The literature data on the state of bone marrow hematopoiesis in patients with chronic radiation syndrome (CRS) are presented. Former employees of the Mayak software who were diagnosed with CRS showed moderate hypoplasia of granulocytopoiesis and megakaryocytopoiesis during the period of disease formation, while maintaining or activating erythropoiesis. At the same time, there was no marked suppression of bone marrow hematopoiesis in residents of the polluted territory in the Southern Urals during the period of CRS formation, however, a statistically significant decrease in the number of erythroblasts and an increase in the number of oxyphilic normocytes (more than 5.6 %) were detected, which may indicate accelerated maturation of erythrocaryocytes. Partial erythropoiesis hyperplasia was noted with high statistical significance in 34.2 % of the irradiated patients, and in 81.6 % there was a delay in maturation of neutrophil granulocytes at the myelocyte level (neutrophil maturation index >1.0), which may be due to functional insufficiency of granulopoiesis. In the long-term period (12–25 years after the cessation of radiation), hematopoiesis remained normal in individuals exposed to doses up to 2 Gy and with absorbed doses in the skeleton up to 1 Sv, according to the study of bone marrow punctures and trepan biopsies. Hypoplastic changes in the bone marrow were observed during irradiation with a dose rate of more than 1 Gy /year and with the incorporation of plutonium exceeding the maximum permissible content by more than 5 times.

This paper presents the results of using three-color FISH staining of chromosomes (DNA probes for chromosome pairs 1, 4, and 12) to study the control level of translocations in peripheral blood lymphocyte cultures of 35 relatively healthy volunteer donors aged from 21 to 72 years. Such information is necessary for the retrospective establishment of both the fact of overexposure itself and for an adequate assessment of the dose received. Translocations made up the bulk of the recorded colored rearrangements. Their frequency was significantly (3.3 times) higher than the level of unstable aberrations (dicentrics and acentrics). At the same time, there was a moderate correlation between the level of FISH translocations and the age of the donors, and gender did not affect this indicator in any way. Also, no significant effect of various types of medical diagnostic radiation, smoking and the disease of the new COVID-19 coronavirus infection on the studied index of chromosome damage was found. In general, the detected frequencies of translocations in genome-equivalent cells in their relationship with age were in fairly good agreement with the results of international studies.

Purpose: To study the possibilities of using for early diagnosis of acute radiation bone marrow syndrome (ARBMS) combined mechanical injuries (CRMI) symptoms of the primary reaction to radiation (time of onset of nausea and vomiting, the multiplicity of the vomiting), as well as to assess the depth of absolute lymphopenia during the first week after radiation exposure. Material and methods: 1. Comparative analysis of the literature data on the early symptoms of traumatic brain injury (TBI) and previously published own data on the primary reaction to radiation exposure in acute radiation syndrome (ARS) of varying severity in 134 victims on 04/26/1986 in the Chernobyl accident. 2. Comparative analysis of the dynamics of the absolute number of peripheral blood lymphocytes in 36 patients with mechanical polytrauma (average age – 40.24 ± 4.07 years) and 11 ARS I patients (comparison group 1, average age – 30.00 ± 2.01 years), as well as 15 ARS II patients (comparison group 2, average age – 28.47 ± 2.03 years). Statistical processing of the material is the IBM SPSS Statistics.23 software package, the Kraskal‒Wallis criteria and the Mann‒Whitney U-criterion for independent samples. The results obtained were considered statistically reliable at p <0.05. Results: 1. Upon admission of a patient with suspected TBI within the framework of CRMI, who has nausea and vomiting, is unconscious and has damage to the skin of the head, dyspeptic syndrome cannot be considered only as a manifestation of the primary reaction to radiation. In the absence of suspicion of TBI, with clear consciousness and intact skin, nausea and vomiting can be used to predict the severity of developing ARBMS. 2. Analysis of the dynamics of peripheral blood lymphocytes in 15 (41.7 %) patients with polytrauma revealed absolute lymphopenia during the first week after mechanical exposure. At the same time, the depth of absolute lymphopenia in trauma without exposure to ionizing radiation at the time when it is usually examined and the severity of ARBMS is determined in individual patients corresponds to the indicators characteristic of ARS I and ARS II (can reach 0.3 × 109/l). Conclusions: The use of methods for early diagnosis of the severity of ARBMS will have some features in CRMI. The use of criteria for the primary reaction to radiation to diagnose the severity of developing ARBMS can be recommended only if the patient has no obvious signs of TBI: consciousness is preserved, there are no signs of mechanical trauma in the head area (hematomas, abrasions, open wounds, bone fractures). In 42 % of patients with mechanical polytrauma, posttraumatic fever may be detected during the first week of follow-up post-traumatic absolute lymphopenia in combination with post-traumatic absolute lymphopenia can lead to an overestimation of the severity of developing ARBMS. The final decision on the prognosis of the severity of ARBMS, as well as CRMI in general and patient management tactics should be made only after evaluating the absorbed dose by cytogenetic method.

