卷 69, 编号 6 (2024)

Purpose: To compare the effectiveness of different methods of treating severe local radiation injuries (LRI) under the same experimental conditions. Material and methods: Male rats of the Wistar-Kyoto inbred line were locally irradiated in the ilioplumbar region of the back using an X-ray unit LNK-268 at a dose of 110 Gy (tube voltage 30 kV, current 6.1 mA, Al filter 0.1 mm thick), at a dose rate of 20.0 Gy/min. The area of the irradiation field was 8.2 cm². Such radiation exposure led to the occurrence of severe LRI in rats with long-term non-healing skin ulcers, without critical radiation exposure to the underlying tissues. For the treatment of severe LRI, surgical methods, cell or drug therapy were used, which were used separately from each other. Treatment began on the 28th day after local irradiation, that is, during the period when the radiation ulcer had already formed and regenerative processes began to activate in the affected area. Various surgical approaches were used: from complete excision of the radiation ulcer to removal of various volumes of necrotic tissue within the radiation ulcer. Cell therapy consisted of transplantation of syngeneous cells of the stromal vascular fraction of adipose tissue or cultured syngeneous multipotent mesenchymal stromal cells. The cells were injected subcutaneously around the radiation ulcer twice at 1-week intervals. For drug therapy of severe local radiation injuries, we used a veterinary complex antibiotic ‒ levotetrasulfin forte, as well as drugs that affect the microcirculation and trophism of irradiated tissues – pentoxifylline and detralex. The drugs were used once a day from the 28th to the 49th day after irradiation. Results and coclusion: The use of surgical methods, cell or drug therapy facilitated the course of the pathological process and accelerated the healing of radiation ulcers. However, different treatments for severe LRI have had different efficacy. In terms of the rate and quality of healing of severe local radiation injuries, drug therapy is less effective than cellular therapy, and cell therapy is less effective than complete surgical excision of radiation ulcers.

The article describes the methodological approaches and principles used by the author to overcome the difficulties encountered in the process of conducting an expert assessment of the professional success of nuclear power plant personnel. This procedure was part of a professiography research, and its purpose was to identify groups of the most and least successful specialists of various profiles, followed by an analysis of their psychological and psychophysiological characteristics.

As a result of trial and error, the author concluded that reliable results can be obtained by consistently using a set of expert assessment methods, starting with a point assessment by experts of individual qualities of the evaluated specialists belonging to the same job group, continuing with the method of their alternative ranking based on professional success. At the final stage, the experts subdivided the ranked lists of evaluated persons of each job position into five qualitatively different levels according to this integral feature (from the most to the least successful).

The algorithm of expert personnel assessment described in this paper has allowed minimizing the impact of some traditional problems that inevitably occur when solving such tasks. It was successfully applied by the author and his colleagues in the process of professiography research conducted at nuclear power plants.

Purpose: To introduce a wide range of specialists with the technique of reconstructive plastic surgery, which was first used in local radiation injury (LRI).

Material and methods: clinical analysis of the case histories of the severe LRI of the hand. The report describes the results of the first autotransplantation of the II toe in the position of the right hand III finger for the restoration of grip function in LRI.

Results: Patient L., 38 years old, was admitted to the A.I. Burnazyan Federal Medical Biophysical Center in 2010 for the treatment of late consequences of severe LRI of the right hand resulting from contact with a gamma radiation source (Ir 192) in 2008. In the period from 2010 to 2018, the patient underwent repeated surgical operations, including reconstructive plastic surgery, which made it possible to achieve healing of constantly recurring late radiation ulcers. However, multiple necrectomies, exarticulations, finger amputations and resections of the phalanges led to the formation of a functionally defective hand and persistent disability of the patient. In 2018, the patient was admitted to the clinic for reconstructive surgery to restore the function of hand grip - microsurgical transplantation of the II toe into the position of the III finger of the hand. As a result of the treatment, the function of grabbing objects with the right hand was restored, and the patient’s ability to work was largely restored.

Conclusions: The obtained long-term functional and aesthetic results allow us to consider the applied method of fingerless hand reconstruction by autotransplantation of the toe with the imposition of microvascular anastomoses optimal. It is advisable to use this type of surgical treatment more widely for the rehabilitation of patients with severe and extremely severe hand LRI.

Material and methods: According to the general blood test data, the dynamics of the relative and absolute number of lymphocytes in 36 patients was studied during the first 10 days after receiving polytrauma. There are 35 men and one woman among them. The average age of the victims at the time of injury was 40.24 ± 4.07 years. The number of studied blood tests in one patient varied from one to 16 during the specified follow–up period (on average, 6). The dynamics of the absolute number of lymphocytes at the same time was also studied in 11 patients (men, average age – 30.00 ± 2.01 years) diagnosed with acute radiation syndrome (ARS) I and in 15 men diagnosed with ARS II (average age – 28.47 ± 2.03 years). Statistical processing of the material was performed using the IBM SPSS Statistics software package.23 using the Kraskal–Wallis criteria and the Mann–Whitney U-test for independent samples. The differences between the obtained results were considered statistically significant at p < 0.05.

