК КОРОНАВІРУСНОЇ ХВОРОБИ (COVID-19) У ПОСТРАЖДАЛИХ ВНАСЛІДОК АВАРІЇ НА ЧОРНОБИЛЬСЬКІЙ АЕС.

INTRODUCTION: The victims of the Chornobyl accident, as well as whole population of Ukraine, have become the object of the COVID-19 pandemic in today's conditions. As of 01.01.2020, 108,898 victims had documented permanent disability (persons with disabilities) and, as a rule, suffered from 4-6 types of non-tumor chronic diseases of internal organs, primarily the circulatory system, as well as oncological and endocrine pathology, that significantly affect the course of COVID-19 in a severe scenario and contribute to death. This determines the relevance of the issue of the impact of comorbid pathology in fatal cases due to coronavirus disease (COVID-19) in victims of the Chornobyl accident.The Objective of the study was to study the nature and significance of comorbid pathology in the victims of the Chernobyl accident who died from COVID-19.Design, object and methods of the study - a retrospective non-randomized, comparative comprehensive analysis of the materials of 134 medical expert cases of male clean-up workers of the Chornobyl accident who died from COVID-19 in 2020-2022 during the pandemic was carried out. The analysis of the materials of expert cases included the study of clinically significant and morphologically confirmed pathological processes. The source of the data was the materials of the Central Interdepartmental Expert Commission of the Ministry of Health of Ukraine on the establishment of causal relationship of diseases, disability and death with the action of ionizing radiation and other harmful factors as a result of the Chernobyl accident. RESULTS: In the structure of comorbid pathology in the clean-up workers of the Chornobyl accident who died due to COVID-19 during 2020-2022, diseases of the circulatory system dominate, which occurred in 86.57% of cases of consideration of medical expert cases. AH complicated the course and contributed to the development of fatal consequences in 52.24% of cases, ChIHD - in 34.32% of cases. The consequences of acute vascular events in the form of post-infarction cardiosclerosis in patients with ChIHD contributed to death in COVID-19 in 29 (21.64%) cases.Cerebrovascular pathology represented by cerebral atherosclerosis was detected in 76 (56.72%) cases of death from COVID-19. Acute vascular cerebral events in the cerebral basin (ischemic and hemorrhagic strokes) contributed to fatal outcomes in 19 (14.18%) cases. The presence and course of diabetes mellitus also had a significant impact on the course and fatal mortality of COVID-19 - 24.63% (33 cases). Chronic respiratory diseases (COPD) influenced the course of COVID-19 and contributed to death in 6.72% (9) of cases, nephrological pathology (ChTIN) - in 2.98% (4) of cases, peptic ulcer disease of the duedenum - in 2.24% (3) of cases. More than half of the clean-up workers of the Chornobyl NPP accident who died due to COVID-19 had more than two severe chronic diseases of the comorbid component and their complications. CONCLUSIONS: Сlean-up workers of the Chornobyl accident who died from COVID-19 had another severe comorbid chronic disease, or several diseases that influenced the course of coronavirus disease and each other and contributed to the development of fatal consequences. Death from COVID-19 is much more common in clean-up workers of the Chornobyl accident suffering from severe disabling non-oncological diseases of the cardiovascular system (arterial hypertension, coronary heart disease), cerebrovascular diseases with consequences of acute vascular events, as well as diabetes mellitus. Victims of the Chornobyl catastrophe, especially clean-up workers of the Chornobyl NPP accident, are at special risk for severe coronavirus disease and death from COVID-19.

STRUCTURE AND CHARACTERISTICS OF THE CHORNOBYL NPP ACCIDENT VICTIMS ACCORDING TO THE MATERIALS OF MEDICAL EXPERTISE OF THE CAUSAL RELATIONSHIP OF DISEASES WITH THE EFFECT OF IONIZING RADIATION IN THE REMOTE POSTACCIDENTAL PERIOD (2023 year). / СТРУКТУРА ТА ХАРАКТЕРИСТИКА ПОСТРАЖДАЛИХ ВНАСЛІДОК АВАРІЇ НА ЧОРНОБИЛЬСЬКІЙ АЕС ЗА МАТЕРІАЛАМИ МЕДИЧНОЇ ЕКСПЕРТИЗИ ЩОДО ПРИЧИННО-НАСЛІДКОВОГО ЗВ'ЯЗКУЗАХВОРЮВАНЬ З ДІЄЮ ІОНІЗУЮЧОГО ВИПРОМІНЮВАННЯ У ВІДДАЛЕНИЙ ПІСЛЯАВАРІЙНИЙ ПЕРІОД (2023 рік).