The article reviews literature data on the state of peripheral blood in different periods of chronic radiation syndrome (CRS). In the period of disease formation in workers of the Mayak Production Association when working under high dose rate irradiation conditions, the time of development of clinical manifestations was determined by the rate of accumulation of the threshold dose value and ranged from 1–2 to 5–8 years. Patients showed moderate leukopenia (2.6–4.0 × 109/l with normal values of 5.0–8.0 × 109/l), thrombocytopenia (70.0-160.0 × 109/l with the normal values of 200.0–300.0 × 109/l). In more severe cases, mainly at high dose rates (more than 1.0 Gy/year), anemic syndrome developed. Damage to hematopoiesis in most cases (except for 2 patients) did not reach the degree of aplastic anemia. The population of the Techa River basin was more heterogeneous in age and health at the time of the onset of radiation exposure, which predetermined the characteristics of the clinical manifestations of CRS. A shortening of the latent period of CRS in children was noted. There were no cases of CRS of grade III severity. Anemic syndrome of radiation genesis was not observed. All identified anemias were associated with iron deficiency. After the cessation of contact with gamma radiation, blood counts were restored, reaching physiological levels in the near future. The concentration of platelets reached the normal value, as a rule, within the next 5 years after withdrawal from production conditions. Leukopenia persisted for up to 25 years, especially in patients with CRS of grade III severity. The reaction of the hematopoietic system to chronic intake of radionuclides is determined by the patterns of their distribution in the body. In the presence of incorporated osteotropic radionuclides, signs of incomplete hematopoiesis regeneration persisted in patients after cessation of irradiation.

Purpose: to familiarize medical workers with the unfavorable course of local radiation injury (LRI) due to its depth and area, damage to underlying bone structures and internal organs, the presence of concomitant severe somatic disease, drug addiction and the impossibility of radical surgical intervention due to a lack of own tissues to hide the ulcerative defect. Material and methods: The article presents a clinical observation of a 46–year-old man who had accidental household contact with a radiation source of electric current RIT-90 with an activity of 30 kCu – a powerful source of bremsstrahlung. Results: The patient suffered severe acute radiation syndrome from extremely uneven beta-gamma irradiation (moderate bone marrow syndrome, acute posterior thoracic LRI of extremely severe degree (IV) – 5%, severe and moderate degree – 10% and both hands of mild degree (I) – 2%). He was admitted to the clinic for treatment 3 months after irradiation. On admission, against the background of pronounced hyperpigmentation and atrophy of the skin of the left and partly right half of the back, there were ulcerative defects in the form of a figure eight (diameter – 10 and 3 cm). The ulcers are covered with a thick layer of fibrin with scanty discharge. Within 3 months after admission to the clinic, pulmonary tuberculosis was treated with good clinical effect. 6 months after the irradiation, a phased surgical treatment was initiated. However, necrotization of transplanted autografts and infection of the ulcerative surface were almost constantly noted. Despite the ongoing supportive, detoxification and antibacterial therapy, multiple organ failure developed, which led to the death of the patient. Conclusions: With extensive and deep radiation lesions accompanied by severe damage to underlying bone structures and vital internal organs localized in anatomical areas that are not subject to amputation, in the presence of severe concomitant somatic pathology in the patient, surgical closure of the skin defect with a full-layer flap with axial blood supply capable of restoring trophicity of the affected tissues becomes an almost unsolvable problem. Covering with patient’s tissues is impossible, first of all, due to the complexity of the necessary size flap extraction. The remaining open skin defect is the gateway to infection with its further generalization and death of the patient. It is possible that the solution in this case may be the use of various collagen films or artificial skin, which will mechanically close the defect, however, the inability to restore trophicity in the area of affected tissues still makes the prognosis extremely unfavorable.

—A review of the information published in the scientific literature and relating to estimation of spontaneous levels of translocations detected by various methods of FISH-staining of chromosomes in the human peripheral blood lymphocyte cultures is presented. Various authors using single, two, and three-color variants are generally indicated by a significant increase in the frequencies of these chromosome aberrations with an increase in the donor age and the absence of the influence of gender. An increase in the translocation yield was recorded for persistent smokers and, apparently, alcoholics. It was recognized as impossible to divide the effect of the race and the territorial position of research laboratories. At the same time, countries can differ significantly in terms of the lifestyle of the population, the background impact of ionizing radiation, and the medical services used, in particular, in terms of the volume of implemented radiation diagnostic research. It limits the use of spontaneous damage levels of chromosomes determined by international studies and indicates the desirability to have relevant data for individual populations. At the same time, it is necessary to state the limitation of similar information about the frequencies of translocations detected with multicolored FISH-staining in the control groups of people.

