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.

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.

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.

BRAIN AND EYE AS POTENTIAL TARGETS FOR IONIZING RADIATION IMPACT: PART II - RADIATION CEREBRO/OPHTALMIC EFFECTS IN CHILDREN, PERSONS EXPOSED IN UTERO, ASTRONAUTS AND INTERVENTIONAL RADIOLOGISTS. / GOLOVNYI MOZOK TA ORGAN ZORU IaK POTENTsIINI MIShENI DLIa VPLYVU IONIZUIuChOGO VYPROMINIuVANNIa: ChASTYNA II ­ RADIATsIINI TsEREBROOFTAL'MOLOGIChNI EFEKTY U DITEI, OSIB, EKSPONOVANYKh VNUTRIShN'O/UTROBNO, ASTRONAVTIV TA INTERVENTsIINYKh RADIOLOGIV.

BACKGROUND: Ionizing radiation (IR) can affect the brain and the visual organ even at low doses, while provoking cognitive, emotional, behavioral, and visual disorders. We proposed to consider the brain and the visual organ as potential targets for the influence of IR with the definition of cerebro-ophthalmic relationships as the «eye-brain axis¼. OBJECTIVE: The present work is a narrative review of current experimental, epidemiological and clinical data on radiation cerebro-ophthalmic effects in children, individuals exposed in utero, astronauts and interventional radiologists. MATERIALS AND METHODS: The review was performed according to PRISMA guidelines by searching the abstract and scientometric databases PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, Google Scholar, published from 1998 to 2021, as well as the results of manual search of peer-reviewed publications. RESULTS: Epidemiological data on the effects of low doses of IR on neurodevelopment are quite contradictory, while data on clinical, neuropsychological and neurophysiological on cognitive and cerebral disorders, especially in the left, dominant hemisphere of the brain, are nore consistent. Cataracts (congenital - after in utero irradiation) and retinal angiopathy are more common in prenatally-exposed people and children. Astronauts, who carry out longterm space missions outside the protection of the Earth's magnetosphere, will be exposed to galactic cosmic radiation (heavy ions, protons), which leads to cerebro-ophthalmic disorders, primarily cognitive and behavioral disorders and cataracts. Interventional radiologists are a special risk group for cerebro-ophthalmic pathology - cognitivedeficits, mainly due to dysfunction of the dominant and more radiosensitive left hemisphere of the brain, andcataracts, as well as early atherosclerosis and accelerated aging. CONCLUSIONS: Results of current studies indicate the high radiosensitivity of the brain and eye in different contingents of irradiated persons. Further research is needed to clarify the nature of cerebro-ophthalmic disorders in different exposure scenarios, to determine the molecular biological mechanisms of these disorders, reliable dosimetric support and taking into account the influence of non-radiation risk factors.

BRAIN AND EYE AS POTENTIAL TARGETS FOR IONIZING RADIATION IMPACT. PART III / FEATURES MORPHOMETRIC RETINAL PARAMETERS, AMPLITUDE AND LATENCY COMPONENTS OF VISUAL EVOKED POTENTIAL IN RADIATION EXPOSED IN UTERO. / GOLOVNYI MOZOK TA ORGAN ZORU IaK POTENTsIINI MIShENI DLIa VPLYVU IONIZUIuChOGO VYPROMINIuVANNIa: ChASTYNA III ­ OSOBLYVOSTI MORFOMETRYChNYKh PARAMETRIV SITChASTOÏ OBOLONKY TA AMPLITUDA I LATENTNIST' KOMPONENTIV ZOROVYKh VYKLYKANYKh POTENTsIALIV U OPROMINENYKh VNUTRIShN'OUTROBNO OSIB.

