SUBCLINICAL INFLAMMATION IN NON/ALCOHOLIC FATTY LIVER DISEASE AT THE REMOTE PERIOD AFTER THE CHORNOBYL ACCIDENT. / SUBKLINIChNE ZAPALENNIa PRY NEALKOGOL'NII ZhYROVII KhVOROBI PEChINKY U VIDDALENOMU PERIODI PISLIa ChORNOBYL'S'KOÏ AVARIÏ.

OBJECTIVE: to evaluate the parameters of inflammatory reaction and oxidative stress in patients with non-alcoholicfatty liver disease (NAFLD) in the remote period after the influence of the Chornobyl accident factors. MATERIALS AND METHODS: Eighty two patients with NAFLD who had been exposed to ionizing radiation as a result ofthe Chornobyl accident and have concomitant cardiovascular pathology were examined. Hematological parametersand the level of highly sensitive C-reactive protein (hsCRP) were determined, and the content of products of oxida-tive modification of lipids and proteins was evaluated. RESULTS: Activation of the processes of oxidative modification of lipids and proteins was observed in most patientswith NAFLD. According to the level of hsCRP, the presence of subclinical inflammation and the risk of developingcomplicated cardiovascular pathology was found in 58 % of patients with NAFLD. The neutrophil / lymphocyte ratiocorrelates positively with hsCRP and can be used as an available routine clinical marker for selection among patientswith NAFLD persons with increased risk of cardiovascular complications. CONCLUSIONS: HsCRP, oxidative modification products of lipids and proteins, ESR, and leukograms should be used toassess the degree of systemic inflammation in people affected by the Chornobyl accident, suffering NAFLD with con-comitant cardiovascular disease.

[HYPERPARATHYROIDISM AND PARATHYROID LESIONS IN THE ChNPP ACCIDENT SURVIVORS]. / GIPERPARATYREOZ TA URAZhENNIa PRYShchYTOPODIBNYKh ZALOZ U OSIB, OPROMINENYKh VNASLIDOK AVARIÏ NA ChAES.

OBJECTIVE: Study of the status of parathyroid glands in individuals exposed to ionizing radiation as a result of the ChNPP accident and comparison with the general population of Ukraine. MATERIALS AND METHODS: Subjects exposed as a result of the ChNPP accident (n = 1,348) and people from the general population of Ukraine (n=655) were examined. Diagnostic ultrasound scan of thyroid and parathyroid glands (PTG) was conducted in all study subjects. The technique of parathyroid ultrasound screening was developed, which led to an increase in the efficiency of their imaging. Additionally, the 25-hydroxyvitamin D (25(OH)D), parathyroid hor- mone, ionized calcium and some other parameters were selectively assayed in serum. RESULTS: High incidence of parathyroid hyperplasia was detected 27-32 years after the irradiation in persons ex- posed as a result of the ChNPP accident, especially in evacuees from the 30-km exclusion zone (71.4%; χ2Yates' = 24.1; р = 0) and residents of radilogically contaminated territories (41.7%; χ2Yates' = 6.45; p < 0.01) having no primary hyperparathyroidism. High prevalence of vitamin D insufficiency and deficiency was revealed in all study subgroups, namely in 83.1 % of the general population of Ukraine along with a bit better vitamin D status in the ChNPP acci- dent survivors i.e. the vitamin insufficiency and deficiency was found in 78.7 % of them. Incidence of hyperparathy- roidism, predominantly of the secondary (normocalcemic) one, was 33.8 % among persons exposed as a result of the ChNPP accident (p > 0.3) being somewhat higher than in the general population of Ukraine (26.1%), despite above- mentioned better supply of vitamin D. CONCLUSIONS: There is a widespread insufficiency or deficiency of vitamin D (over 78.7%) in the population of Ukraine in general providing an unfavorable background for the higher prevalence of health disorders associated with calcium and phosphorus metabolism. The latter features parathyroid hyperplasia and musculosceletal, immune, cardiovascular, and endocrine system comorbidities. Such disorders should exacerbate with a secondary increase in parathyroid hormone secretion (26.1 %). Higher incidence of normocalcemic hyperparathyroidism (33.8% versus 26.1%) against a background of better vitamin D status among irradiated individuals indicates the existence of other factors, where the past combined effects of Chornobyl radioactive fallout and external parathyroid exposure are most likely to be involved. This could explain the greater number of cases of parathyroid hyperplasia and hyper- parathyroidism among the exposed subjects. However the additional precise studies are required here with clarifi- cation of the personal data in population groups of the ChNPP accident survivors. Participants of the ChNPP acci- dent clean-up work in the «iodine period¼ of 1986 are of especial concern here. Besides that, the study population should be expanded with inclusion of subjects exposed in prenatal period.

