bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.35754/0234-5730-2023-68-1-98-128bloodjour-436Research ArticleРЕКОМЕНДАЦИИRЕCOMMENDATIONSРекомендации по диагностике и лечению костномозговой формы острой лучевой болезниRecommendations for the diagnosis and treatment of bone marrow form of acute radiation syndromehttps://orcid.org/0000-0002-9241-7238СамойловА. С.SamoylovA. S.

Александр Сергеевич Самойлов, доктор медицинских наук, профессор, член-корр. РАН, генеральный директор

123098

Москва

Alexander S. Samoylov, Dr. Sci. (Med.), Professor, Corresponding Member of RAS, General Director

123098

Moscow

asamoilov@fmbcfmba.ruhttps://orcid.org/0000-0003-0812-4596КончаловскийМ. В.KonchalovskyM. V.

Михаил Вадимович Кончаловский, кандидат медицинских наук, ведущий научный сотрудник

лаборатория клинической радиационной медицины

123098

Москва

Michail V. Konchalovsky, Cand. Sci. (Med.), Leading Researcher of the Laboratory

Laboratory of Clinical Radiation Medicin

123098

Moscow

konch_mv@mail.ruhttps://orcid.org/0000-0003-1565-4560БушмановА. Ю.BushmanovA. Yu.

Андрей Юрьевич Бушманов, доктор медицинских наук, профессор, первый заместитель генерального директора

123098

Москва

Andrey Yu. Bushmanov, Dr. Sci. (Med.), Professor, First Deputy General Director

123098

Moscow

radclin@yandex.ruhttps://orcid.org/0000-0002-7571-971XГалстянИ. А.GalstyanI. A.

Ирина Алексеевна Галстян, доктор медицинских наук, доцент, заведующая лабораторией

лаборатория клинической радиационной медицины

123098

Москва

Irina A. Galstyan, Dr. Sci. (Med.), Head of the Laboratory

Laboratory of Clinical Radiation Medicine

123098

Moscow

igalstyan@rambler.ruhttps://orcid.org/0000-0001-7396-0246НугисВ. Ю.NugisV. Yu.

Владимир Юрьевич Нугис, доктор биологических наук, заведующий лабораторией

лаборатория радиационной гематологии и цитогенетики

123098

Москва

Vladimir Yu. Nugis, Dr. Sci. (Biol.), Head of the Laboratory

Laboratory of Radiation Hematology and Cytogenetics

123098

Moscow

 

nugisvju@list.ruhttps://orcid.org/0000-0003-1262-7161ДавтянА. А.DavtyanA. A.

Анаит Арташесовна Давтян, кандидат медицинских наук, заведующая отделением

отделение острой лучевой патологии и ее последствий (гематологическое)

123098

Москва

Anahit A. Davtyan, Cand. Sci. (Med.), Head of the Department

Department of Acute Radiation Pathology and its Consequences (Hematology)

123098

Moscow

adavtyan@fmbcfmba.ruhttps://orcid.org/0009-0001-6988-9069КолгановаЛ. Р.KolganovaL. R.

Людмила Рафаиловна Колганова, гематолог

111123

Москва

Ludmila R. Kolganova, Hematologist

111123

Moscow

lkolganova@mosmedzdrav.ruhttps://orcid.org/0000-0003-3863-8424МетляеваН. А.MetlyaevaN. A.

Нэля Андреевна Метляева, доктор медицинских наук, доцент, ведущий научный сотрудник

лаборатория клинической радиационной медицины

123098

Москва

Nelya A. Metlyaeva, Dr. Sci. (Med.), Docent, Leading Researcher

Laboratory of Clinical Radiation Medicine

123098

Moscow

nmetlyaeva@fmbcfmba.ruhttps://orcid.org/0000-0001-6879-4108ТорубаровФ. С.TorubarovF. S.

Феликс Сергеевич Торубаров, доктор медицинских наук, профессор, главный научный сотрудник

лаборатория клинической радиационной медицины

123098

Москва

Felix S. Torubarov, Dr. Sci. (Med.), Professor, Chief Researcher

Laboratory of Clinical Radiation Medicine

123098

Moscow

torubarov_felix@mail.ruФГБУ «Государственный научный центр Российской Федерации — Федеральный медицинский биофизический центр им. А. И. Бурназяна» ФМБА РоссииРоссияBurnasyan Federal Medical Biophysical Center of FMBA of RussiaRussian FederationГБУЗ «Московский клинический научный центр имени А. С. Логинова» Департамента здравоохранения г. МосквыРоссияThe Loginov Moscow Clinical Scientific CenterRussian Federation20231305202368198128Copyright © Самойлов А.С., Кончаловский М.В., Бушманов А.Ю., Галстян И.А., Нугис В.Ю., Давтян А.А., Колганова Л.Р., Метляева Н.А., Торубаров Ф.С., 20232023Самойлов А.С., Кончаловский М.В., Бушманов А.Ю., Галстян И.А., Нугис В.Ю., Давтян А.А., Колганова Л.Р., Метляева Н.А., Торубаров Ф.С.Samoylov A.S., Konchalovsky M.V., Bushmanov A.Y., Galstyan I.A., Nugis V.Y., Davtyan A.A., Kolganova L.R., Metlyaeva N.A., Torubarov F.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/436