Loss of health and workability, as well as deaths due to harmful influence of the Chornobyl catastrophe (including radiation exposure) during performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposure not through their own fault but due to a radiation accident, caused the development of a special form of medical expertise as part of the of medical social protection system for these suffered contingents. OBJECTIVE: To study and characterize the structure of the affected categories (clean-up workers and victims) of the Chornobyl catastrophe based on the materials of expert cases of the Central Interdepartmental Expert Commission of Ministry of Health of Ukraine (CIEC) in the remote post-accidental period (2013-2023). MATERIAL AND METHODS: The work was performed in the design of a retrospective study that based on analysis of the structure of all categories of Chornobyl NPP accident (ChNPP) victims during 2008-2023 years and studying of more 57 000 medical expert cases, which were considered by CIEC during 2013-2022 to establish a causal relationship between the disease and influence of radiation exposure and other harmful factors and conditions during ChNPP accident. RESULTS: The total number of affected adult citizens as on 01.01.2023, compared to 2008, decreased by 511,877 persons, or by 27.90 % (from 1,834,536 to 1,322,659 persons). The number of clean-up workers of the accident decreased from 276,327 (2008) to 162,180 (2023), or by 114,147 people (41.30 %), that means - during the last 15 years, almost every third-second clean-up worker who participated in the liquidation of the consequences of the accident at the ChNPP died. The number of adult victims decreased from 1,558,209 in 2008 to 1,160,479 in 2023, or by 25.52 % (397,730 persons). In the structure of medical expert cases during 2013-2022 the leading place as the reason of disease, disability and death is occupied by oncological diseases - 60.3 %, cerebrovascular diseases and their complications make up 10.00 %, diseases of the cardiovascular system - 19.6 %. CONCLUSION: In the remote post-accidental period (2013-2023) has increased the need of expertise of the causal relationship of disability and the causes of death with the influence of the ChNPP accident consequences for medical and social support. During 2013-2023 period quick reducing for all categories of affected due to the Chornobyl NPP accident taken place. In the structure of medical expert cases during 2013-2023 the leading place as the reason of disease, disability and death is occupied by oncological, cardiovascular and cerebrovascular diseases.

ACUTE RADIATION SICKNESS IN HUMAN: ETIOPATHOGENESIS, CLINIC, DIAGNOSIS AND TREATMENT (LECTURE). / ГОСТРА ПРОМЕНЕВА ХВОРОБА ЛЮДИНИ: ЕТІОПАТОГЕНЕЗ, КЛІНІКА, ДІАГНОСТИКА ТА ЛІКУВАННЯ (ЛЕКЦІЯ).

Under the conditions of war in Ukraine, there remains a high probability that russia will use nuclear weapons or commit terrorist acts against nuclear power plants, which will lead to exposure of the population in doses that cause acute radiation sickness (ARS). In this regard, our medical service must be ready for the treatment of ARS of various degrees of severity under a mass influx of victims. In peacetime, ARS is a rather infrequent pathology, so most doctors lack experience in its treatment. This article, having the form of a lecture, presents material on the pathogenesis, classification, clinic, diagnosis and treatment of ARS, taking into account the modern achievements of radiation medicine. Treatment of ARS is based on the use of pharmaceutical drugs that are licensed in Ukraine. The article will be useful for doctors and medical workers of all branches and levels of health care, who will have to deal with irradiated persons in order to timely identify patients with ARS and provide them with effective treatment.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE¼ - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2021. / REZUL'TATY ROBOTY DU «NATsIONAL'NYI NAUKOVYI TsENTR RADIATsIINOÏ MEDYTsYNY NATsIONAL'NOÏ AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY¼ U 2021 ROTsI.