Results: Relative lymphopenia was detected in 25 (69.4 %) patients diagnosed with polytrauma. A combination of absolute and relative lymphopenia was found in 15 (41.7 %) patients. Only transient relative lymphopenia was detected in 10 patients. The depth of absolute lymphopenia detected in polytrauma was compared with a similar indicator at the same time in ARS I and ARS II. The depth of absolute lymphopenia in trauma without exposure to ionizing radiation at the time when it is usually studied to determine the severity of ARBMS reached the indicators characteristic of ARS I and ARS II (up to 0.3–0.5 × 10⁹/L.). At the same time, the nature of the dynamics of the absolute number of lymphocytes in trauma is radically different from that in acute radiation exposure.

Conclusion: The data obtained allow us to consider the possible deepening of absolute lymphopenia in CRMI in 42 % of cases as one of the manifestations of the phenomenon of mutual aggravation, which can lead to an early aggravation of the predicted severity of the developing ARBMS. The data obtained indicate that this weighting may be + 1, in rare cases +2 degrees of severity of ARS to the true degree of severity corresponding to the absorbed dose of radiation exposure.

Purpose: The study of regularities in the incidence of solid cancer in the Urals Cohort of the Exposed Population Offspring over a 65-year follow-up period.

Material and methods: The study was conducted by cohort method. The cohort under study is the Urals Cohort of the Exposed Population Offspring. It includes offspring of the population exposed in the period from 1950 to 1960 in the Southern Urals (on the Techa River and at the East Urals radioactive trace). The catchment area includes 5 districts of the Chelyabinsk region, as well as the city of Chelyabinsk and the city of Ozyorsk. The follow-up period was 65 years, from 01.01.1956 to 31.12.2020, the number of the analytical cohort for 2024 is 24952 people, the number of person-years under follow-up is 850698. Calculation of cases, incidence rates, person-years and statistical processing of data were performed by standard methods using the DATAB program module of the Epicure statistical package.

Results: During the 65-year period, 569 cases of solid cancers were registered in the catchment area. In women the most frequent cases were neoplasms of female reproductive organs, breast, thyroid gland, whole intestine and upper digestive tract organs; in men - respiratory organs, upper digestive tract and whole intestine. A significant increase in the incidence rates was found in women in age groups older than 20 years and in men in groups older than 30 years. Statistically significant sex-depended differences were observed only in the age groups between 30 and 50 years. No significant differences in the incidence rates among offspring of different ethnic groups were found. An assessment of incidence rates by calendar periods was carried out: in women, a significant increase in incidence rates began in 1990, in men in 2005 and significant differences by sex were observed only in the period from 2005 to 2020.

Conclusion: The study revealed patterns in the incidence of solid malignant neoplasms within the offspring cohort by sex, age and depending on the calendar period. These patterns will be taken into account in future studies when assessing the dependence of the incidence of solid malignant neoplasms in offspring on parental gonadal dose.

Purpose: We tried to create a hepatospecific paramagnetic contrast agent – a paramagnetic analogue of ^99mTc-technefit, by obtaining a paramagnetic Mn(II) complex with phytic (D-myo-inositol-1, 2, 3, 4, 5, 6– hexakisdihydrophosphoric) acid.

Material and methods: A hepatotropic magnetic resonance contrast compound was obtained as an aqueous solution containing a paramagnetic Mn(II) complex with D-myo-inositol-1, 2, 3, 4, 5, 6-hexakis dihydrophosphoric (phytic) acid in a concentration of 0.5 M, with the addition of a 0.5M aqueous solution of meglumine (N-methylglucamine) in a ratio of 1:4 by volume to maintain pH in the range of 6.2–7.8, as well as to improve the stability of the solution. The working name of the Mn(II) complex with phytic acid phytomang®. The toxicological properties of the compound were evaluated when administered to laboratory mice, R₁ relaxation and imaging properties in Wistar laboratory rats weighing 350-400 g, using low-field (field strength 0.2 T) and high-field (field strength 1.5 T) MR tomographs.

Results: For 0.5 M of an aqueous solution of Mn-phytate, with the addition of meglumine, LD₅₀, when administered acutely to laboratory animals – mice, is more than 18.7 ml / kg of body weight, which allows this compound to be classified according to GOST 12.1.007-76 standards to group 4 – low-hazard substances. The thermodynamic stability constant was 17.5. Spin-lattice relaxivity R1 in aqueous solution at a field strength of 0.2T: R₁ = 6.82 1/ms. After intravenous administration to healthy rats with preserved liver function, Mn-phytate is distributed in the bloodstream, with rapid absorption within 5 minutes by liver tissue, followed by partial (up to 7 ± 3 % of the dose) excretion into bile after 30 minutes or more. The total uptake of the drug by the liver is 72 ± 7 % of the administered dose.

Conclusion: The complex compound Mn (II) with D-myo-inositol-1, 2, 3, 4, 5, 6– hexakis dihydrophosphoric (phytic) acid belongs to low-toxic substances, is stable in aqueous media and has a high relaxability R₁, selectively accumulates and intensively contrasts the liver parenchyma, and can be considered as the basis for creating a hepatospecific paramagnetic contrast preparation for use in MRI diagnostics liver in experimental and clinical studies.