Objective: to compare the frequencies of translocations detected by one-color and three-color FISH painting in the long term (24 years) after local over-irradiation (more than 100 Gy) of a patient during radiation therapy for breast cancer. Material and methods: The material for the cytogenetical study were the cultures of venous blood lymphocytes of this patient. Cultivation of lymphocytes and preparation of chromosome preparations were carried out using variants of standard methods. Chromosomes were stained separately with one-color or three-color DNA probes for 1, 4 and 12 pairs. In both cases, 1000 metaphases were analyzed. Results: In the present study, when using the one-color FISH-method, the frequency of detected reciprocal translocations was 0.5 per 100 analyzed cells, while with tricolor painting they were 2.2 times higher (1.0 per 100 metaphases). When using the available linear-quadratic dose dependence, the average dose to the whole body was estimated at 0.28 Gy, which is a consequence of the local nature of radiation damage, the death of lymphocytes in the zone of high-dose radiation damage and the obvious impossibility of their division. Conclusion: The study of the frequency of chromosomal translocations in the long term after local overexposure during therapy in a patient for breast cancer using a three-color FISH-analysis is a more sensitive method in comparison with a one-color variant of FISH-painting.

Purpose: To study the effect of the phenomenon of mutual aggravation on the early diagnosis of the severity of acute radiation bone marrow syndrome (ARBMS), which develops within the framework of combined radiation-mechanical injury (CRMI). 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: to present the materials of long-term (38 years) monitoring of the health status of a group of patients who had underwent acute radiation syndrome (ARS) in 1986 as a result of the Chernobyl accident and had been living in the territory of the Russian Federation. Materials and methods: the results of cytogenetic dynamic observation of 74 direct participants in the Chernobyl accident who had been examining at the clinic in the period from 1986 to 2012, as well as the results of dynamic inpatient observation of 10 of them permanently residing in Moscow, are summarized. Medical supervision consisted of annual planned hospitalizations in connection with patient requests, or emergency hospitalizations in connection with the detection of acute or exacerbation of a chronic disease. Laboratory and instrumental examination of organs and organ systems critical to the effects of radiation, as well as an extended cancer search, was carried out. Results: according to cytogenetic studies for all degrees of severity of ARS, starting from the 1st degree, the frequency of translocations in blood lymphocytes significantly exceeds the spontaneous level. The initial level of translocations depends on the initial dose estimate. The time of decrease in the frequency of translocations due to the presence of part of the translocations in unstable cells, from the initial value to an established constant level, apparently occurs in the first 5-8 years. Analysis of individual blood curves revealed transient moderate cytopenia, most often thrombocytopenia. Myelodysplastic syndrome (MDS) and leukemias were detected in 5 patients (2- Moscow group, 3- Ukranian group) from the entire group who underwent ARS as a result of the Chernobyl accident, which significantly exceeds the expected level. The diagnosis of radiation cataract was established in 11 patients. Two patients underwent surgical treatment. In the acute period ARS local radiation injuries (LRI) was detected in 59 patients. By 2005, 38 patients with the effects of LRI were observed (33 in Ukraine and 5 in Moscow). The most severe long-term consequences in the form of pronounced cicatricial atrophic changes, radiation fibrosis, and late radiation ulcers were detected in patients with grade III – IV LRI. 1 out of 10 observed patients developed primary multiple metachronous cancer of the genitourinary system, 2 patients – prostate cancer, 1 – metastatic lesion with an undetected primary tumor, 3 – multiple foci of basal cell skin cancer. The causes of death in 8 out of 10 patients were: cardiovascular pathology, MDS and leukemia, cirrhosis of the liver, oncological disease with undetected primary localization of the tumor, suicide in an oncological patient. Conclusions: The experience of providing medical care to victims of the Chernobyl accident with acute radiation injuries and further in the period of long-term consequences indicates the need to maintain constant readiness to provide medical care in case of a radiation accident, as well as adequate information during and after the accident, which will reduce the long-term consequences. Patients who have undergone ARS need lifelong medical supervision and the provision of necessary medical care. The main causes of permanent disability of patients who have undergone ARS are the consequences of LRI (recurrent late radiation ulcers, radiation fibrosis, contractures, scars, etc.). Radiation cataract is the cause of temporary disability (before surgical treatment). Patients who have undergone ARS need adequate social adaptation. The revealed effect of exposure to relatively uniform radiation is an increase in the frequency of MDS and leukemia.