   Введение. Только массовая радиационная авария, а не отдельные гетерогенные по условиям воздействия инциденты способствует ревизии и развитию знаний и лечебных возможностей при острой лучевой болезни (ОЛБ).   Цель — представить рекомендации по диагностике и лечению костномозговой формы ОЛБ от относительно равномерного облучения.   Общие сведения. Проведен анализ литературы по проблеме диагностики и лечения ОЛБ, а также обобщен опыт оказания медицинской помощи пострадавшим 26 апреля 1986 г. во время радиационной аварии на ЧАЭС (104 больных ОЛБ) в клиническом отделе ФГБУ ГНЦ ФМБЦ им А. И. Бурназяна ФМБА России. При поступлении в медицинское учреждение участников радиационной аварии важным мероприятием является проведение медицинской сортировки, то есть распределения пострадавших на группы по принципу нуждаемости в однородных лечебно-профилактических и эвакуационных мероприятиях в зависимости от медицинских показаний, конкретных условий обстановки и прогноза выживаемости больного на основании оценки дозы и прогнозирования тяжести течения ОЛБ всеми доступными методами физической и биологической дозиметрии (расчетный метод, моделирование ситуации, клинические признаки первичной реакции на облучение, цитогенетический метод, абсолютное количество лимфоцитов периферической крови в течение первых 8 дней после облучения, динамика абсолютного количества нейтрофилов периферической крови и др.). Объем лечебных мероприятий зависит от степени тяжести развивающейся ОЛБ и включает в себя терапию инфекционных осложнений и геморрагического синдрома. Назначение миелостимуляции с целью уменьшения глубины и длительности радиационно-индуцированной цитопении рекомендуется при облучении в дозе свыше 1,5 Гр. Трансплантация аллогенных гемопоэтических стволовых клеток при ОЛБ рекомендуется в узком дозовом диапазоне от 10 до 13 Гр при отсутствии сопутствующих тяжелых травм и ожогов. Даны рекомендации по лечению орофарингеального и кишечного синдромов.

   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.