Research activities and scientific advance achieved in 2021 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effectsand health effects of the Chornobyl accident.The report also shows the results of scientific-organizational and health care work, staff training. The Scientific Council meeting of NAMS approved the NRCRM Annual Report.

MEDICAL EXPERTISE FOR ESTABLISH CAUSATION OF DISEASE, LEADING TO LOSS OF HEALTH, DISABILITY AND DEATH WITH THE ACTION OF IONIZING RADIATION AND OTHER HARMFUL FACTORS OF THE CHORNOBYL ACCIDENT IN THE REMOTE POST-ACCIDENTAL PERIOD (2013-2022). / MEDYChNA EKSPERTYZA VSTANOVLENNIa PRYChYNNOGO ZV'IaZKU ZAKhVORIuVAN', ShchO PRYZVODIaT' DO VTRATY ZDOROV'Ia, INVALIDNOSTI TA SMERTI VNASLIDOK DIÏ IONIZUIuChOGO VYPROMINIuVANNIa TA INShYKh ShKIDLYVYKh FAKTORIV ChORNOBYL'S'KOÏ KATASTROFY U VIDDALENOMU PISLIaAVARIINYINOMU PERIODI (2013­2022 rr.).

Loss of health and workability, as well as deaths due to harmful influence of the Chornobyl Catastrophe (including radiation exposure) during performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposure not through their own fault but due to a radiation accident, caused the development of a special form of medical expertise as part of the of medical social protection system for these suffered contingents. OBJECTIVE: To study and characterize the structure of the affected categories (clean-up workers and victims) of the Chernobyl Catastrophe based on the materials of expert cases of the Central Interdepartmental Expert Commission (CMEC) in the remote post-accidental period (2013-2022). MATERIAL AND METHODS: The work was performed in the design of a retrospective study that based on studying of 50,974 expert cases, which were considered by CIEC during 2013-2022 to establish a causal relationship between the disease and influence of radiation exposure and other harmful factors and conditions during ChNPP accident using a systematic analytical approach to assessing the medical and nonmedical parameters presented in medical expert documentation. RESULTS: The total number of affected adult citizens as on 01.01.2022, compared to 2008, decreased by 477,953 persons, or by 26.05 % (from 1,834,536 to 1,354,746 persons). The number of clean-up workers of the accident decreased from 276,327 (2013) to 171,725 (2022), or by 104,602 people (37.85 %), that means - during the last 10 years, almost every third clean-up worker who participated in the liquidation of the consequences of the accident at the Chernobyl NPP died. The number of adult victims decreased from 1,558,209 in 2008 to 1,183,021 in 2022, or by 24.08 % (375,188 persons). The average annual reduction in the absolute number of clean-up workers of ChNPP accident during 2013-2022 is about 7,770 people per year (9,424 during 2021), adult victims - 27,045 people per year (28,922 during 2021). In the structure of medical expert cases during 2013-2022 the leading place as the reason of disease, disability and death is occupied by oncological diseases - 52.72 %, cerebrovascular diseases and their complications make up 17.08 %, diseases of the cardiovascular system - 19.6 %. CONCLUSION: In the remote post-accidental period (2013-2022) has increased the need of expertise of the causal relationship of disability and the causes of death with the influence of the Chornobyl NPP accident consequences for medical and social support. During 2013-2022 period quick reducing for all categories of affected due to the Chornobyl NPP accident taken place. In the structure of medical expert cases during 2013-2022 the leading place as the reason of disease, disability and death is occupied by oncological diseases.

RETINA VESSELS CHANGES IN CHORNOBYL NUCLEAR POWER PLANT EMPLOYEES WHO EXPERIENCED LONG-TERM ABNORMAL RADIATION EXPOSURE AT THE WORKPLACE AS A RESULT OF THE OCCUPATION OF CHORNOBYL NUCLEAR POWER PLANT IN 2022. / ZMINY SUDYN SITKIVKY V SPIVROBITNYKIV ChORNOBYL'S'KOÏ ATOMNOÏ ELEKTROSTANTsIÏ, IaKI ZAZNALY TRYVALOGO NENORMOVANOGO RADIATsIINOGO VPLYVU NA ROBOChOMU MISTsI VNASLIDOK OKUPATsIÏ ChAES U 2022 ROTsI.