Introduction. Only a massive radiation accident, and not individual incidents heterogeneous in terms of exposure conditions, contributes to the revision and development of knowledge and therapeutic capabilities in acute radiation syndrome (ARS). Aim - to present recommendations based on literature data and own clinical experience for the diagnosis and treatment of a typical bone marrow form of ARS from relatively uniform irradiation. General information. An analysis of the literature on the problem of diagnosis and treatment of ARS was carried out, and the experience of providing medical care to victims of the April 26, 1986 radiation accident at the Chernobyl Nuclear Power Plant (104 patients with OLB) in the clinical department of the A.I. Burnazyan State Medical Center of the FMBA of Russia is summarized. When admitting individuals involved in a radiation accident into a medical institution, one of the most important measures of action is to conduct medical sorting, that is, the distribution of victims into groups according to the principle of need for homogeneous therapeutic, preventive and evacuation measures, depending on medical indications, specific conditions of the situation and the prognosis of the patient's survival based on dose assessment and prediction of the severity of the course of ARS by all available methods of physical and biological dosimetry (calculation method, simulation of the situation, clinical signs of the primary reaction to radiation, cytogenetic method, absolute number of peripheral blood lymphocytes during the first 8 days after irradiation, dynamics of the absolute number of peripheral blood neutrophils, etc.). The scope of therapeutic measures depends on the severity of the developing ARS, including the therapy of infectious complications and hemorrhagic syndrome. The appointment of myelostimulation in order to reduce the depth and duration of radiation-induced cytopenia is recommended when irradiated at a dose of more than 1.5 Gy. Transplantation of allogeneic hematopoietic stem cells in ARS is recommended in a narrow dose range from 10 to 13 Gy in the absence of concomitant severe injuries and burns. Recommendations for the treatment of oropharyngeal and intestinal syndromes are given.

Psychophysiological examination was carried out on two patients, former border guards, who suffered on October 05, 1982 as a result of accidental contact with a source of gamma radiation (137Cs) while on duty while serving on the Iranian-Azerbaijani border in the ranks of the Soviet army. They suffered ARS of the 1st degree with extremely uneven gamma irradiation in the form of local radiation injuries of the hands of varying severity. The assessment of the aver -age dose for the whole body according to the frequency of dicentrics in cultures of peripheral blood lymphocytes in patient No. 1 and patient No. 2 is the same and is 0,26 Gy. Psychophysiological research was carried out in dynamics in 2001-2013 using the automated software and methodological complex «Expert». According to the MMPI data, both victims have a hyperthymic type of psychophysiological adaptation with varying degrees of severity. Patient No. 2 is a chronically hyperthymic personality with a significant increase in the profile on the 9th scale and with its gradual increase in dynamics, which reflects the persistence of hyperthymic personality traits and causes an overstrain of mental adaptation, with an increase in the dynamics of the tendency to explain their difficulties and problems by somatic distress (1Hs). Patient No. 1 has a hyperthymic personality type with a moderate increase in profile dynamics on the ninth scale. A personality trait is indicated by a high, growing in dynamics, indicator on the K scale, which determines behavior depending on social approval and concern for one’s social status. The appearance in dynamics (2013) of a peak on scales 1 (preoccupation with the state of health) and 4 (emotional tension in direct behavior) determines the insufficient ability to internalize the social norm, i.e. insufficient ability to perceive this norm as part of one’s own settings (a combination of profile peaks on scales 4 and 9). The presence of profile peaks on the 7th scale and the scales of the neurotic triad reflect the tendency to various options for the implementation of antisocial attitudes in a socially acceptable way, the desire to appear in a favorable light (scale L). Sufficiently high intelligence and demonstrative behavior determine good adaptation to the environment with self-confidence, high social adaptability, and resilience in overcoming difficulties.

— The results of cytogenetic analysis using mainly three-color FISH staining of peripheral blood lymphocyte chromosomes in a single patient exposed to irradiation as a result of the accident at the Chernobyl nuclear power plant in a dose initially estimated from the frequency of dicentrics (3.2 Gy) are presented. The material was obtained in a total time interval of 9053–12 554 days (24.8–34.4 years) after the radiation effect. Not always together, the sets of DNA probes to {1, 4, 12} and {2, 3, 8} pairs of chromosomes were used at all times. For the entire period of observation, the genomic frequency of translocations (a total of complete and incomplete) did not change statistically significantly. The retrospective dose estimations were made using previously obtained in vitro dose–effect dependences and ranged from 1.98 to 2.44 Gy and from 2.14 to 2.67 Gy when analyzing the metaphases of all cells and only stable cells, respectively. The problem of accounting for clonal cells with chromosome translocations is discussed.