One of the current problems of modern radiobiology is determine the characteristics of the manifestation of radiation-induced effects not only at different dose loads, but also at different stages of development of the organism. In previous reports, we have summarized available evidence that at certain ages there is a comparative acceleration of radiation-induced pathological changes in the eye and brain, and the study and assessment of the risk of possible ophthalmic and neurological pathology in remote periods after contamination of radioactive areas. Data of irradiated in utero individuals are possible on the basis of observation of the state of the visual analyzer in persons who underwent intrauterine irradiation in 1986. Therefore, a parallel study of retinal morphometric parameters, amplitude and latency of components of evoked visual potentials in irradiated in utero individuals was performed. OBJECTIVE: to evaluate the retinal morphometric parameters, amplitude and latency components of the evoked visual potentials in intrauterine irradiated persons. MATERIALS AND METHODS: The results of surveys of 16 people irradiated in utero in the aftermath of the Chornobyl disaster were used; the comparison group were residents of Kyiv of the corresponding age (25 people). Optical coherence tomography was performed on a Cirrus HD-OCT, Macular Cube 512x128 study technique was used. At the same time, the study of visual evoked potentials on the inverted pattern was performed, and occipital leads wereanalyzed. Visual evoked potentials were recorded on a reversible chess pattern (VEP) - an electrophysiological test, which is a visual response to a sharp change in image contrast when presenting a reversible image of a chessboard. RESULTS: In those irradiated in utero at the age of 22-25 years, there was a probable increase in retinal thickness in the fovea, there was a tendency to increase the thickness of the retina in the areas around the fovea. When recording visual evoked potentials on a reversible chess pattern in this group, there was a tendency to decrease the amplitudes of components (N75, P100, N145, P200) in the right and left parieto-occipital areas and asymmetric changes in latency of these components. CONCLUSIONS: Early changes of fovea recorded in OCT and decreasing amplitudes of components of visual evoked potentials on the reversible chess pattern at the age of 22 25 years may indicate a risk of development in patients irradiated in utero, early age-related macular degeneration, as well as increased risk and increased risk structures of the visual analyzer.

BRAIN AND EYE AS POTENTIAL TARGETS FOR IONIZING RADIATION IMPACT. Part І. THE CONSEQUENCES OF IRRADIATION OF THE PARTICIPANTS OF THE LIQUIDATION OF THE CHORNOBYL ACCIDENT. / GOLOVNYI MOZOK TA ORGAN ZORU IaK POTENTsIINI MIShENI DLIa VPLYVU IONIZUIuChOGO VYPROMINIuVANNIa. Chastyna I. TsEREBROOFTAL'MOLOGIChNI EFEKTY OPROMINENNIa V UChASNYKIV LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChAES.

BACKGROUND: Exposure to ionizing radiation could affect the brain and eyes leading to cognitive and vision impairment, behavior disorders and performance decrement during professional irradiation at medical radiology, includinginterventional radiological procedures, long-term space flights, and radiation accidents. OBJECTIVE: The objective was to analyze the current experimental, epidemiological, and clinical data on the radiation cerebro-ophthalmic effects. MATERIALS AND METHODS: In our analytical review peer-reviewed publications via the bibliographic and scientometric bases PubMed / MEDLINE, Scopus, Web of Science, and selected papers from the library catalog of NRCRM - theleading institution in the field of studying the medical effects of ionizing radiation - were used. RESULTS: The probable radiation-induced cerebro-ophthalmic effects in human adults comprise radiation cataracts,radiation glaucoma, radiation-induced optic neuropathy, retinopathies, angiopathies as well as specific neurocognitive deficit in the various neuropsychiatric pathology including cerebrovascular pathology and neurodegenerativediseases. Specific attention is paid to the likely stochastic nature of many of those effects. Those prenatally and inchildhood exposed are a particular target group with a higher risk for possible radiation effects and neurodegenerative diseases. CONCLUSIONS: The experimental, clinical, epidemiological, anatomical and pathophysiological rationale for visualsystem and central nervous system (CNS) radiosensitivity is given. The necessity for further international studieswith adequate dosimetric support and the follow-up medical and biophysical monitoring of high radiation riskcohorts is justified. The first part of the study currently being published presents the results of the study of theeffects of irradiation in the participants of emergency works at the Chornobyl Nuclear Power Plant (ChNPP).

RESULTS OF WBC-MONITORING OF FIREFIGHTERS PARTICIPATING IN RESPONSE TO CHORNOBYL FOREST FIRES IN APRIL-MAY 2020. / REZUL'TATY LVL-MONITORYNGU POZhEZhNYKh, ShchO BULY ZADIIaNI U GASINNI LISOVOÏ POZhEZhI V ZONI VIDChUZhENNIa ChAES U KVITNI­TRAVNI 2020 ROKU.