During the occupation of the Chornobyl Nuclear Power Plant (ChNPP) in 2022, a group of employees remained in the working town for a long time. These personnel were exposed to long-term radiation and non-radiation factors of the production environment, as well as stress and other factors. These factors could result in negative changes of health.It is known that radiation exposure causes changes in the course and caliber of retinal vessels. OBJECTIVE: to assess the condition of retinal arteries and veins and the level of incorporated 137Cs content in persons who were exposed to prolonged exposure to radiation and non-radiation factors of industrial environment, as they were at the workplace overtime during the occupation of the Chornobyl Nuclear Power Plant in 2022. MATERIALS AND METHODS: A comprehensive ophthalmological examination was carried out. Which included the determination of the diameter of the retinal arteries and veins, the arteriovenous ratio, of 55 people from among the personnel of the ChNPP, who worked under the conditions of the occupation of the ChNPP. All those examined were examined on an expert human radiation counter. The results of the ophthalmological examination were compared with the results of earlier examinations of ChNPP employees of the same age groups. RESULTS: It was established that in the examined group, a decrease in the arterio-venous ratio was observed, mainly due to the expansion of retinal veins. Dilatation of the veins was asymmetric, mainly the branches of the central vein of the retina of the right eye were more dilated. Retinal arteries were narrowed in all examined subjects. When comparing the results with the data of previous examinations, it was established that the arterio-venous ratio in this group was probably lower than in previously examined employees of the ChNPP of the same age groups. At the same time, the maximum registered value of the content of incorporated 137Сs was 713 Bq/organism, none of the examined exceeded the control level of 1,000 Bq/organism. CONCLUSIONS: Violation of blood circulation in the retina was detected - a probable increase in the arteriovenous ratio due to the expansion of the retinal veins in the personnel of the Chornobyl nuclear power plant who worked under the conditions of the occupation of the ChNPP in 2022. Since the examined subjects did not exceed the control level of incorporated 137Сs content (1,000 Bq/organism), the observed effect may be a consequence of the influence of other, both radiation and non-radiation factors.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE¼ - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2020. / REZUL'TATY ROBOTY DU «NATsIONAL'NYI NAUKOVYI TsENTR RADIATsIINOÏ MEDYTsYNY NATsIONAL'NOÏ AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY¼ U 2020 ROTsI.

Research activities and scientific advance achieved in 2020 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident. The report also shows the results of scientific-organizational and health care work, staff training. The Scientific Council meeting of NAMS approved the NRCRM Annual Report.

THE BRONCHOPULMONARY SYSTEM DAMAGE UNDER THE INFLUENCE OF IONIZING RADIATION EXPOSURE AND RADIONUCLIDES INHALATION IN THE CONDITIONS OF THE CHORNOBYL CATASTROPHE (SUMMARIZING OF 35 YEARS RESEARCH EXPERIENCE). / URAZhENNIa BRONKhOLEGENEVOÏ SYSTEMY VNASLIDOK VPLYVU IONIZUIuChOGO OPROMINENNIa TA INGALIaTsIINOGO NADKhODZhENNIa RADIONUKLIDIV V UMOVAKh ChORNOBYL'S'KOÏ KATASTROFY (UZAGAL'NENNIa DOSVIDU 35 ROKIV DOSLIDZhEN').

The review is devoted to the summarizing of 35 years of research of ionizing radiation exposure and radionuclidesinhalation influence on the bronchopulmonary system of clean-up workers of the Chornobyl NPP accident. Radiationand hygienic preconditions for the formation of chronic respiratory pathology are considered, taking into accountthe dosimetric data of irradiation of the bronchopulmonary system.The main clinical symptoms, features of disorders of pulmonary ventilation capacity and endoscopic forms of lesionsof the bronchopulmonary system of participants in the liquidation of the accident were determined.On the basis of pathomorphological, microbiological and immunological researches the pathomorphosis of chronicnonspecific lung diseases in the conditions of the Chernobyl catastrophe is proved.It is proved that under combined influence of external irradiation and inhalation of a fragmentary mixture ofradionuclides in the condition of the Chernobyl catastrophe, the bronchopulmonary system has become one of themain «targets¼-tissues, of realization of stochastic and nonstochastic effects.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE¼ - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2019. / REZUL'TATY ROBOTY DU «NATsIONAL'NYI NAUKOVYI TsENTR RADIATsIINOÏ MEDYTsYNY AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY¼ U 2019 ROTsI.