острая лучевая болезньдиагностикабиодозиметриялечениемиелостимуляциятрансплантация костного мозгаacute radiation syndromediagnosisbiodosimetrytreatmentgrowth factorsallogeneic hematopoietic stem cell transplantationИсследование не имело спонсорской поддержкиThe study had no sponsorshipReferencesInternational Atomic Energy Agency. Medical management of radiation injuries, Safety Reports Series No. 101. Vienna: IAEA; 2020.International Atomic Energy Agency. Medical management of radiation injuries, Safety Reports Series No. 101. Vienna: IAEA; 2020.Радиационная медицина: руководство для врачей-исследователей и организаторов здравоохранения. Т. 2: Радиационные поражения человека. Под ред. Л.А. Ильина. М.: ИздАТ, 2001.Radiation medicine: A guide for medical researchers and public health organizers. Vol. 2: Radiation damage to humans. Edited by L.A. Iljin. Moscow: IzdAT Publ.; 2001. (In Russian).Swartz H.M., Flood A.B., Gougelet R.M., et al. A critical assessment of biodosimetry methods for large-scale incidents. Helth Phys. 2010; 98(2): 95–107. DOI: 10.1097/HP.0b013e3181b8cffd.Swartz H.M., Flood A.B., Gougelet R.M., et al. A critical assessment of biodosimetry methods for large-scale incidents. Helth Phys. 2010; 98(2): 95–107. DOI: 10.1097/HP.0b013e3181b8cffd.Олесова В.Н., Смельцов А.В., Илевич Ю.Р. и др. Применение ЭПР-дозиметрии на мини-пробах эмали зуба. Российский стоматологический журнал. 2010; 4: 15–7.Olesova V.N., Smeltsov A.V., Ilevich Y. R., et al. Application of EPR dosimetry on mini-samples of tooth enamel. Rossiyskiy Stomatologicheskiy Zurnal. 2010; 4: 15–7. (In Russian).Крючков В.П., Кочетков О.А., Цовьянов А.Г. Радиационно-дозиметрические аспекты ликвидации последствий аварии на Чернобыльской АЭС. М.: ИздАТ; 2011.Kryuchkov V.P., Kochetkov O.A., Tsovyanov A.G. Radiation-dosimetric aspects of liquidation of the consequences of the Chernobyl accident. Moscow: IzdAT Publ.; 2011. (In Russian).Romanyukha A., Trompier F., Reyes R.A. Q-band electron paramagnetic resonance dosimetry in tooth enamel: Biopsy procedure and determination of dose detection limit. Rad Environ Biophys. 2014; 53(2): 305–10.Romanyukha A., Trompier F., Reyes R.A. Q-band electron paramagnetic resonance dosimetry in tooth enamel: Biopsy procedure and determination of dose detection limit. Rad Environ Biophys. 2014; 53(2): 305–10.Mendelsohn M.L. Introduction to biological dosimetry. New horizons in biological dosimetry: proceedings of the International Symposium on Trends in Biological Dosimetry, held in Lerici, Italy, October 23–27, 1990. Eds. B.L. Gledhill, F. Mauro. New York: Wiley-Liss, Inc.; 1991.Mendelsohn M.L. Introduction to biological dosimetry. New horizons in biological dosimetry: proceedings of the International Symposium on Trends in Biological Dosimetry, held in Lerici, Italy, October 23–27, 1990. Eds. B.L. Gledhill, F. Mauro. New York: Wiley-Liss, Inc.; 1991.Lloyd D., Edwards A., Moquet J., et al. Doses in radiation accidents investigated by Chromosome aberration analysis. XXI. Review of cases investigated, 1994–1996. Chilton: National Radiological Protection Board; 1996.Lloyd D., Edwards A., Moquet J., et al. Doses in radiation accidents investigated by Chromosome aberration analysis. XXI. Review of cases investigated, 1994–1996. Chilton: National Radiological Protection Board; 1996.Владимиров В.Г. Предисловие. В кн.: Радиобиологические подходы к диагностике лучевых поражений: сборник научных трудов. Л.; 1987: 3–5.Vladimirov V.G. Foreword. In: Radiobiological approaches to diagnosis of radiation lesions. (Collection of scientific papers). Leningrad; 1987: 3–5. (In Russian).Fliedner T.M., Friesecke I., Beyrer K. (eds). Medical management of radiation accidents: Management of the acute radiation syndrome. London: The British Institute of Radiology; 2001.Fliedner T.M., Friesecke I., Beyrer K. (eds). Medical management of radiation accidents: Management of the acute radiation syndrome. London: The British Institute of Radiology; 2001.Bender M.A., Gooch P.C. Persistent chromosome aberrations in irradiated human subjects. Radiat Res. 1962; 16: 44–53.Bender M.A., Gooch P.C. Persistent chromosome aberrations in irradiated human subjects. Radiat Res. 1962; 16: 44–53.Bender M.A., Gooch P.C. Types and rates of X-ray-induced chromosome aberration yields in human blood irradiated in vitro. Proc Nat Acad Sci U S A. 1962; 48(4): 522–32. DOI: 10.1073/pnas.48.4.522.Bender M.A., Gooch P.C. Types and rates of X-ray-induced chromosome aberration yields in human blood irradiated in vitro. Proc Nat Acad Sci U S A. 1962; 48(4): 522–32. DOI: 10.1073/pnas.48.4.522.Cytogenetic dosimetry: Applications in preparedness for and response to radiation emergencies. Vienna: IAEA; 2011.Cytogenetic dosimetry: Applications in preparedness for and response to radiation emergencies. Vienna: IAEA; 2011.Нугис В.Ю., Козлова М.Г., Никитина В.А. Современное состояние проблемы цитогенетической индикации дозы. Сборник статей, посвященных 70-летию ФГБУ «ГНЦ РФ — ФМБЦ имени А.И. Бурназяна» (1946–2016 гг.). Под общ. ред. Л.А. Ильина, В.В. Уйба, А.С. Самойлова. М.: ФГБУ ГНЦ ФМБЦ им. А.И. Бурназяна ФМБА России; 2016: 222–37.Nugis V.Yu., Kozlova M.G., Nikitina V.A. Current state of the problem of cytogenetic dose indication. A collection of articles dedicated to the 70th anniversary of the Federal State Budgetary Institution “SCC of the Russian Federation — FMBC named after A.I. Burnazyan” (1946–2016). L.