Purpose: To study the effect of the radiation dose rate on the dynamics of peripheral blood indicators in various periods of chronic radiation syndrome (CRS), which developed as a result of professional prolonged radiation exposure in a cohort of former employees of the Mayak plant who underwent inpatient examination at the clinic of the A.I. Burnazyan Federal Medical Biophysical Center of the FMBA of Russia in the period up to 1995. Material and methods: The study of the dynamics of absolute peripheral blood indices in former employees of Mayak plant who were exposed to prolonged industrial radiation with a dose rate of less than 0.001 Gy/day (25 people), 0.003‒0.007 Gy/day (12 people) and 0.008‒0.07 G/day (15 people) during the periods of formation, outcomes and immediate, as well as long-term consequences of CRS. Statistical processing of the material was performed using the IBM SPSS Statistics software package 23.0 using the Kruskal–Wallis criteria and the Mann–Whitney U-test for independent samples. The results obtained were considered statistically reliable at p < 0.05. Results: In a group of patients irradiated with a dose rate of 0.008‒0.07 Gy/day during the periods of formation, as well as the outcomes and immediate consequences of CRS, platelet-, leuco- and deep neutropenia were noted. A decrease in the number of erythrocytes and hemoglobin was detected only in the period of outcomes and immediate consequences. The development of agranulocytosis and anemic syndrome are signs that distinguish the course of CRS in this group of patients from the clinical picture of typical CRS. In the period of long-term consequences, 60 % of patients (9 out of 15) developed oncohematological diseases. At an irradiation power of 0.003‒0.007 Gy/day anemic syndrome was found in 4 out of 12 patients. Leukopenia was observed in the periods of outcomes and immediate consequences. Granulocytopenia was detected in all three periods of the course of CRS. In the long term, 2 patients from this group developed oncohematological diseases At an irradiation power of less than 0.001 Gy/day shallow thrombocytopenia and neutropenia are noted in the periods of outcomes and immediate consequences of CRS. In the period of long-term consequences, all the average values of peripheral blood indicators correspond to normal levels. Conclusions: With prolonged irradiation of a person with a dose rate of 0.008‒0.07 Gy/ day or more, with the accumulation of a total dose of 1.7‒9.6 Gy and a contact duration of 6‒96 months, one can expect the development of CRS with a peculiar subacute clinical course of bone marrow syndrome (BMS), manifested by the defeat of all three hematopoietic sprouts, the development of agranulocytosis, anemia and, probably, in 60 % of cases of leukemia development with an unfavorable prognosis for the patient’s life. The main factor determining this feature of the course of BMC CRS is the dose rate, which exceeds 0.008 Gy / day (2 Gr/year). At a dose rate of 0.003‒0.007 Gy / day (0.7‒1.7 Gy / year), the course of CRS with the development of agranulocytosis is possible in 25 %, anemia – in 33 % of observations. This course of the disease is most likely with a dose rate approaching the upper limit of the named range and high total doses. In other cases, the course of the disease is favorable. In the long-term period, moderate, transient leuko-, neutro- and thrombocytopenia are possible. With prolonged irradiation with a dose rate of less than 0.001 Gy / day (0.25 Gy / year), the course of the disease is relatively favorable with almost complete restoration of hematopoiesis in the long term.

Purpose: to study the features of the state of the bone marrow according to cytological and histological studies at different periods of the course of CRD, caused by exposure to different dose rates, which developed as a result of professional prolonged exposure in a cohort of former employees of a radiation hazardous enterprise who underwent inpatient examination at the clinic of the A.I. Burnazyan Federal Medical and Biomedical Center in the period up to 1995. Material and methods: the study of the results of cytological and histological studies of the bone marrow was carried out in former workers of the Mayak Production Association who were exposed to long-term industrial exposure with a dose rate of 0.008−0.07 Gy / day (15 people), 0.003−0.007 Gy / day (12 people) and less than 0.001 Gy/day (25 people), during periods of formation, outcomes, immediate and long-term consequences of CRS. At the stage of studying the results of histological examination of the bone marrow, 54 more patients with CRS were added to the third group, irradiated with a dose rate of less than 0.001 Gy / day. Statistical processing of the material was carried out using the IBM SPSS Statistics software package.23 using the Kruskal‒Wallis test and the Mann‒Whitney U-test for independent samples. The results obtained were considered statistically significant at p < 0.05. Results: At a dose rate of 0.008−0.07 Gy / day during the formation period, the myelogram revealed narrowing of the granulocyte and expansion of the red germs, acceleration of maturation of granulocytes with a normal erythrocyte maturation index and leuko-erythroblast ratio. In peripheral blood – agranulocytosis. In the period of outcomes and immediate consequences − narrowing of the granulocytic, expansion of erythrocyte germs, acceleration of maturation of neutrophils with other myelogram parameters within normal limits. In the blood − agranulocytosis, anemic syndrome. In the long term, in the case of restoration of hematopoietic function, narrowing of the granulocytic germ with other myelogram parameters within the reference values. However, with a similar course of CRS in 60 % of patients in periods of outcomes and long-term consequences, the development of myelodysplastic syndrome with transformation into acute leukemia or aplastic anemia is possible. At an irradiation dose rate of 0.003−0.007 Gy / day in the period of CRD formation, the myelogram revealed an expansion of the granulocytic germ, with other indicators within the normal range. In the period of outcomes and immediate consequences, an acceleration of maturation of granulocytes and an increase in the leuko-erythroblastic ratio were found. In the long term, a narrowing of the granulocytic and expansion of the erythrocyte sprouts, a slight acceleration of the maturation of granulocytes were found. Hystological examination: polymorphocellular bone marrow – in 11 out of 25 patients, hypoplasia – in 9 out of 25, signs of hyperplasia – in 5 out of 25. In the long term, 2 patients from this group developed oncohematological diseases. At an irradiation power of less than 0.001 Gy / day, during all periods of CRD, normal values of granulocytic and erythrocyte sprouts were noted in the myelograms of patients. In the period of CRD formation, the normal size of the granulocytic germ was achieved due to the accelerated maturation of neutrophils. The leuko-erythroblastic ratio in the period of long-term consequences was significantly higher than the norm (5.29 and 4.5, respectively). Hystological examination: 32 out of 64 patients had polymorphocellular bone marrow, 22 out of 64 had hypoplastic bone marrow, 7 out of 64 had bone marrow hyperplasia. Conclusion: regular changes in hematopoietic tissue and peripheral blood in CRD can serve as diagnostic criteria, based on which it is possible to assume the dose rate of radiation to which the patient was exposed, and also on their basis, it is possible to predict the outcome and long-term consequences of CRD that developed as a result of this exposure.