Research activities and scientific advance achieved in 2019 at the State Institution «National Research Center forRadiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problemsof the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaborationwith the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annualreport. The report presents the results of fundamental and applied research works of the study of radiation effectsand health effects of the Chornobyl accident.The report also shows the results of scientific-organizational and health care work, staff training.The Scientific Council meeting of NAMS approved the NRCRM Annual Report.

THE EXPERTISE OF THE CAUSAL RELATIONSHIP BETWEEN THE DEVELOPMENT OF ARTERIAL HYPERTENSION WITH PARTICIPATION IN WORKS FOR LIQUIDATION OF THE CONSEQUENCES OF CHORNOBYL NPP ACCIDENT IN REMOTE POSTACCIDENTAL PERIOD. / EKSPERTYZA PRYChYNNOGO ZV'IaZKU ROZVYTKU ARTERIAL'NOÏ GIPERTENZIÏ Z UChASTIu V ROBOTAKh PO LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChORNOBYL'S'KII AES U VIDDALENOMU PISLIaAVARIINOMU PERIODI.

Loss of health and work ability, as well as deaths from diseases of the circulatory system (DCS), first of all arterialhypertension (AH), due to radiation exposure (RE) in the conditions of Chernobyl catastrophe (ChC) in the performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposurenot through their own fault but due to a radiation accident, caused the development of a special form of medicalexpertise as part of the of medical social protection system for these suffered contingents. OBJECTIVE: to optimize decision-making criteria for the expert estimation of the casual relationship between development and progression of AH under the influence of RE in clean-up workers of the Chornobyl NPP accident (CWs)in the remote postaccidental period based on the study of odds ratio (OR) of the course of the disease. MATERIAL AND METHODS: A retrospective analysis of the structure of 16073 cases of victims of the Chornobyl NPP(ChNPP) accident, considered by the Central Interagency Expert Commission of Ministry of Health of Ukraine for diseases, reason of disability and death causal relationship to ChNPP accident (CIEC) during 2014-2016, allowed toform a group of 401 cases of CW with AH to determine the OR of the course of the disease. The main group consisted of 330 CWs for whom the development of AH has a causal relationship with the participation in the work for liquidation consequences of the Chornobyl NPP accident (WLAc), the comparison group - 71 CWs in respect of whoma negative expert decision was made. There were not significant differences between both groups of CWs in doseof external radiation exposure (DERE) in the main group - (0.155 ± 0.085) Sv, in CWs of the comparison group -(0.135 ± 0.086) Sv (р = 0.868). RESULTS: In the remote postaccidental period, HSC take the second place (39.62 %) in the structure of medicalexpertise of the causal relationship of the diseases development and progression with RE for all categories of victims of the Chernobyl accident. The share of cases of AH was 28.4% of the total number of cases considered CWs. Inthe structure of cases of relationship of diseases of CWs that led to death, the share of AH was 17.8 %. In CWs themain group the AH developed in (9.4 ± 6.2) years after participation in WLAc, which is on average 6 years earlierthan in the comparison group (р < 0.001). AH in the main group of CWs developed at the age of 5.8 years youngerthan in the comparison group (р = 0.0005). The need for inpatient treatment come 8.6 years earlier (14.6 ± 7.7years) than in CWs comparison group (р < 0.001). At DERE 0,05 Sv and over, increases the probability of developmentand progression of AH that has causal relationship with participation in the WLAc. For medical expertise of thecausal relationship of the AH development and progression with WLAc at DERE 0.20 Sv and over the significant evidence value have the next criteria: terms Somatoform Vegetative (autonomic) Dysfunction (SVD) development(within 3,5 years) and its transformation into AH (within 7 years), verification of the AH diagnosis (within 9,5 years),inpatient treatment for SVD or AH (within 15 years), vascular events (Acute Cerebrovascular Accident - Stroke(ACVA) - within 24 years after participation in the WLAc or 11 years after the AH diagnosed, myocardial infarction(MI) - within 22 years after participation in the WLAc or 10.5 years after the AH diagnosed), the establishment ofpermanent disability. CONCLUSION: Radiation factor has an evidence influence on the development and progression of AH in CWs. Criteria ofthe development and progression of AH in CWs can be used for evidence-based medical expertise for estimation of thecausal relationship of the disease with the WLAc in the remote post accidental period at DERE more than 0.20 Sv.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE¼ - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2018. / REZUL'TATY ROBOTY DU «NATsIONAL'NYY̆ NAUKOVYY̆ TsENTR RADIATsIY̆NOÏ MEDYTsYNY NATsIONAL'NOÏ AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY¼ U 2018 ROTsI.