А. Ilyin, V.V. Uyb, А.S. Samoilov, eds. Moscow: FSBI SCC FMBC named after A.I. Burnazyan FMBA Russia; 2016: 222–37. (In Russian).Abe Y., Miura T., Yoshida M.A., et al. Increase in dicentric chromosome formation after a single CT scan in adults. Sci Rep. 2015; 5: 13882. DOI: 10.1038/srep13882.Abe Y., Miura T., Yoshida M.A., et al. Increase in dicentric chromosome formation after a single CT scan in adults. Sci Rep. 2015; 5: 13882. DOI: 10.1038/srep13882.M’kacher R., Maalouf E.E.L., Ricoul M., et al. New tool for biological dosimetry: Reevaluation and automation of the gold standard method following telomere and centromere staining. Mutat Res. 2014; 770: 45–53. DOI: 10.1016/j.mrfmmm.2014.09.007.M’kacher R., Maalouf E.E.L., Ricoul M., et al. New tool for biological dosimetry: Reevaluation and automation of the gold standard method following telomere and centromere staining. Mutat Res. 2014; 770: 45–53. DOI: 10.1016/j.mrfmmm.2014.09.007.Sullivan J.M., Prasanna P.G.S., Grace M.B., et al. Assessment of biodosimetry methods for a mass-casualty radiological incident: Medical response and management considerations. Health Phys. 2013; 105(6): 540–54. DOI: 10.1097/HP.0b013e31829cf221.Sullivan J.M., Prasanna P.G.S., Grace M.B., et al. Assessment of biodosimetry methods for a mass-casualty radiological incident: Medical response and management considerations. Health Phys. 2013; 105(6): 540–54. DOI: 10.1097/HP.0b013e31829cf221.Севанькаев А.В., Хвостунов И.К., Снигирева Г.П. и др. Сравнительный анализ результатов цитогенетических обследований контрольных групп лиц в различных отечественных лабораториях. Радиационная биология. Радиоэкология. 2013; 53(1): 5–24. DOI: 10.7868/S0869803112060124.Sevan’kaev A.V., Khvostunov I.K., Snigiryova G.P., et al. Comparative analysis of cytogenetic examination of control groups of subjects carried out in different Russian laboratories. Radiationnaya biologiya. Radioecologiyа. 2013; 53(1): 5–24. DOI: 10.7868/S0869803112060124. (In Russian).Чирков А.А., Чистопольский А.С., Нугис В.Ю. О влиянии мощности дозы на прогноз динамики количества нейтрофилов в крови по результатам цитогенетического анализа лимфоцитов у лиц, пострадавших при аварии на Чернобыльской АЭС. Медицинская радиология. 1991; 36(1): 36–8.Chirkov A.A., Chistopolsky A.S., Nugis V.Yu. The effect of the dose on the prognosis of the time course of the blood neutrophil count on the basis of cytogenetic findings of lymphocytes in the affected population at the Chernobyl accident. Meditsinskaya radiologiya. 1991; 36(1): 36–8. (In Russian).Нугис В.Ю., Дудочкина Н.Е. Закономерности элиминации аберраций хромосом у людей после острого облучения по данным культивирования лимфоцитов периферической крови в отдаленные сроки. Радиационная биология. Радиоэкология. 2006; 46(1): 5–15.Nugis V.Yu., Dudochkina N.Eu. The regularities of chromosome aberrations elimination in lymphocyte cultures of the peripheral blood of people in late times after acute irradiation. Radiationnaya biologiya. Radioecologiyа. 2006; 46(1): 5–15. (In Russian).Huber R., Kulka U., Lörch T., et al. Automated metaphase finding: An assessment of the efficiency of the METAFER2 system in a routine mutagenicity assay. Mutat Res. 1995; 334(1): 97–102. DOI: 10.1016/0165-1161(95)90035-7.Huber R., Kulka U., Lörch T., et al. Automated metaphase finding: An assessment of the efficiency of the METAFER2 system in a routine mutagenicity assay. Mutat Res. 1995; 334(1): 97–102. DOI: 10.1016/0165-1161(95)90035-7.Sun M., Moquet J.E., Barnard S., et al. Doses in radiation accidents investigated by chromosomal aberration analysis XXV. Review of cases investigated, 2006–2015. Chilton, Didcot: Centre for Radiation, Chemical and Environmental Hazards, Public Health England; 2016.Sun M., Moquet J.E., Barnard S., et al. Doses in radiation accidents investigated by chromosomal aberration analysis XXV. Review of cases investigated, 2006–2015. Chilton, Didcot: Centre for Radiation, Chemical and Environmental Hazards, Public Health England; 2016.Rogan P.K., Li Y., Wilkins R., et al. Radiation dose estimation by automated cytogenetic biodosimetry. Radiat Prot Dosimetry. 2016; 172(1–3): 207–17. DOI: 10.1093/rpd/ncw161.Rogan P.K., Li Y., Wilkins R., et al. Radiation dose estimation by automated cytogenetic biodosimetry. Radiat Prot Dosimetry. 2016; 172(1–3): 207–17. DOI: 10.1093/rpd/ncw161.Fenech M. Cytokinesis-block micronucleus cytome assay. Nat Protoc. 2007; 2(5): 1084–104. DOI: 10.1038/nprot.2007.77.Fenech M. Cytokinesis-block micronucleus cytome assay. Nat Protoc. 2007; 2(5): 1084–104. DOI: 10.1038/nprot.2007.77.Kenzhina L.B., Mamyrbayeva A.N., Lukashenko S.N., et al. Background level of unstable chromosome aberrations in the Kazakhstan population: A human biomonitoring study. Int J Environ Res Public Health. 2022; 19(14): 8485. DOI: 10.3390/ijerph19148485.Kenzhina L.B., Mamyrbayeva A.N., Lukashenko S.N., et al. Background level of unstable chromosome aberrations in the Kazakhstan population: A human biomonitoring study. Int J Environ Res Public Health. 2022; 19(14): 8485. DOI: 10.3390/ijerph19148485.Нугис В.Ю., Чирков А.А. Способ оценки дозы и величины облученного объема тела при частичном радиационном поражении по результатам цитогенетического анализа культур лимфоцитов периферической крови. Радиобиология. 1989; 29(6): 838–40.Nugis V.Yu., Chirkov A.A. Estimation of dose and body volume affected by partial irradiation by the results of the cytogenetic analysis of peripheral blood lymphocyte cultures. Radiobiologiya. 1989; 29(6): 838–40. (In Russian).Пяткин Е.К., Филюшкин И.В., Нугис В.Ю. Оценка равномерности облучения по результатам цитогенетического исследования лимфоцитов периферической крови человека. Терапевтический архив. 1986; 58(9): 30–3.Pyatkin Е.K., Filyushkin I.V., Nugis V.Yu. Evaluation of radiation evenness by cytogenetic study of human peripheral blood lymphocytes. Terapevticheskii arkhiv. 1986; 58(9): 30–3. (In Russian).Филюшкин И.В., Нугис В.Ю., Чистопольский А.