Purpose: To demonstrate the possibility of a combined approach in the treatment of a patient with locally advanced squamous cell carcinoma of the nasopharynx, complicated by massive erosive bleeding using endovascular embolization, proton therapy and targeted therapy.

Material and methods: The Federal Scientific Research Center for Reconstruction and Research has developed a method of a combined approach to the treatment of patients with malignant neoplasms of the nasopharynx, during which endovascular embolization and proton beam therapy in combination with targeted therapy are consistently used.

Results: A set of sequential treatment procedures and drug administration allowed us to eliminate life-threatening bleeding, normalize the patient’s general condition, conduct a course of proton radiation therapy for a patient with locally advanced squamous cell carcinoma of the nasopharynx, complicated by massive bleeding, and achieve stable local control over the process.

Conclusion: The use of the described tactics in the treatment of tumors of the nasopharynx and oral cavity allows in a short period to move from urgent endovascular occlusion of bleeding vessels to the stages of special antitumor treatment, providing a combined approach to the treatment of head and neck tumors.

Rеlevance: Castleman’s disease is a relatively rare heterogeneous group of lymphoproliferative diseases, the incidence of the localized form is 15, and the multicentric form is about 5 people per 1 million population. Currently, surgical treatment is the most radical in the treatment of localized forms of Castleman’s disease, and in cases where the clinical situation is considered unresectable, the treatment strategy is not strictly defined. Studies of the effect of radiation therapy on the survival rates of patients with Castleman’s disease remain isolated to this day, up to the description of individual clinical cases. This is due to the low incidence of this pathology, which does not allow for high-power randomized clinical trials. However, empirical accumulation of experience suggests that conducting remote radiation therapy in total doses of 40 Gy helps to achieve long-term local control. The use of modern methods of radiation therapy in the form of volume-modulated radiation therapy makes it possible to avoid serious post-radiation damage to healthy organs and tissues adjacent to the tumor, and can help in achieving stable local control in the treatment of unrecoverable forms. It is possible to use DLT protocols used in the treatment of lymphomas, which may be comparable in their effectiveness for Castleman’s disease, which requires subsequent research.

Purpose: Аn analysis of a rare clinical observation of the successful use of rotational volume-modulated radiation therapy in the treatment of an unresectable localized form of Castleman’s disease.

Material and methods: The search and analysis of literature data in Russian and English for the period from 2000 to 2023 in the databases Medline/PubMed, RSCI/Elibrary, CyberLeninka, Google Scholar, devoted to the diagnosis and treatment of Castleman’s disease. Clinical observation of the use of rotational volume-modulated radiation therapy in the treatment of an unresectable localized form of Castleman’s disease with lesions of the supraclavicular lymph nodes (hyaline-vascular type, unicentric variant).

Results: Rotational volume-modulated radiation therapy of an unresectable localized form of Castleman’s disease can have a stable and safe consolidating effect in the form of long-term local control.

A computational assessment was made of the possibility of verifying dose distributions during proton radiation therapy using PET imaging of positron activity in human tissues, which was formed as a result of proton irradiation. To compare the dose distribution of a particle energy-modulated proton beam with a diameter of 10 mm with an initial particle energy of 100 MeV, ensuring uniform irradiation of the target in a 13 mm zone (at the level of 90 % of the radiation dose) at the end of the particle path, with a map of induced activity from the radionuclides ¹¹C, ¹³N and ¹⁵O, numerical calculations were performed in a Monte–Carlo code using the Geant4 simulation program. In the modeling process, a volume with dimensions of 50 × 50 × 100 mm was used, simulating soft tissues of the human body with a density of 1 g/cm³, consisting of hydrogen atoms (62 %), carbon (12 %), oxygen (24 %) and nitrogen (1.1 %). The cross sections for the formation of radionuclides ¹¹C, ¹³N and ¹⁵O in the reactions ¹²C(p, pn)¹¹C, ¹⁴N(p, α)¹¹C, ¹⁶O(p, αpn)¹¹C, ¹⁴N(p, pn)¹³N, ¹⁶O(p, α)¹³N, ¹⁶O(p, pn)¹⁵O have been calculated, which were used to calculate the distributions of positron activity in the irradiated volume. Taking into account the short half-lives of the radionuclides under consideration (primarily oxygen-15), calculations of isoactivities and depth distributions of accumulated radioactivities were performed for various time intervals after irradiation.

The performed computational modeling of the distributions of activities of radionuclides ¹¹C, ¹³N and ¹⁵O during the passage of a modulated proton beam, taking into account the decay of produced radionuclides after irradiation, shows that by recording for 15 minutes the induced activity of PET radionuclides 2 minutes after irradiation, it is possible to obtain data on the compliance of the planned and irradiation of tumors performed during proton therapy. However, small levels of generated activity (at a level of 2 Gy for finely fractionated irradiations) require a device with high efficiency in recording annihilation radiation and high spatial resolution at the level of 1.5–2.0 mm.

Key words: proton irradiation, radionuclides, induced activity, PET, dose fields, verification