Research activities and scientific advance achieved in 2018 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident; fulfillment of tasks of «State Social Program for Improving Safety, Occupational Health and Working Environment in 2014-2018¼.The report also shows the results of scientific-organizational and health care work, staff training. The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 21, 2019.

RETROSPECTIVE ASSESSMENT OF CLINICAL-MORPHOLOGICAL CHANGES OF THE HEPATOBILIARY SYSTEM IN LIVER CIRRHOSIS OF THE CHORNOBYL NPP ACCIDENT CLEAN-UP WORKERS. / RETROSPEKTYVNA OTsINKA KLINIKO-MORFOLOGIChNYKh ZMIN GEPATOBILIARNOÏ SYSTEMY PRY TsYROZI PEChINKY V UChASNYKIV LIKVIDATsIÏ NASLIDKIV ChORNOBYL'S'KOÏ KATASTROFY.

OBJECTIVE: to retrospectively characterize changes in the hepatobiliary system in liver cirrhosis (LC) in the clean-up workers of the Chornobyl NPP accident and to determine the factors of disease progression according to the expert materials of the Central Interagency Expert Commission on Establishing the Causal Relationship of the Diseases with the influence of factors of Chornobyl NPP accident. MATERIALS AND METHODS: Based on the data of 60 cases of the Central Interagency Expert Committee on establishing the causal link of diseases with the impact of the Chornobyl NPP accident, the factors of development, concomitant pathology and indicators of the hepatobiliary system status in 49 deceased and 11 alive clean-up workers with LC were investigated. RESULTS: A retrospective study of the morphological changes of the hepatobiliary system in the clean-up workers with LC showed that the main pathologic anatomical diagnosis in 37.8 % of cases was small-nodal LC, in 8.9 % - micromacronodular, in 4.4 % - large-nodal, in 2.2 % - primary biliary LC, in the other 40 % of cases - LC with uncer- tain nodal structure, as well as 2 (4.4 %) cases of fatty liver and 1 case (2.2 %) of portal cirrhosis against the back- ground of fatty liver. Pathomorphological changes were characterized by expressed growth of fibrous tissue with replacement of the liver parenchyma (fields of fibrosis), increase in size and impaired structure of the liver, thick- ening and tightening of its capsule, fibrotic changes in other organs - gastric mucosa, pancreas, spleen, lungs, heart. Histological examination revealed lobe structure abnormalities, false lobules, periportal fibrosis, lymphoid-lympho- cytic infiltration, diffuse fatty small-sized and large-drop dystrophy, and hepatocyte atrophy. Common inflammato- ry processes and fibrotic changes of other organs and systems: cardiovascular, urinary, bronchopulmonary, stomach, pancreas and spleen made the course of the LC more severe. The most frequent were cardiovascular diseases, signi- ficantly more frequent among the deceased than alive patients: hypertension - 67.3 % and 45.5 %, p < 0.05, coro- nary heart disease - 57.1 % and 18 %, p < 0.05. In most cases, the cause of death in the clean-up workers with LC was hepatic and cellular failure (53.3 %), which together with hepatic-renal failure (17.8 %) made 71.1 %. CONCLUSION: Changes in the hepatobiliary system of change in in the clean-up workers with LC were characterized by marked growth of fibrotic tissue with replacement of the parenchyma and impaired liver structure, fibrotic changes in other organs, diffuse fatty small and large droplet dystrophy and atrophy of hepatocytes. The severe course of the LC with the manifestation of the disease at the stage of decompensation was due to a vague clinical picture, lack of subjective symptoms of liver disease, slow, steadily progressing development, lack of or inadequate examination and treatment, a significant number of concomitant pathology of other organs and systems. The fac- tors of the development of LC in the clean-up workers were the long course of chronic liver disease, numerous con- comitant pathology, long stay in the accident zone, the effect of ionizing radiation, as well as the lack of dispensa- ry supervision and adequate treatment.