С. Сравнительный цитогенетический анализ культур облученных лимфоцитов и смешанных культур облученных и необлученных клеток. Медицинская радиология и радиационная безопасность. 1999; 44(3): 19–26.Filyushkin I.V., Nugis V.Yu., Chistopolskij A.S. Comparative cytogenetic analysis of cultures of irradiated lymphocytes and mixed cultures of irradiated and nonirradiated cells. Mediеtsinskaya Radiologiyа I Radiatsionaya Вesopasnost. 1999; 44(3): 19–26. (In Russian).Гуськова А.К., Надежина Н.М., Метляева Н.А. и др. Острая лучевая болезнь. В кн.: Реакции организма человека на воздействие опасных и вредных производственных факторов. Т. 2. М.; 1991: 173–89.Guskova A.K., Nadejina N.M., Metlyaeva N.A., et al. Acute radiation disease. In: Reactions of the human body to the effects of hazardous and harmful production factors Vol. 2. Moscow:1991; 173–89. (In Russian).Пяткин Е.К., Покровская В.Н., Триска В.В. Частота хромосомных аберраций в культурах лимфоцитов костного мозга и периферической крови человека после γ-облучения in vitro. Медицинская радиология. 1980; 25(2): 44–8.Pyatkin Е.К., Pokrovskaya V.N., Triska V.V. Frequency of chromosomal aberrations in lymphocyte cultures of the bone marrow and peripheral blood of man after γ-irradiation in vitro. Meditsinskaya radiologiya. 1980; 25(2): 44–8. (In Russian).Baranov A.E., Konchalovski M.V., Soloviev W.Yu., Guskova A.K. Use of blood cell count changes after radiation exposure in dose assessment and evaluation of bone marrow function. The medical basis for radiation accident preparedness II. Clinical experience and follow-up since 1979. Proceedings of the Second International REAC/TS Conference on the Medical Basis for Radiation Accident Preparedness, October 20–22, 1988. New York: Elsevier; 1990: 427–44.Baranov A.E., Konchalovski M.V., Soloviev W.Yu., Guskova A.K. Use of blood cell count changes after radiation exposure in dose assessment and evaluation of bone marrow function. The medical basis for radiation accident preparedness II. Clinical experience and follow-up since 1979. Proceedings of the Second International REAC/TS Conference on the Medical Basis for Radiation Accident Preparedness, October 20–22, 1988. New York: Elsevier; 1990: 427–44.Нугис В.Ю. Прогноз пострадиационной динамики числа нейтрофилов крови в случаях острого неравномерного облучения (цитогенетические исследования). Радиационная биология. Радиоэкология. 2018; 58(5): 498– 510. DOI: 10.1134/S0869803118040112.Nugis V.Yu. Prognosis of dynamics of radiation-induced blood neutrophil count according to the results of cytogenetic research of the peripheral blood lymphocyte cultures in cases of acute non-uniform exposures (cytogenetic investigations). Radiationnaya biologiya. Radioecologiyа. 2018; 58(5): 498–510. DOI: 10.1134/S0869803118040112. (In Russian).Баранов А.Е. Острая лучевая болезнь: биологическая дозиметрия, ранняя диагностика и лечение, исходы и отдаленные последствия. В кн.: Радиационные поражения человека. Избранные клинические лекции, методическое пособие. Под ред. А.В. Барабановой, А.Е. Баранова, А.Ю. Бушманова, А.К. Гуськовой. М.: Слово; 2007: 53–84.Baranov A.E. Acute radiation syndrome: Biological dosimetry, early diagnosis and treatment, outcomes and long-term consequences. In: Radiation damage to humans. Selected clinical lectures, methodological guide. A.V. Barabanova, A.E. Baranov, A.Y. Bushmanov, A.K. Guskova (eds). Moscow: Slovo; 2007: 53–84. (In Russian).Ossetrova N.I., Fares A.M., MacVittie T.J., et al. The use of discriminant analysis for evaluation of early-response multiple biomarkers of radiation exposure using nonhuman primate 6-Gy whole-body radiation model. Radiat Meas. 2007; 42: 1158–63. DOI: 10.1016/j.radmeas.2007.05.031.Ossetrova N.I., Fares A.M., MacVittie T.J., et al. The use of discriminant analysis for evaluation of early-response multiple biomarkers of radiation exposure using nonhuman primate 6-Gy whole-body radiation model. Radiat Meas. 2007; 42: 1158–63. DOI: 10.1016/j.radmeas.2007.05.031.Blalely W.F., Ossetrova N.I., Whitnall M.N., et al. Multiple parameter radiation injury assessment using a nonhuman primate radiation model-biodosimetry applications. Health Phys. 2010; 98(2): 153–9. DOI: 10.1097/HP.0b013e3181b0306d.Blalely W.F., Ossetrova N.I., Whitnall M.N., et al. Multiple parameter radiation injury assessment using a nonhuman primate radiation model-biodosimetry applications. Health Phys. 2010; 98(2): 153–9. DOI: 10.1097/HP.0b013e3181b0306d.Maltsev V.N., Ivanov A.A., Mikhailov V.F. Mazurik V.K. The individual prognosis of the gravity and of the outcome of acute radiation disease based on immunological indexes. Radiat Biol Radioecol. 2006; 46(2): 152–8.Maltsev V.N., Ivanov A.A., Mikhailov V.F. Mazurik V.K. The individual prognosis of the gravity and of the outcome of acute radiation disease based on immunological indexes. Radiat Biol Radioecol. 2006; 46(2): 152–8.Cengiz M., Akbulut S., Atahan I.L., Grigsby P.W. Acute phase response during radiotherapy. Int J Radiat Oncol Biol Phys. 2001; 49(4): 1093–6. DOI: 10.1016/s0360-3016(00)01426-7.Cengiz M., Akbulut S., Atahan I.L., Grigsby P.W. Acute phase response during radiotherapy. Int J Radiat Oncol Biol Phys. 2001; 49(4): 1093–6. DOI: 10.1016/s0360-3016(00)01426-7.Chen I.W., Kereiakes J.G., Silberstein E.B., et al. Radiation-induced change in serum and urinary amylase levels in man. Radiat Res. 1973; 54(1): 141–51.Chen I.W., Kereiakes J.G., Silberstein E.B., et al. Radiation-induced change in serum and urinary amylase levels in man. Radiat Res. 1973; 54(1): 141–51.Akashi M., Hirama T., Tanosaki S., et al. Initial symptoms of acute radiation syndrome in the JCO criticality accident in Tokai-mura. J Radiat Res. 2001; 42(Suppl): S157–66. DOI: 10.1269/jrr.42.s157.Akashi M., Hirama T., Tanosaki S., et al. Initial symptoms of acute radiation syndrome in the JCO criticality accident in Tokai-mura. J Radiat Res. 2001; 42(Suppl): S157–66. DOI: 10.1269/jrr.42.s157.Jaworska A., Ainsbury E.A., Fattibene A., et al. Operational guidance for radiation emergency response organisations in Europe for using biodosimetric tools developed in EU MULTIBIODOSE project. Radiat Prot Dosim. 