MORPHOLOGICAL AND FUNCTIONAL MYOCARDIAL ABNORMALITIES IN THE CHORNOBYL NPP ACCIDENT CLEAN-UP WORKERS OF «IODINE¼ PERIOD HAVING GOT TYPE 2 DIABETES MELLITUS. / STRUKTURNO-FUNKTsIONAL'NI ZMINY MIOKARDA V UChASNYKIV LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChORNOBYL'S'KII AES IODNOGO PERIODU, IaKI ZAKhVORILY NA TsUKROVYI DIABET 2 TYPU.

OBJECTIVE: Evaluation of morphological and functional myocardial abnormalities in the Chornobyl NPP (ChNPP)accident clean-up workers (ACUW) of the «iodine¼ period exposed to ionizing radiation at a young age and havinggot the type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: The ChNPP ACUW of «iodine¼ period (n=111) exposed to ionizing radiation (IR) at a young age(18-35 years) were involved in the study. Subjects having got the T2DM were included in study Group I (n = 66), per-sons with normal glucose challenge test were selected as a comparison Group II (n = 45). External radiation doses (ERD)ranged from 10 to 860 mSv. The Group III (clinical control) included persons having got the T2DM with no radiationexposure in a history (n=20). Group IV was the normative one. There was no statistical difference between the groups inage, sociodemographic characteristics and level of education. Echocardiography and cardiac Doppler sonography wereperformed in one- and two-dimensional regimens according to the recommendations of the European Association ofEchocardiography. Total adiponectin and proinflammatory cytokine (TNF-α and IL-6) concentrations were assayed by theimmunoenzyme method. Statistical processing of data was carried out using the Microsoft® Exel 2002 software. RESULTS: Myocardial remodeling in the ChNPP ACUW of a «iodine¼ period having the T2DM occurred through a sig-nificant increase of its linear parameters. Volumetric parameters (EDV, ESV and their indexes) were within maximumpermissible limits significantly exceeding however the values in the Group IV. There was aт increase in myocardialmass of the left ventricle and its indices with the formation of structural-geometric abnormalities, mainly in theform of concentric hypertrophy with a decrease in the myocardial contractile capacity. There was no differences ofthe vast majority of key morphometric parameters of myocardium in the dose subgroups, while in persons with ERD> 500 mSv the incidence of serious left ventricular hypertrophy (LVMMI > 149 g/m2) significantly exceeded thisvalue in individuals with lower ERD. At a maximum ERD the more intense fibroplastic processes were observed inmyocardium [a significant increase in the interstitial collagen volumetric fraction (ICVF)] as compared to the caseswith ERD up to 50 mSv. Intensification of myocardial fibroblastic processes occurred in the comparizin group andgroup off clinical control. In combination with concentric myocardial hypertrophy this may lead to an increased riskof cardiovascular complications. Strong negative correlation was revealed between the parameters of left ventricu-lar structure in diastole and adiponectin level in the ChNPP ACUW of a «iodine¼ period with diagnosed T2DM, high-lighting its cardioprotective effect. At the same time, the content of FNP-α and IL-6 proinflammatory cytokines hada positive correlation with the main parameters of abnormal myocardial remodeling, indicating the possibility oftheir role in unfavorable cardiovascular modifications. CONCLUSIONS: The decreased adiponectin level and elevated levels of TNF-α and IL-6 in the ChNPP ACUW of a«iodine¼ period having got the T2DM are the meaningful factors in progression of LV geometric remodeling. Togetherwith fibroplastic processes (a significant increase in ICVF) this may be a basis for the development of myocardialremodeling processes, namely a concentric hypertrophy, which is a prerequisite for the development of complica-tions in cardiovascular system.