This work presents the results of the use of three-color FISH-staining of chromosomes (DNA probes to 1, 4 and 12 pairs of chromosomes) for the cytogenetic study of peripheral blood lymphocyte cultures of four patients at different times after irradiation in various emergency situations. All victims had initial dose estimations: one by EPR signal in the tooth enamel (1.12 Gy) and three by the dicentric frequencies (1.9; 3.2 and 4.3 Gy). There was a strong significant linear correlation between the observed translocation frequencies and the initial dose estimations. Retrospective indication of the dose by translocation frequencies was carried out with the help of own dose-effect curve, the obtained on the basis of experiments with the irradiation of blood of healthy donors in vitro. At the same time, dose estimates in the long terms after irradiation in three of these patients with the greatest lesion were significantly lower than they were established earlier (1.26; 2.06 and 2.47 Gy). The coincidence of the initial and repeated results was observed only in one remaining patient.

For a long time, the attention of researchers studying combined radiation-mechanical injuries (CRMI) has been focused on the study of individual syndromes: mechanical trauma and acute radiation syndrome. To diagnose and assess the severity of each syndrome, tests used for isolated injuries are recommended. However, the results of tests based on counting the number of different peripheral blood cells in an initially healthy person and in an injured patient who has experienced severe bleeding will be different. Accordingly, the assessment of the severity of developing acute radiation disease these patients will differ. The possibility of predicting the severity of developing radiation injury in CRMI using a lymphatic test during the first week after exposure is also being evaluated. In this report, based on the literature data, the dynamics of the absolute number of lymphocytes in patients with multiple mechanical injuries is considered. The results of numerous clinical and experimental studies indicate that severe and multiple injuries, starting from the first hours and during the first week of observation, are characterized by instability of the number of lymphocytes in peripheral blood with significant absolute lymphopenia on the first day. It is shown that the depth of lymphopenia and the rate of recovery of the number of lymphocytes to normal values depends on the severity of the mechanical injury. In addition, the deepening of lymphopenia is also caused by urgent medical measures that are standard in the provision of medical care for severe trauma with blood loss: massive infusion therapy and the appointment of corticosteroids. Thus, the use of a lymphocytic test in CRMI to assess the radiation dose without taking into account the significance of the trauma suffered will lead to a false prognosis of the degree of developing acute radiation damage, as well as to the lack of differentiation between the effects of radiation and non-radiation factors, and, consequently, to errors in patient management tactics.

This work presents the results of the use of three-color FISH-staining of chromosomes (DNA probes to pairs of chromosomes 1, 4, and 12) for the cytogenetic study of peripheral blood lymphocyte cultures of four patients at different times after irradiation in various emergency situations. All patients had initial dose estimations: one by EPR signal in the tooth enamel (1.12 Gy) and three by dicentric frequencies (1.9, 3.2, and 4.3 Gy). There was a strong significant linear correlation between the observed translocation frequencies and the initial dose estimations. Retrospective indication of the dose by translocation frequencies was carried out with the help of the dose–effect curve, obtained on the basis of experiments with the irradiation of blood of healthy donors in vitro. At the same time, the dose estimates in the long term after irradiation in three of these patients with the greatest lesions were significantly lower than they had been established earlier (1.26, 2.06, and 2.47 Gy). Coincidence of the initial and repeated results was observed only in one remaining patient.