2015; 164(1–2): 165–9. DOI: 10.1093/rpd/ncu294.Jaworska A., Ainsbury E.A., Fattibene A., et al. Operational guidance for radiation emergency response organisations in Europe for using biodosimetric tools developed in EU MULTIBIODOSE project. Radiat Prot Dosim. 2015; 164(1–2): 165–9. doi: 10.1093/rpd/ncu294.Ramphal R., Gucalp R., Rotstein C., et al. Clinical experience with single agent and combination regimens in the management of infection in the febrile neutropenic patients. Am J Med. 1996; 100(6A): 83S–89S. DOI: 10.1016/s0002-9343(96)00113-1.Ramphal R., Gucalp R., Rotstein C., et al. Clinical experience with single agent and combination regimens in the management of infection in the febrile neutropenic patients. Am J Med. 1996; 100(6A): 83S–89S. DOI: 10.1016/s0002-9343(96)00113-1.Information on Cefepime (marketed as Maxipime). U. S. Food and Drug Administration. 2015. URL: https://www.fda.gov/drugs/postmarket-drug-safetyinformation-patients-and-providers/information-cefepime-marketed-maxipime.Information on Cefepime (marketed as Maxipime). U. S. Food and Drug Administration. 2015. URL: https://www.fda.gov/drugs/postmarket-drug-safetyinformation-patients-and-providers/information-cefepime-marketed-maxipime.Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group. J Infect Dis. 1991; 163(5): 951–8.Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group. J Infect Dis. 1991; 163(5): 951–8.Shenep J.L., Hughes W.T., Roberson P.K., et al. Vancomycin, ticarcillin, and amikacin compared with ticarcillin-clavulanate and amikacin in the empirical treatment of febrile, neutropenic children with cancer. N Engl J Med. 1988; 319(16): 1053–8. DOI: 10.1056/NEJM198810203191604.Shenep J.L., Hughes W.T., Roberson P.K., et al. Vancomycin, ticarcillin, and amikacin compared with ticarcillin-clavulanate and amikacin in the empirical treatment of febrile, neutropenic children with cancer. N Engl J Med. 1988; 319(16): 1053–8. DOI: 10.1056/NEJM198810203191604.Lin M.Y, Hayden M.K. Methicillin-resistant Staphylococcus aureus and vancomycin-resistent enterococcus: Recognition and prevention in intensive care units. Crit Care Med. 2010; 38(8 Suppl): S335–44. DOI: 10.1097/CCM.0b013e3181e6ab12.Lin M.Y, Hayden M.K. Methicillin-resistant Staphylococcus aureus and vancomycin-resistent enterococcus: Recognition and prevention in intensive care units. Crit Care Med. 2010; 38(8 Suppl): S335–44. DOI: 10.1097/CCM.0b013e3181e6ab12.Mermel L.A., Allon M., Bouza E., et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 49(1): 1–45. DOI: 10.1086/599376.Mermel L.A., Allon M., Bouza E., et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 49(1): 1–45. DOI: 10.1086/599376.Neofytos D., Horn D., Anaissie E., et al. Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis. 2009; 48(3): 265–73. DOI: 10.1086/595846.Neofytos D., Horn D., Anaissie E., et al. Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis. 2009; 48(3): 265–73. DOI: 10.1086/595846.Bhatti Z., Shaukat A., Almyroudis N.G., Segal B.H. Review of epidemiology, diagnosis, and treatment of invasive mould infections in allogeneic hematopoietic stem cell transplant recipients. Mycopathologia. 2006; 162(1): 1–15. DOI: 10.1007/s11046-006-0025-x.Bhatti Z., Shaukat A., Almyroudis N.G., Segal B.H. Review of epidemiology, diagnosis, and treatment of invasive mould infections in allogeneic hematopoietic stem cell transplant recipients. Mycopathologia. 2006; 162(1): 1–15. DOI: 10.1007/s11046-006-0025-x.Michallet M., Ito J.I. Approaches to the management of invasive fungal infections in hematological malignancy and hematoietic cell transplantation. J Clin Oncol. 2009; 27(20): 3398–409. DOI: 10.1200/JCO.2008.20.1178.Michallet M., Ito J.I. Approaches to the management of invasive fungal infections in hematological malignancy and hematoietic cell transplantation. J Clin Oncol. 2009; 27(20): 3398–409. DOI: 10.1200/JCO.2008.20.1178.Pizzo P.A., Robichaud K.J., Gill F.A., Witebsky F.G. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med. 1982; 72(1): 101–11. DOI: 10.1016/0002-9343(82)90594-0.Pizzo P.A., Robichaud K.J., Gill F.A., Witebsky F.G. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med. 1982; 72(1): 101–11. DOI: 10.1016/0002-9343(82)90594-0.Staber P., Langner S., Dornbusch H.J., Neumeister P. Antifungal management in cancer patients. Wien Med Wochenschr. 2007; 157(19–20): 503–10. DOI: 10.1007/s10354-007-0466-y.Staber P., Langner S., Dornbusch H.J., Neumeister P. Antifungal management in cancer patients. Wien Med Wochenschr. 2007; 157(19–20): 503–10. DOI: 10.1007/s10354-007-0466-y.Walsh T.J., Finberg R.W., Arndt C., et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med. 1999; 340(10): 764–71. DOI: 10.1056/NEJM199903113401004.Walsh T.J., Finberg R.W., Arndt C., et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med. 1999; 340(10): 764–71. DOI: 10.1056/NEJM199903113401004.Meyers J.D., Flournoy N., Thomas E.D. Infection with herpes simplex virus and cell-mediated immunity after marrow transplant. J Infect Dis. 1980; 142(3): 338–46. DOI: 10.1093/infdis/142.3.338.Meyers J.D., Flournoy N., Thomas E.D. Infection with herpes simplex virus and cell-mediated immunity after marrow transplant. J Infect Dis. 1980; 142(3): 338–46. DOI: 10.1093/infdis/142.3.338.Saral R., Ambinder R.F., Burns W.H., et al. Acyclovir prophylaxis against herpes simplex virus infection in patients with leukemia. A randomized, doubleblind, placebo-controlled study. Ann Intern Med. 1983; 99(6): 773–6. DOI: 10.7326/0003-4819-99-6-773.Saral R., Ambinder R.F., Burns W.H., et al. Acyclovir prophylaxis against herpes simplex virus infection in patients with leukemia. A randomized, double-blind, placebo-controlled study. Ann Intern Med. 1983; 99(6): 773–6. DOI: 10.7326/0003-4819-99-6-773.Greenberg R.N., Mullane K., van Burik J.A.H., et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. 