Serum content of total adipionectin in the ChNPP accident clean up workers of the «iodine period¼ suffering from type 2 diabetes mellitus (literature review and research data). / RIVEN' ZAGAL'NOGO ADYPONEKTYNU V KROVI UChASNYKIV LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChAES Y̆ODNOGO PERIODU, IaKI KhVORIIuT' NA TsUKROVYY̆ DIABET 2 TYPU (ogliad literatury ta rezul'taty doslidzhen').

OBJECTIVE: assay of the total adiponectin level in the ChNPP accident clean up workers (ACUW) of the «iodine peri od¼ exposed to ionizing radiation in a young age and suffering now from type 2 diabetes mellitusMaterials and methods. The Chernobyl Nuclear Power Plant accident clean up workers (ACUW) of the iodine period (n=111) exposed to ionizing radiation at a young age (18-35 years) were examined in two groups: Group I (main study group, n=66) of persons with type 2 diabetes mellitus (DM) and Group II (comparison group, n=45) of persons with normal glucose challenge test results. Total radiation doses varied in the range of 10.0-860.0 mSv. Group III (nosological control group, n=20) included persons suffering type 2 DM but not exposed to ionizing radiation (IR) and Group IV were apparently healthy. All study groups were representative by the age. Anthropometric data and parameters of glycemic control were assayed. Index of the homeostatic model for assessing insulin resistance (HOMA IR) was calculated. Level of total adiponectin was assayed by the immune enzyme method. Statistical pro cessing of the data was carried out using Missrosoft® Exxel 2002 software. RESULTS AND CONCLUSIONS: Serum concentration of total adiponectin in the Chornobyl NPP ACUW of the iodine peri od and suffering type 2 DM despite having normal body weight or overweight or any degree of obesity was signifi cantly lower compared to apparently healthy persons ACUW with and normal glycemic control. Moderate negative correlation was found between the level of total adiponectin and degree of obesity in the ACUW suffering type 2 DM (t = 0.367, p <0.05). With an increase in the duration of the disease there was a decrease in serum concentration of total adiponectin in the Chornobyl NPP ACUW of iodine period suffering type 2 DM and in the group of nosologi cal control. The most favorable type of glycemic profile was peculiar for patients in the main group with higher lev els of total serum adiponectin and the lowest body mass index (up to 25 kg/m2). An increase in the body mass index was accompanied by an adverse combination of abnormalities in glycemic metabolism (increased glucose concen tration, IRI, and HbA1c), insulin resistance (a significant increase in HOMA) against the background of a decrease in concentration of total adiponectin. No significant differences were found in adiponectin levels in dose subgroups. At the same time, the reliable differences between the main group and comparison group were found in the 2-5th dose subgroups, which are due to differences in numbers of people with metabolic syndrome (obesity) in the groups.

Peculiarities of gastrointestinal disease concomitant to heart connective tissue dysplasia in children born from persons exposed to ionizing radiation in childhood after the ChNPP accident. / Osoblyvosti patologii' shlunkovo-kyshkovogo traktu u ditej iz syndromom dysplazii' spoluchnoi' tkanyny sercja, jaki narodylysja vid bat''kiv, oprominenyh v dytjachomu vici v rezul''tati avarii' na ChAES.