CLINICAL TYPES OF CATARACTS IN A LONG-TERM PERIOD AFTER ACUTE RADIATION SICKNESS. / KLINIChNI RIZNOVYDY KATARAKTY U VIDDALENOMU PERIODI PISLIa PERENESENOÏ GOSTROÏ PROMENEVOÏ KhVOROBY.

OBJECTIVE: to describe the clinical types of cataracts in the remote period after acute radiation sickness (ARS). MATERIALS AND METHODS: Twenty four - thirty three years after the emergency exposure, a complete ophthalmolog- ic examination of 53 reconvalescents of ARS conducted. The average age of patients at the time of the examination was (64.6 ± 1.2) years, the average radiation dose of the examined patients was (2.39 ± 0.17) Gy. Ophthalmologic examination included visometry with and without correction, tonometry, autorefractokeratometry, biomicroscopy on a slit lamp, retroillumination photography (infrared and color) of a lens. To evaluate the results of surveys used statistical methods: calculation of average values of quantitative indicators, estimation of probability difference by Student's method. RESULTS: In 10 patients (17 eyes) of the 53 reconvalescents of ARS in the remote period after irradiation artifakia after surgical treatment was recognized. In all other patients, changes in the transparency of the lens were detect- ed, and most patients had combined changes. Radiation cataract with it's characteristic clinical picture was detect- ed in 32 people, and in one more case, it's first signs were recorded. But 14 reconvalescents of ARS in the remote period after irradiation had not radiation cataract. CONCLUSIONS: Radiation cataract has not been detected in 14 reconvalescents of ARS in the remote period after irra- diation; the radiation doses of these patients significantly exceeds the threshold levels. Therefore, the absence of it's signs in the remote period in individuals exposed to doses above 2 Gy may indicate that this well-known radia- tion-induced effect is stochastic. Further analysis of the clinical features of the len's pathology in the reconvales- cents of ARS is promising for the study of the mechanism of damage to the lens in this category of victims of the Chornobyl accident.

LUNG FUNCTION AND TELOMERE RELATIVE LENGTH IN CLEAN-UP WORKERS OF CHORNOBYL NPP ACCIDENT IN A REMOTE POST-ACCIDENT PERIOD. / FUNKTsIONAL'NYY̆ STAN BRONKhOLEGENEVOÏ SYSTEMY TA VIDNOSNA DOVZhYNA TELOMER V UChASNYKIV LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChAES U VIDDALENOMU PISLIaAVARIY̆NOMU PERIODI.

OBJECTIVE: The objective was to study the relationship between functional status of bronchopulmonary system and telomere length in clean-up workers of Chornobyl NPP accident in a remote post-accident period. MATERIALS AND METHODS: A study was performed in 113 clean-up workers of Chornobyl NPP accident. Individual do- cumented doses of irradiation in clean-up workers ranged from 1,0 to 880 mSv (330.4 ± 317.7 (M ± SD)). The aver- age age of the Chornobyl NPP participants was (62.21 ± 6.99) years. A complex of functional pulmonary tests (spirometry, body plethysmography, examination of lung diffusion capacity) was performed. Relative telomere length (RTL) was analysed by flow-FISH. RESULTS: There was a tendency to decrease the relative telomere length in clean-up workers with COPD I-II stage and COPD III-IV, compared with patients with the absence of bronchopulmonary diseases (RTL 15,2 ± 2,7). Significantly shorter telomeres were observed in patients with COPD who were exposed to radiation at a dose of more than 500 mSv (13.6 ± 2.5) compared with COPD patients who were exposed at a dose <10 mSv (RTL 15.3 ± 2.3). When analyzing the correlation relationships of the studied indicators, no significant associations were found with the relative telomere length. At this stage of the study no association of relative telomere length with age, body mass index, and functional criteria (FEV1 (l), intrathoracic pressure (ITGV), total lung capacity (TLC), diffusion lung capac- ity (DLCO)) was detected. CONCLUSIONS: The analyzed telomere length relationship from liquidators of the Chernobyl found no direct associa- tion with indicators of lung function tests, however, showed a trend towards reducing the relative telomere length in clean-up workers who suffer from COPD and exposed to doses from 100 to 500 mSv and above 500 mSv.