2006; 50(1): 126–33. DOI: 10.1128/AAC.50.1.126-133.2006.Greenberg R.N., Mullane K., van Burik J.A.H., et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. 2006; 50(1): 126–33. DOI: 10.1128/AAC.50.1.126-133.2006.Pitisuttitsum P., Negroni R., Graybill J.R., et al. Activity of posaconazole in the treatment of central nervous system fungal infections. J Antimicrob Chemother. 2005; 56(4): 745–55. DOI: 10.1093/jac/dki288.Pitisuttitsum P., Negroni R., Graybill J.R., et al. Activity of posaconazole in the treatment of central nervous system fungal infections. J Antimicrob Chemother. 2005; 56(4): 745–55. DOI: 10.1093/jac/dki288.Raad I.I., Graibill J.R., Bustamante A.B., et al. Safety of long-term oral posaconazole use in the treatment of refractory invasive-fungal infections. Clin Infect Dis. 2006; 42(12): 1726–34. DOI: 10.1086/504328.Raad I.I., Graibill J.R., Bustamante A.B., et al. Safety of long-term oral posaconazole use in the treatment of refractory invasive-fungal infections. Clin Infect Dis. 2006; 42(12): 1726–34. DOI: 10.1086/504328.Raad I.I., Hachem R.Y., Herbrecht R., et al. Posaconazole as salvage treatment for invasive fusariosis in patients with underlying hematologic malignancy and other conditions. Clin Infect Dis. 2006; 42(10): 1398–403. DOI: 10.1086/503425.Raad I.I., Hachem R.Y., Herbrecht R., et al. Posaconazole as salvage treatment for invasive fusariosis in patients with underlying hematologic malignancy and other conditions. Clin Infect Dis. 2006; 42(10): 1398–403. DOI: 10.1086/503425.Meersseman W., Lagrou K., Maertens J., et al. Galactomannan in bronchoalveolar lavage fluid: A tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med. 2008; 177(1): 27–34. DOI: 10.1164/rccm.200704-606OC.Meersseman W., Lagrou K., Maertens J., et al. Galactomannan in bronchoalveolar lavage fluid: A tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med. 2008; 177(1): 27–34. DOI: 10.1164/rccm.200704-606OC.Wheat L.J., Walsh T.J. Diagnosis of invasive aspergillosis by galactomannan antigenemia detection using an enzyme immunoassay. Eur J Clin Microbiol Infect Dis. 2008; 27(4): 245–51. DOI: 10.1007/s10096-007-0437-7.Wheat L.J., Walsh T.J. Diagnosis of invasive aspergillosis by galactomannan antigenemia detection using an enzyme immunoassay. Eur J Clin Microbiol Infect Dis. 2008; 27(4): 245–51. DOI: 10.1007/s10096-007-0437-7.De Pauw B., Walsh T.J., Donnelly J.P., et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008; 46(12): 1813–21. DOI: 10.1086/588660.De Pauw B., Walsh T.J., Donnelly J.P., et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008; 46(12): 1813–21. DOI: 10.1086/588660.Michallet M., Ito J.I. Approaches to the management of invasive fungal infections in hematologic malignancy and hematopoietic cell transplantation. J Clin Oncol. 2009; 27(20): 3398–409. DOI: 10.1200/JCO.2008.20.1178.Michallet M., Ito J.I. Approaches to the management of invasive fungal infections in hematologic malignancy and hematopoietic cell transplantation. J Clin Oncol. 2009; 27(20): 3398–409. DOI: 10.1200/JCO.2008.20.1178.Walsh T.J., Pappas P., Winston D.J., et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med. 2002; 346(4): 225–34. DOI: 10.1056/NEJM200201243460403.Walsh T.J., Pappas P., Winston D.J., et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med. 2002; 346(4): 225–34. DOI: 10.1056/NEJM200201243460403.Powers J.H., Dixon C.A., Goldberger M.J. Voriconazole versus liposomal amphotericin B in patients with neutropenia and persistent fever. N Engl J Med. 2002; 346: 289–90. DOI: 10.1056/NEJM200201243460414.Powers J.H., Dixon C.A., Goldberger M.J. Voriconazole versus liposomal amphotericin B in patients with neutropenia and persistent fever. N Engl J Med. 2002; 346: 289–90. DOI: 10.1056/NEJM200201243460414.Levine S.J. An approach to the diagnosis of pulmonary infections in immune-supressed patients. Semin Respir Infect. 1992; 7(2): 81–95.Levine S.J. An approach to the diagnosis of pulmonary infections in immune-supressed patients. Semin Respir Infect. 1992; 7(2): 81–95.Reusser P., Einsele H., Lee J., et al. Randomized multicenter trial of foscarnet versus gancyclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood. 2002; 99(4): 1159–64. DOI: 10.1182/blood.v99.4.1159.Reusser P., Einsele H., Lee J., et al. Randomized multicenter trial of foscarnet versus gancyclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood. 2002; 99(4): 1159–64. DOI: 10.1182/blood.v99.4.1159.Linden P.K., Moellering R.C., Wood C.A., et al. Treatment of vancomycinresistant Enterococcus faecium infections with quinupristin/dalfopristin. Clin Infect Dis. 2001; 33(11): 1816–23. DOI: 10.1086/323899.Linden P.K., Moellering R.C., Wood C.A., et al. Treatment of vancomycinresistant Enterococcus faecium infections with quinupristin/dalfopristin. Clin Infect Dis. 2001; 33(11): 1816–23. DOI: 10.1086/323899.Mave V., Garcia-Diaz R., Islam T., Hasbun R. Vancomycin-resistant enterococcal bacteraemia: Is daptomycin as effective as linezolid? J Antimicrob Chemother. 2009; 64(1): 175–80. DOI: 10.1093/jac/dkp154.Mave V., Garcia-Diaz R., Islam T., Hasbun R. Vancomycin-resistant enterococcal bacteraemia: Is daptomycin as effective as linezolid? J Antimicrob Chemother. 