Purpose: Study of chromosomal aberration yields with a three-color FISH method in the peripheral blood lymphocyte cultures of patients with breast cancer before and after local irradiation. Material and methods: Venous blood was obtained from 24 patients aged from 33 to 79 years which suffering from cancer of the left or right breast after the implementation of a sectoral or radical resection of an affected organ with subsequent local adjuvant distant radiation therapy (DRT) to the scar area. Also it could be preceded by adjuvant polychimotherapy (PCT). A linear accelerator of the Trilogy system based on the Clinac iX platform was used for local irradiation. SOD was installed at 50 Gy per 25 fractions (daily 2 Gy). venous blood sampling produced to PCT and/or DRT and after 1 and/or 3 months after irradiation. A set of DNA probes to 1, 4 and 12 pairs of chromosomes was used for three-color FISH staining. Results: Levels of translocations, dicentrics and acentrics (per 100 cells) in peripheral blood lymphocyte cultures of patients up to DRT did not differ significantly with and without PCT and were amounted to average 0.63 ± 0.10; 0.10 ± 0.04 and 0.17 ± 0.06, respectively. The frequency of these chromosome rearrangements significantly increased after radiation therapy by an average of up to 4.62 ± 0.46; 1.48 ± 0.19 and 0.95 ± 0.14. The differences between 1 and 3 months of taking material after irradiation were absent. One of the patients, unlike the rest, was cytogenetically examined 11 years after a similar local irradiation, and the frequencies of translocations and dicentrics in her lymphocyte culture were 4.56 and 0.19 (per 100 cells), respectively, while they were varied from 1.63 to 10.00 for translocations and from 0.27 (0 in one patient) to 4.06 for dicentrics for other patients. Conclusion: When using a three-color FISH method there was a significant increase in the frequencies of translocations, dicentrics and acentrics in peripheral blood lymphocyte cultures of patients after DRT of breast cancer. At the same time there were more translocations than dicentrics and, apparently, they remain at the initial level for a long time. The frequency of translocations per 1 cell with translocations in the peripheral blood lymphocyte cultures in most cases exceeds 1 after local DRT of the breast cancer. The correlation between average physical doses to the whole body and cytogenetical estimates in individual patients was statistically insignificant.

Purpose: A socio-psychophysiological assessment of the adaptation of two patients with local radiation injuries (LRI) of the hands of severe and moderate severity and acute radiation sickness (ARS) of the 1st degree, according to the characteristics of their individual mental adaptation and the stages of the course of local radiation injuries (30 years of observation). Material and methods: Psychophysiological examination was carried out on two patients, former border guards, who were injured on October 5, 1982 as a result of accidental contact with a source of gamma radiation (cesium – 137) while on duty while serving on the Iranian-Azerbaijani border in the ranks of the USSR army. They suffered grade I ARS with extremely uneven gamma irradiation in the form of local radiation injuries of the hands of varying severity. The assessment of the average dose to the whole body by the frequency of dicentrics in the cultures of peripheral blood lymphocytes in patient No. 1 and patient No. 2 is the same and amounts to 0.26 Gy. One of them, patient No. 1, had a local radiation injury of the left and right hand of the III degree of severity. In 1984 – 1985, he underwent amputation of the nail phalanges of the 1st and 2nd fingers of the left hand; in 2003, skin grafting was performed for late radiation ulcer of the 3rd fingers of the left hand. Patient No. 2 had grade III-IV LRI in both hands with severe and extremely severe sequelae of local radiation damage to both hands. Amputation stumps 1 – 5 fingers of the right and left hand. Rough cicatricial – atrophic changes in the skin of the left hand with a violation of its function. Condition after multiple surgical interventions, including autotransplantation of full-thickness flaps on vascular pedicles. Psychophysiological research was carried out in dynamics in 2001, 2003, 2008, 2009, 2011, 2013 using the automated software and methodological complex “Expert”, designed to study personal properties of a person, cognitive and intellectual characteristics of a person according to the MMPI method, the Cattell,s 16-Personality Factor Questionnaire (16PF), Raven’s Progressive Matrices test, sensorimotor reaction (SSR, СSR) and reaction to a moving object (RMO). Results: According to MMPI data, both victims have a hyperthymic type of psychophysiological adaptation with varying degrees of severity. Patient No. 2 is a chronically hyperthymic personality with a significant increase in the profile on scale 9 and with a gradual increase in dynamics, which reflects the persistence of hyperthymic personality characteristics and causes an overstrain of mental adaptation, with an increase in the dynamics of the tendency to explain their difficulties and problems with somatic ill-being (1Hs). Characterological features were determined by high emotionality (factor A – 9.8 stan), sufficiently high intelligence (factor B – 7.3 stan), sufficient integration and sthenism of behavior, high dominance and freedom of behavior (factor F – 8.5 stan), due to a propensity for increased self-esteem, a high propensity to take risks (H – 9.3 stan), down-to-earth interests (factor M). Very high extroverted behavior (factor F2 –--- 9.9 stan). High rates of the Raven test and sensorimotor reactions. Thus, the personality profile of patient No. 2 has the form of a pronounced chronic hyperthymic personality, which determines the overstrain of mental adaptation, with manifestations of psychosomatic hypochondria. Patient No. 1, according to the data of psychophysiological examination, revealed a hyperthymic personality type with a moderate increase in the dynamics of the profile on the ninth scale. The personality trait is also indicated by a high, growing in dynamics, indicator on the K scale, which determines behavior depending on social approval and concern for one’s social status. On the first three scales (1, 2, 3) there is a type of conversion V – this is a combination of unpleasant physical sensations with vegetative anxiety and with a predominance of demonstrative tendencies aimed at overcoming difficulties caused by the state of health (scales 1 and 3). The appearance in dynamics (2013) of a peak on scales 1 and 4 determines the insufficient ability to internalize the social norm, i.e. insufficient ability to perceive this norm as part of their own attitudes (combination of profile peaks on scales 4 and 9). The presence of profile peaks on the 7th scale and on the scales of the neurotic triad reflect the tendency towards various options for the implementation of asocial attitudes in a socially acceptable way, the desire to look in a favorable light (scale L). A sufficiently high intelligence and demonstrative behavior determine good adaptation to the environment with self-confidence, high social adaptability, and resilience in overcoming difficulties. Conclusion: Psychophysiological assessment of personality and current mental state determined individual personality traits in two patients with hyperthymic type of psychophysiological adaptation of varying severity, who underwent ARS, severe and extremely severe local radiation injuries 30 years after the radiation incident, respectively. A significant increase in the profile on the 9th scale in patient No. 2 was constantly detected, reflecting the persistence of the described personality traits characteristic of chronically hyperthymic individuals. A high level of hyperthymic activity causes him to overstrain his psychophysiological adaptation, with manifestations of psychosomatic hypochondria A moderate increase in the profile on scale 9 and scale 3 characterized patient No. 1 as an optimistic, energetic and capable of high activity person, concerned about his social status (high values ​​on the K scale). The appearance in the dynamics (2013) of a peak on the 1 (concern with the state of health) and 4 on the scale (emotional tension in direct behavior) determine the insufficient ability to internalize the social norm, i.e. insufficient ability to perceive this norm as part of one’s own attitudes (combination of profile peaks on scales 4 and 9). The presence of profile peaks on the 7th scale and the scales of the neurotic triad reflect the tendency for the implementation of asocial attitudes in a socially acceptable way.