Study objective. The study examined the peculiarities of upper gastrointestinal tract diseases in children suffering from a syndrome of heart connective tissue dysplasia (HCTDS) born from persons exposed to ionizing radiation in a childhood after the ChNPP accident. Materials and methods. The study included 120 children suffering from HCTDS (group I) and 75 persons having no signs of the syndrome (Group II). Diagnosis of HCTDS was obtained from echocardiography in Band M-modes and Doppler echocardiography. Esophagogastroduodenoscopy was performed using a flexible endoscope "OLYMPUS" model GIF-P3. Abdominal diagnostic ultrasound was used to assay the structure of abdominal parenchymal viscera. Results. Upper gastrointestinal tract diseases (UGITD) manifest earlier in children suffering the HCTDS (beginning from a preschool age). Along with age the systemic pattern of organ and system injury becomes evident i.e. there were 6.8 clinical/nosological entities per one child in Group I and 4.9 in Group II. Clinical presentation of chronic UGITD diseases in children suffering concomitant HCTDS were characterized by more frequent exacerbation after the psychoemotional and physical strain, more frequent intestinal motor dysfunction, nervous system disorders (80 %), and chronic infections (62.2 %). Endoscopic pattern of chronic UGITD with concomitant HCTDS featured a combination of mucosal inflammation (a range of various forms of esophagitis, erythematous and hypertrophic gastroduodenopathy) with abnormal gastrointestinal motor function i.e. gastroesophageal and duodenogastric reflux (73.34 %). Destructive lesions at most of duodenal zone were found in 20 %. Conclusions. UGITD namely chronic gastroduodenitis with typically concomitant involvement of several parts of digestive tract are most prevalent within all digestive system diseases in remote period upon the Chornobyl disaster in children born from persons exposed to ionizing radiation in a childhood. Presentation of UGITD occurs earlier in children suffering HCTDS with evident systemic pattern of organ and system injury along with an age. Refluxes of various nature and localization are the leading factors for UGITD onset in children suffering HCTDS. Thus a range of multidirectional tools of reflux disease prophylaxis is required for inclusion to the disease management.

Peculiarities of viruses Herpesviridae family persistence in patients with non-alcoholic fatty liver disease who had been exposed to the factors of Chornobyl NPP accident. / Osoblyvosti persystencii' virusiv rodyny herpesviridae u hvoryh na nealkogol''nu zhyrovu hvorobu pechinky, jaki zaznaly dii' faktoriv Chornobyl''s''koi' avarii'

Objective - to define the features of viruses persistence belonging to the Herpesviridae family in patients with non-alcoholic fatty liver disease (NAFLD) who had been exposed to the factors of Chornobyl NPP accident. Material and methods. The main group included 45 male NAFLD patients sufferers of Chornobyl NPP accident with absorbed doses of external irradiation in the range of 10-580 mSv. The group of nosology comparison consisted of 20 male NAFLD patients with the doses of irradiation within the limits of natural radiation background and regulated doses of medical irradiation. Antibodies to the viruses of herpes simplex 1/2 types (anti-HSV-1/2 IgG), cytomegalovirus (anti-CMV IgG) and Epstein-Barr virus (anti-EBV IgG) were determined by ELISA according to instructions of manufacturer. Results. There were no patients in both groups without IgG antibodies characterizing persistence of some Herpesviridae representative. Tendencies to the increase of antibodie levels to the viruses of herpes simplex, cytomegaly and Epstein-Barr in the seropositive patients, who had been exposed to the factors of Chornobyl NPP accident relative to the patients of group of nosology comparison were found. There were no differences between the subgroups of patients with steatohepatosis (SH) and nonalcoholic steatohepatitis (NASH) in the main group by anti-HSV-1/2 IgG and anti-CMV IgG levels while in the group of comparison SH patients had 60.5 % higher level of anti-HSV-1/2 IgG (p < 0.05) than NASH patients and anti-CMV IgG - 88.2 % respectively. Besides for NASH patients of main group anti-CMV IgG level exceeded 79.6 % (p = 0,02) analogical level for NASH patients in the group of comparison. The mixt infection by the viruses of 1/2 types herpes simplex and cytomegaly was most often determined in all groups with the direct correlation between the levels of anti-HSV-1/2 IgG and anti-CMV IgG. The markers of cytomegalovirus monoinfection were registered only in NASH patients both in main group and in the group of comparison. Conclusion. According to the presence of class IgG antiviral antibodies, NAFLD patients regardless of radiation influence in anamnesis have high prevalence of Herpesviridae family viral infection: herpes simplex 1/2 types, cytomegalovirus and Epstein-Barr virus. In the group of patients who had been exposed to the factors of Chornobyl NPP accident greater part of seropositive results and higher mean values of the probed antibodies titres were registered than in the groups of comparison. The mixt infection by the viruses of herpes simplex 1/2 types and cytomegaly was registered in most patients with existence of direct correlation between the levels of anti-HSV-1/2 IgG and anti-CMV IgG.