OBJECTIVE: of this study was to determine the levels of radionuclides in the rescuers' bodies of the SES during firefighting in the exclusion zone of the Chornobyl nuclear power plant and to assess the dose of internal radiation dueto this receipt. MATERIALS AND METHODS: From 06.04.2020 to 19.05.2020 in the State Institution «National Research Center forRadiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) measurements of the contentof incorporated gamma radionuclides on whole body counters (WBC) operational class «Screener-3M¼ (Minimumdetected activity (MDA) is 300-500 Bq for 5 minutes of measurement at 137Cs) and expert high-sensitivity WBC (MDAis 20 Bq for 10 minutes of measurement at 137Cs). 470 people (523 measurements) in three groups of personnel ofthe SES of Ukraine who took part in the forest fire liquidation in the exclusion zone in the period from April 4 toMay 5, 2020 were examined. Mathematical and spectrometric methods are used in the work. RESULTS AND CONCLUSIONS: In the vast majority (95 %) of the personnel of the SES of Ukraine, examined at the WBCoperational class «Screener-3M¼ (more than 500 measurements), the assessment of the values of the individualeffective dose of internal radiation due to 137Cs in the body during firefighting, assuming that it receipt occurredduring operation in the exclusion zone, did not exceed the minimum dose detected by MDD (5-14 µSv). The average value of the effective dose of internal radiation in the group of personnel of the State Emergency Service ofUkraine in Kyiv, which participated in the elimination of forest fires in the exclusion zone from April 4 to May 5, 2020(26 people) studied at the expert WBC, is 2.5 ± 1.1 µSv, in the group of personnel of the SES of Ukraine in Cherkasyregion, which participated in the fire on April 19-24, 2020 (9 people) - 2.2 ± 0.6 µSv, in the group of personnel ofthe SES of Ukraine in the Kyiv region, which took part in the elimination of the forest fire in the exclusion zone onApril 4 - May 5, 2020 (42 people) - 4.4 ± 2.4 µSv. Maximum values of 5.1 µSv, 3.5 µSv, 11.8 µSv in the groups ofKyiv city, Cherkasy and Kyiv regions, respectively, which is much lower than the basic dose limit for the populationfrom man-made sources of 1000 µSv · year-1 according to the Law of Ukraine about protection of the person againstinfluence of ionizing radiation.

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.

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.

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.

MORPHOMETRIC PARAMETERS OF RETINAL MACULAR ZONE IN RECONVALESCENTS OF ACUTE RADIATION SICKNESS (IN REMOTE PERIOD). / MORFOMETRYChNI PARAMETRY MAKULIaRNOÏ ZONY SITKIVKY U REKONVALESTsENTIV GOSTROÏ PROMENEVOÏ KhVOROBY (U VIDDALENOMU PERIODI).

OBJECTIVE: evaluate the retinal morphometric parameters of the reconvalescents in remote period after acute radi-ation sickness. MATERIALS AND METHODS: A complete ophthalmologic examination was carried out on 7 reconvalescents of acuteradiation sickness. The examined are divided into two subgroups: 1) patients with macular degeneration of the reti-na (8 eyes); 2) patients without clinical signs of macular pathology (6 eyes). Parameters of the retina in the cen-tral retina zone studied using the method of optical coherence tomography. To evaluate the results of surveys usedstatistical methods: average values of quantitative indicators calculation, estimation of probability difference byStudent's method. RESULTS: Optical coherence tomography revealed a statistically significant increase of the thickness of the retina inthe fovea in all reconvalescents of acute radiation sickness. CONCLUSIONS: It was shown that the thickness of the retina in the fovea and paramacular zone in persons who suf-fered acute radiation sickness is significantly higher than in the control. These changes observed in all reconvalis-cents ARS - both in person with sings of macular degeneration, and in those whose clinical manifestations were notdetected. The presence of a correlation between the volume of the retina in the macular zone and the documentedradiation dose of the study group emphasizes the perspectives of next OCT examination of the retina of reconvales-cents of ARS to study the mechanism of retina's damage in this category of victims of the Chornobyl accident.

The morphological changes of mucous membrane of stomach and duodenum of contractor organization personnel, which works in radiation hazard conditions at the object Shelter of Chornobyl NPP. / Morfologichni zminy slyzovoi obolonky shlunka ta dvanadtsiatypaloi kyshky u personalu pidriadnykh pidpryiemstv, iakyi pratsiuie u radiatsiino-nebezpechnykh umovakh na ob'iekti Ukryttia Chornobyl's'koi AES.