Introduction. The use of ionizing radiation as a production factor in the late 1940s - early 1950s. began in the absence of a clear understanding of the permissible radiation doses for workers, as well as knowledge of diagnostic criteria and developed therapeutic measures for developing chronic radiation sickness (CRS). Since then, a great deal of experience has been accumulated in the diagnosis and treatment of CRS. Currently, there are no conditions at the workplace for chronic exposure of workers in doses exceeding the permissible ones. However, taking into account the constant expansion of the scope of using sources of ionizing radiation, it is necessary to remember about the possibility of CRS development due to prolonged exposure in case of violation of their storage or their loss. The study aimed to explore the formation of radiation bone marrow syndrome (RBS) due to chronic exposure in doses that exceed the maximum permissible, accumulated with different dose rates of radiation. Material and methods. We selected the medical records of 27 people (24 men and 3 women) who had RBS as a result of chronic professional gamma radiation exposure. The selection criteria were the diagnosis of grade II-III chronic radiation syndrome (CRS) in the presence of agranulocytosis or anemic syndrome in the period of the disease formation and, especially, in the development of myelodysplastic syndrome (MDS) or aplastic anemia in the period of the CRS consequences. Identified clinical and dosimetric CRS features of 27 patients exposed to chronic irradiation with a dose rate of 0.0002-0,009 Gy/h and the summary dose of 1.7 and 9.6 Gy, accumulated over a period of 6 to 96 months were compared the characteristics of 84 patients CRS exposed a lower dose rates (less than 0,0003 Gy/h) and 26 patients with acute radiation syndrome moderate (II) severity as a result of irradiation the dose rates of 0.14-3,7 Gy/h, total dose of 2 to 4 Gy. Results. The criteria of atypical subacute CRS course are identified: the rate of chronic radiation exposure - not less than 0.001-0.009 Gy/h with a summary dose of 1.7-9.6 Gy accumulated over a period of 6-96 months, the presence of agranulocytosis in the period of CRS formation and anemic syndrome in the periods of CRS formation and outcomes. These signs predict the development MDS in 60% of the patients in the period of the CRS consequences. Conclusion. Retrospective study determined that long-term human exposure to a dose rate of 0.001-0,009 Gy/h (0,005-0,05 Gy/day) and more in the accumulation of a summary dose of 1.7 and 9.6 Gy and duration of contact 6-96 months in 60% of cases can be expected development CRS with a subacute clinical course RBS. The main factor determining this feature of the course of RBS is the dose rate exceeding 0.001 Gy / h (2 Gy/year). In the subacute course of CRS, the early outcome in MDS is essentially deterministic. The development of agranulocytosis and anemic syndrome are typical signs of the subacute course of CRS.