STATE INSTITUTION NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2017. / REZUL'TATY ROBOTY DU NATsIONAL'NYI NAUKOVYI TsENTR RADIATsIINOÏ MEDYTsYNY NATsIONAL'NOÏ AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY U 2017 ROTsI.

Research activities and scientific advance achieved in 2017 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident; fulfillment of tasks of «State social program for improving safety, occupational health and working environment in 2014-2018 years¼.The report also shows the results of scientific-organizational and health care work, staff training.The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 23, 2018.

PROBLEMS OF MEDICAL EXPERTISE FOR DISEASES THAT BRING TO DISABILITY AND DEATH AS A RESULT OF RADIATION EXPOSURE INFLUENCE IN CONDITIONS OF THE CHERNOBYL CATASTROPHE IN REMOTE POSTACCIDENTAL PERIOD. / PROBLEMY MEDYChNOÏ EKSPERTYZY ZAKhVORIuVAN', ShchO PRYZVELY DO VTRATY PRATsEZDATNOSTI TA SMERTI VNASLIDOK VPLYVU IONIZUIuChOGO OPROMINENNIa V UMOVAKh ChORNOBYL'S'KOÏ KATASTROFY U VIDDALENOMU PISLIaAVARIINOMU PERIODI.

BACKGROUND: The Chornobyl catastrophe (ChCt) resulted in radiation exposure of great quantity of people. Amongthem there were personnel of Chernobyl NPP (ChNPP) and workers of supporting enterprises, radiation protectionprofessionals, clean-up workers of different specialties including military personnel that were send for liquidationof its consequences, inhabitants of the Prypyat city and Chernobyl 30km exclusive zone (including children) thatwere evacuated during first days after accident and population of radioactive contaminated territories. Loss ofhealth, disability and death as a result of radiation exposure influence in conditions of the ChCt under discharge ofprofessional, military or official duties and/or living on radiation contaminated territories not by his own fault callfor developing of special form of medical expertise as part of medical social protective system for this contingents.The objective of the study was to analyze the state of medical and social expertise for the interdependence of thediseases that bring to the disability and death with the impact of the Chornobyl accident consequences for the adultpopulation and to determine the main directions for improvement of this system. MATERIALS AND METHODS: The analysis of the medical expertise state for the interdependence of the diseases thatbring to the disability and death by the effect of the Chornobyl accident consequences for the adult population ina remote post-accidental period during 2013-2017 years (26142 personal medical expert investigations) was per-formed. RESULTS AND CONCLUSIONS: It was determined that the total number of population suffered from ChCt during 2007-2018 years reduced for 26.05 % or by 657,988 persons. At the same time, there has been rapid increase in the num-ber of victims with disability who received positive medical expertize certificate about interdependence of diseasewith effect of ChCt (the 1st category according Ukrainian legislation) - from 40,106 in 1995 to 107,115 in 2018. Theincrease in the frequency of medical expertise cases of oncological diseases - 51,49 %, as well as cases concerningthe interdependence of diseases that caused the deaths of the victims - 34,99 % were shown. The outstandingissues of the medical expertise of diseases interdependence with ChCt effects for certain categories of victims (thy-roid cancer in persons who have lost their status after reaching adulthood, the definition of the legitimacy of thestatus of victims for inhabitants of territories that undergone radiation ecological control (the 4th-V category) thatrequire changes and additions to the legislative framework are discussed.