2009; 64(1): 175–80. DOI: 10.1093/jac/dkp154.Moellering R.C. Linezolid: The first oxazolidinone antimicrobial. Ann Intern Med. 2003; 138(2): 135–42. doi: 10.7326/0003-4819-138-2-200301210-00015.Moellering R.C. Linezolid: The first oxazolidinone antimicrobial. Ann Intern Med. 2003; 138(2): 135–42. doi: 10.7326/0003-4819-138-2-200301210-00015.Moise P.A., Forrest A., Birmingham M.C., Schentag J.J. The efficacy and safety of linezolid as treatment for Staphylococcus aureus infections in compassionate use patients who are intolerant of, or who have failed to respond to vancomycin. J Antimicrob Chemother. 2002; 50(6): 1017–26. DOI: 10.1093/jac/dkf215.Moise P.A., Forrest A., Birmingham M.C., Schentag J.J. The efficacy and safety of linezolid as treatment for Staphylococcus aureus infections in compassionate use patients who are intolerant of, or who have failed to respond to vancomycin. J Antimicrob Chemother. 2002; 50(6): 1017–26. DOI: 10.1093/jac/dkf215.Shorr A.F., Kunkell M.J., Kollef M. Linezolid versus vancomycin for Staphylococcus aureus bacteraemia: Pooled analysis of randomized studies. J Antimicrob Chemother. 2005; 56(5): 923–9. DOI: 10.1093/jac/dki355.Shorr A.F., Kunkell M.J., Kollef M. Linezolid versus vancomycin for Staphylococcus aureus bacteraemia: Pooled analysis of randomized studies. J Antimicrob Chemother. 2005; 56(5): 923–9. DOI: 10.1093/jac/dki355.The radiological accident in Goiânia. Vienna: IAEA; 1988.The radiological accident in Goiânia. Vienna: IAEA; 1988.The radiological accident at the irradiation facility in Nesvizh. Vienna: IAEA; 1996.The radiological accident at the irradiation facility in Nesvizh. Vienna: IAEA; 1996.Птушкин В.В. Гемопоэтические факторы роста: биологические основы функционирования и клиническое применение. Материалы второй ежегодной Российской онкологической конференции «Современные тенденции развития лекарственной терапии опухолей». М.; 1998: 24–8.Ptushkin V.V. Hematopoietic growth factors: Biological bases of functioning and clinical application. Proceedings of the second annual Russian oncological conference “Modern trends in the development of drug therapy for tumors”. Moscow; 1998: 24–8. (In Russian).Баранов А.Е., Гейл Р.П., Гуськова А.К. Трансплантация костного мозга после общего облучения у пострадавших при аварии на Чернобыльской АЭС. Гематология и трансфузиология. 1989; 34(3): 3–16.Baranov A.E., Gayl R.P., Guskova A.K. Bone marrow transplantation after general irradiation in victims of the Chernobyl accident. Gematologiya I Transfusiologiya. 1989; 34(3): 3–16. (In Russian).Yao B., Jiang B.R., Ai H.S., et al. Biological dose estimation for two severely exposed patients in a radiation accident in Shandong Jining, China, in 2004. Int J Radiat Biol. 2010. 86(9): 800–8. DOI: 10.3109/09553002.2010.481320.Yao B., Jiang B.R., Ai H.S., et al. Biological dose estimation for two severely exposed patients in a radiation accident in Shandong Jining, China, in 2004. Int J Radiat Biol. 2010. 86(9): 800–8. DOI: 10.3109/09553002.2010.481320.Guo M., Dong Z., Qiao J., et al. Severe acute radiation syndrome: treatment of a lethally 60Co-source irradiated accident victim in China with HLA-mismatched peripheral blood stem cell transplantation and mesenchymal stem cells. J Radiat Res. 2014; 55(2): 205–9. DOI: 10.1093/jrr/rrt102.Guo M., Dong Z., Qiao J., et al. Severe acute radiation syndrome: treatment of a lethally 60Co-source irradiated accident victim in China with HLA-mismatched peripheral blood stem cell transplantation and mesenchymal stem cells. J Radiat Res. 2014; 55(2): 205–9. DOI: 10.1093/jrr/rrt102.Ricks R.C., Berger M.E., O’Hara F.M. The medical basis for radiation accident preparedness: The clinical care of victims. The Parthenon Publishing Group; 2002: 313–8.Ricks R.C., Berger M.E., O’Hara F.M. The medical basis for radiation accident preparedness: The clinical care of victims. The Parthenon Publishing Group; 2002: 313–8.Englund J.A., Sullivan C.J., Jordan M.C., et al. Respiratory syncytial virus infection in immunocompromised adults. Ann Intern Med. 1988; 109(3): 203–8. DOI: 10.7326/0003-4819-109-3-203.Englund J.A., Sullivan C.J., Jordan M.C., et al. Respiratory syncytial virus infection in immunocompromised adults. Ann Intern Med. 1988; 109(3): 203–8. DOI: 10.7326/0003-4819-109-3-203.Гуськова А.К., Баранов А.Е., Барабанова А.В. и др. Диагностика, клиническая картина и лечение острой лучевой болезни у пострадавших на Чернобыльской АЭС. Сообщение 2. Некостномозговые синдромы лучевых поражений. Терапевтический архив. 1989; 8: 99–103.Guskova A.K., Baranov A.E., Barabanova A.V., et al. Diagnosis, clinical picture and treatment of acute radiation sickness in victims of the Chernobyl nuclear power plant. Message 2. Extra-spinal syndromes of radiation lesions. Terapevticheskii arkhiv. 1989; 8: 99–103. (In Russian).Preston D.L., Shimisu D.A., Pierce D.A., et al. Studies of mortality of atomic bomb survivors. Report 13. Solid cancer and noncancer disease mortality 1950– 1997. Radiat Res. 2003; 160(4): 381–407. DOI: 10.1667/rr3049.Preston D.L., Shimisu D.A., Pierce D.A., et al. Studies of mortality of atomic bomb survivors. Report 13. Solid cancer and noncancer disease mortality 1950– 1997. Radiat Res. 2003; 160(4): 381–407. DOI: 10.1667/rr3049.Pierce D.A., Shimizu Y., Preston D.L., et al. Studies of the mortality of atomic bomb survivors. Report 12, Part I. Cancer: 1950–1990. Radiat Res. 1996; 146(1): 1–27. DOI: 10.2307/3579391.Pierce D.A., Shimizu Y., Preston D.L., et al. Studies of the mortality of atomic bomb survivors. Report 12, Part I. Cancer: 1950–1990. Radiat Res. 1996; 146(1): 1–27. DOI: 10.2307/3579391.

The authors declare that there are no conflicts of interest present.