Russian Academy of Medical Sciences, Russia
Title: Polysystemic analysis for risk group revealing in nuclear plant stuff
Mikhail Karganov was born in Odessa, USSR. In 1980 he graduated from Moscow Mendeleev Institute of Chemical Technology, organic-fuel faculty, technology of microbiological production. He has completed his PhD at the age of 28 years from Institute of General Pathology and Pathophysiology, Russian Academy of medical sciences, postdoctoral studies D.Sci. degree (2001) from the same Institute. From 2001 till now he is the Head of Laboratory of Polysystemic Investigations of Institute of General Pathology and Pathophysiology. The sphere of his scientific researches of the last 15 years includes the development of new biophysical methodologies which enable to detect in a rapid noninvasive mode the functional status of regulatory systems of organism responsible for preservation of its adaptive potencies. They offered to define this new trend in the medical diagnostics of so-termed dysregulation state of organism, which precedes formation of different pathological processes, as objective sanological monitoring.
The health risk due to radiation exposure and the causality can be revealed only through long-term and detailed radiobiological and epidemiological studies. Many individuals (medical staff, aircrew, miners, Chernobyl clean-up workers, nuclear weapons tests participants, nuclear industry workers) are, or have been, exposed to ionizing radiation in the course of their work and the epidemiological study of occupationally irradiated groups offers an important opportunity to complement the estimates of risks to health resulting from exposure to radiation that are obtained from other populations. By a wide range of effects, the existing real radiation, physical, chemical, and biological hazards can be divided into two categories: 1) risks in the deterministic range of doses and concentrations (doses and concentrations far surpassing the established thresholds), 2) risks in the stochastic range of doses and concentrations (doses and concentration near the established thresholds). In the deterministic range of doses and concentrations, the biological effects strictly depend on doses and concentrations of anthropogenic factors and can be detected by existing methods of epidemiological analysis. In the stochastic range of doses and concentrations of anthropogenic factors, the consequences strictly depend on individual sensitivity of biological objects, including humans. Due to individual variability of physiological processes, the same anthropogenic factor in equal doses and concentrations will cause certain effects in some organisms (sensitive), will not cause in others, and will induce resistance in the thirds. This implies that at the population level three subpopulations should be determined at relatively low-dose and low-concentration exposures: Sensitive, neutral, and super resistant. The ratio between these subpopulations can serve as a measure of population risk from this exposure. Stable fixation of the pathological trace is preceded by processes of dysregulation of the corresponding functions. The most probable pathological outcomes can be predicted on the basis of the results of polysystemic monitoring by detecting dysregulation in certain systems of the organism (cardiorespiratory, psychomotor, and metabolism systems). Monitoring is carried out using computerized measurement instrumentation and data processing systems, which provides the basis for strict quantitative assessment of the dynamics of risk for the studied populations. The testing included seven functional systems: constitution, myocardial contractility, autonomic regulation of the heart rate, regulation of peripheral circulation, psychomotor regulation, and respiratory regulation. Using this approach, we examined workers of 1) Shipyard for repair and recycling of nuclear-powered ships (130 workers) 2) Nuclear fuel complex plant (300 workers). We can assume that working conditions in group of workers with directly exposed group (welders, burners, riveters, fitters, and other workers on the vessel hull) lead to aggravation of functional strain in the psychomotor system. The population examined by us is characterized by high percent of workers with job tenure more than 10 years. Despite the above peculiarities, a half of the examinees had no verified chronic pathologies. Cardiovascular pathologies constitute 13% of all verified pathologies. It was 2.5-fold less incident than pathologies of the locomotor apparatus and inflammatory and degenerative processes. Low incidence of somatic pathologies in the analyzed population attests to good health status of workers, which can be explained by effective therapeutic and preventive measures. The incidences of pathologies of the locomotor apparatus and inflammatory and degenerative diseases were similar in all groups (26-32%). These findings suggest that the detected functional burden by the psychomotor system disturbances in directly exposed group reflects peculiarities of functional adaptation, rather than premorbid state of the individual. The fact that pathologies of the locomotor apparatus rank first among somatic diseases attests to indirect effect of strain on these processes. General metabolic changes were evaluated by the method of laser correlation spectroscopy (LCS). This method allows evaluation of the percent contribution of particles with different size into light scattering in biological fluids. Basing on the increase (or decrease) in the percent contribution of particles of this or that fraction into light scattering, the proposed semiotic classification of serum/plasma samples including 8 shifts of various directions in homeostasis and humoral immunity: intoxication-, catabolic-, dystrophic-, allergic-, autoimmune-like, and normological spectra and 2 types of mixed spectra. The percent of intoxication-like shifts increases with deterioration of working conditions. In the group with the worst working conditions, analysis of the urine revealed predominance of allergic-like shifts. This method was used by us in the study performed on a nuclear fuel plant for detection of groups at risk of hematological diseases and evaluation of the severity and prognosis of the course of these diseases on the basis of the detected metabolic shifts. We evaluated the distribution of subcellular components of biological fluids from patients with hematological diseases (iron-deficient and B12-deficient anemia’s, lymphogranulomatosis, multiple myelomas, chronic lymphocytic leukemia, chronic myelocytic leukemia, thrombocytemia, and polycythemia). Thus, a risk group for hematological diseases (anemia, n=11 and erythremia, n=5) was determined. The validity of the risk group formation was confirmed by standard hematological studies. LCS analysis of blood serum and urine and standard clinical blood testing for eosinophil count detected a risk group for allergic diseases (5 women and 8 men). This group included individuals with moderate or pronounced allergic shifts and mixed shifts with the allergic component. Since the target was detection of the risk group by the brochopulmonary pathologies, further functional testing revealed reduced vital lung capacity in 5 examinees. Tiffeneau index was reduced in 4 individuals; this parameter is more important for evaluation of allergic bronchopulmonary pathologies. In 2 examinees, reduced Tiffeneau index was associated with increased relative content of eosinophil’s. Conclusion Based on the above, the algorithm of evaluation of chronic radiation, chemical, and combined risks should include the following steps: 1. On the basis of the detected shifts in the system regulating metabolism and immunity (LCS of biological fluids), reference groups for differentiation significant shifts are formed. 2. In the corresponding reference groups, variants related to functional tension in the major physiological systems are detected. 3. On the basis of systemic analysis of the tensest states in the major physiological systems, risk groups for the corresponding pathologies are formed within the selected reference groups.
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