UNLABELLED: Аim: The determination of morphological features of stomach and duodenum mucous of membrane (MM) damage at a personnel that works in radiation hazard conditions at the object of "Shelter" of Chornobyl NPP (OS) by the endoscopic monitoring with biopsy material inspection from a gastro-duodenal zone on the stages of check - in (InC) and the special medical control (SpC). MATERIALS AND METHODS: the complex clinical-endoscopic and morphological examination with the biopsy of MM of stomach and duodenum in 126 workers of OS (man in the age from 20 to 59) was carried out. Doses of external radiation exposure were from 0,14 to 79,6 mSv, доза internal radiation exposure were from 0,1 to 3 mSv/Results: For the personnel of OS contract organisations differently directed pathomorphological changes of MM at InC and increase of frequency of their exposure at an inspection during SC, that generally correspond to chronic H.pylori-associated pangastritis with violation of microcirculation and trophism, disregeneration changes of epithelial layer. CONCLUSIONS: for the personnel of contract organizations, which participated in radiation hazard works on ОS a presence of chronic H.pylori-associated pangastritis with the increase of frequency of atrophic changes of MM (nonmetaplastic or metaplastic type) and development of erosive-ulcerous defects of gastro-duodenal zone was founded out.For workers, who had previous influence of ionizing irradiation the greater frequency of disregeneration (hyperplasia / intestinal metaplasia) changes of epithelium that accordingly promotes the risk of neoplasmes transformations was clarified.Providing of EGDFS (at a necessity with the biopsy of MM) is at InC and next stages of medical control for personnel, that executes radiation hazard works on ОS is the highly informative evidential and necessary method of inspection for determination of form and degree of pathological changes of overhead departments of gastrointestinal tract for warning of progress of disease and development of complications, maintenance of workers health and workability.

Estimation of the multiple sclerosis risk in population living on contaminated territories after the Chornobyl catastrophe.

UNLABELLED: Multiple sclerosis (MS) is one of the most socially important and challenging issues in a today's neuroscience. There are estimated to be over 20,000 such patients in Ukraine of which at least 2.5 thousand being the Chornobyl accident survivors. All of them require substantial direct state and indirect expenses for their care and maintenance. OBJECTIVE: To estimate and calculate the risk values of MS in population living in contaminated areas after the Chornobyl accident compared to other population groups. MATERIALS AND METHODS: Data provided by the State institution "Centre for Medical Statistics Ministry of Health of Ukraine" and data set from the specialized medical publications were the primary sources of information about the incidence of MS in different regions of Ukraine. Statistical and analytical research methods were applied. Calculation of the MS risk was performed according to the method of R. Fletcher et al. RESULTS: The MS risk estimation and calculations of parameters were made for population of areas contaminated after the Chornobyl accident compared to other population groups. Relative risk, additional risk and population risk values of the MS morbidity appeared being higher among the population under the impact of risk factors such as living in areas of contamination than in patients without no impact of unfavorable factors in the same area. CONCLUSION: Received results point to the need of in-depth study of problem with the purpose of development and application of medical and organizational arrangements focused on the health care optimization for specified population.

Radiation protection and health of personnel of contracting enterprises participating in works for transformation of the object "shelter" of SSE Chornobyl NPP into an ecologically safe system.

UNLABELLED: Transformation of the object "Shelter" (OS) of SSE Chornobyl NPP into an ecologically safe system is one of the most important state programs in Ukraine. Both medical and dosimetric measures on healthcare of personnel participating in these works ranks the main place among most actual problems of contemporary clinical radiobiology, radiation hygiene, and radiation protection. The study objective was to work out and implement the medical and biophysical checking of the health status and workability both with radiation protection of personnel executing works on transformation of OS into an ecologically safe system. MATERIALS AND METHODS. The interdependent complex program of medical and biophysical (for internal and external irradiation) control of personnel executing the production tasks under conditions of ionizing radiation impact and open sources of ionizing radiation. Realization of medical examination envisages the estimation of the status of haemopoietic, immune, endocrine, respiratory systems, organ of vision, nervous system, psychics status and psychophysiological adaptation, ear, both with circulatory, digestive, urogenital, and bone-muscular system. There were 19434 cases of medical control of personnel in total. RESULTS: Results of the input medical control testify to the following: 4698 (48.90%) were admitted to work, 4909 (51.10%) were rejected. Individual annual effective doses of irradiation in the major part of cases did not exceed 12 mSv. There were 1845 cases of 239+240Pu content in excrements exceeding the level of 1.5 mBq/sample at a current biophysical control. Individual doses of internal irradiation at that did not exceed 1 mSv. CONCLUSIONS: The program of medical and biophysical service for reconstruction works on the OS proved its necessity and efficiency as its results showed that under the unique radiation-hygienical conditions not engineering challenges and technical problems but issues of how to save the health and workability of people and prevent the overdose of personnel including due to an internal irradiation are most critical.