国内外核应急医学救援装备建设与发展情况概要

目的研制一款在核化突发事件发生时能够迅速开设撤收、自动化程度高的洗消作业移动平台。方法通过文献检索和实地调研,摸索核化伤员去污洗消的实际需求,采用模块化设计,并通过专家论证法,完善移动平台设计细节。结果成功研制的洗消平台采用了电动螺纹推杆结构自动拓展方舱,可在3 min迅速展开,每小时可同时对重伤员(1人/h,≤5人/d)和中轻伤员(4人/h,≤20人/d)进行舱内洗消。同时针对突发核辐射与化学中毒事件卫生应急处置队伍的需求,分别完成装载平台、通信监控、综合保障等三个子系统模块设计。结论该款洗消平台能够快速启动应急响应,对受到核化污染的伤病员进行去污洗消,减少人员伤亡,避免污染扩散。     

Retrospective luminescence dosimetry: development of approaches to application in populated areas downwind of the Chernobyl NPP

The cumulative absorbed dose in fired-clay bricks collected from ten buildings in the populated contaminated settlement (137Cs, 1,470 kBq m(-2)) of Stary Vishkov, located 175 km downwind of the Chernobyl Nuclear Power Plant (NPP) in the Bryansk administrative region of Russia, was determined using luminescence techniques by five laboratories. At each location, the cumulative dose, after subtraction of the natural background dose, was translated to absorbed dose in air using conversion factors derived from Monte Carlo simulations. The simulations employed source distributions inferred from contemporary soil contamination data and also took into account heterogeneity of fallout deposition. At four locations the cumulative dose at a reference location was calculated, enabling the luminescence determinations to be compared directly with values of cumulative absorbed dose in air obtained using deterministic models. A "local" conversion factor was also derived from the Monte Carlo simulations for locations where the disturbance of soil was significant. Values of the "local" cumulative dose in air calculated using this factor were compared with those predicted using the deterministic models at each sampled location, allowing location factors to be calculated. The methodology developed is generally applicable to populated areas contaminated by radioactive fallout in which brick buildings are found. The sensitivity of the luminescence techniques for bricks from this region of Russia was sufficient to evaluate cumulative absorbed dose in brick due to fallout of less than 20 mGy.     

Magnitude of fission product depositions from atmospheric nuclear weapon test fallout in France

The external dose attributable to fallout from worldwide atmospheric nuclear testing, which represents about 40% of the total effective dose received before 2000, is dominated by specific fission products such as 95Zr, 104Ba, 106Ru, 103Ru, and 144Ce, which are far less well-documented than 90Sr and 137Cs. The depositions of these nuclides over France were calculated on the basis of activity measurements in air and rainwater samples collected from 1961 to 1977. These depositions were then compared to the same radionuclides activities measured in grass during that period. This study shows that the transfer and deposition processes occur in a very similar manner for all the studied radionuclides. Depositions calculated in this study, consistent in most cases with UNSCEAR estimates, constitute a good basis for the external dose assessment of nuclear weapon test fallout over Western Europe.     

The Chernobyl experience in the area of retrospective dosimetry

The Chernobyl accident, which occurred on 26 April 1986 at a nuclear power plant located less than 150 km north of Kiev, was the largest nuclear accident to date. The unprecedented scale of the accident was determined not only by the amount of released activity, but also by the number of workers and of the general public involved, and therefore exposed to increased doses of ionising radiation. Due to the unexpected and large scale of the accident, dosimetry techniques and practices were far from the optimum; personal dosimetry of cleanup workers (liquidators) was not complete, and there were no direct measurements of the exposures of members of the public. As a result, an acute need for retrospective dose assessment was dictated by radiation protection and research considerations. In response, substantial efforts have been made to reconstruct doses for the main exposed cohorts, using a broad variety of newly developed methods: analytical, biological and physical (electron paramagnetic resonance spectroscopy of teeth, thermoluminescence of quartz) and modelling. This paper reviews the extensive experience gained by the National Research Center for Radiation Medicine, Academy of Medical Sciences, Ukraine in the field of retrospective dosimetry of large cohorts of exposed population and professionals. These dose reconstruction projects were implemented, in particular, in the framework of epidemiological studies, designed to follow-up the medical consequences of the Chernobyl accident and study health effects of ionizing radiation, particularly Ukrainian-American studies of cataracts and leukaemia among liquidators.     

Comparison of retrospective luminescence dosimetry with computational modeling in two highly contaminated settlements downwind of the Chernobyl NPP

The cumulative absorbed dose in bricks collected from six buildings in two heavily contaminated settlements (137Cs > 2,000 kBq m(-2)) located downwind of the Chernobyl Nuclear Power Plant was determined using luminescence techniques by six laboratories. The settlements, Vesnianoje in Ukraine and Zaborie in Russia, are located in, respectively, proximal and distal locations relative to the Chernobyl Nuclear Power Plant. The luminescence determinations of cumulative dose in brick, after subtraction of the natural background dose, were translated to absorbed dose in air at a Reference Location using conversion factors derived from Monte Carlo simulations of photon transport. The simulations employed source distributions inferred from contemporary soil contamination data and also took into account heterogeneity of fallout deposition. This translation enables the luminescence determinations to be compared directly with values of cumulative absorbed dose obtained by computational modeling and also other dose reconstruction methods. For each sampled location the cumulative dose was calculated using three deterministic models, two of which are based on the attenuation of dose-rate with migration of radionuclides in soil and the third on historic instrumental gamma dose-rate data. The results of the comparison of the two methods indicate overall agreement within margins of +/-25%. The methodology developed is generally applicable and adaptable to areas contaminated by much lower levels of radioactive fallout in which brick buildings are found.     

Thyroid disease associated with exposure to the Nevada nuclear weapons test site radiation: a reevaluation based on corrected dosimetry and examination data

BACKGROUND: A study was begun in 1965 to 1966 to determine whether children exposed to radioactive iodine from nuclear weapons testing at the Nevada Test Site from 1951 through 1962 were at higher risk of thyroid disease. In 1993, we reported that among those examined in 1985 to 1986 (Phase II) there was an association between radiation from the Nevada Test Site and thyroid neoplasms. METHODS: We reevaluated the relationship between exposure to Nevada Test Site fallout and thyroid disease using newly corrected dose estimates and disease outcomes from the Phase II study. A prospective cohort of school children 12 to 18 years old living in Utah, Nevada, and Arizona was first examined for thyroid disease in 1965 to 1966 and reexamined in 1985 to 1986. In the Phase II report, 2497 subjects formed the basis for this analysis. Thyroid disease, including thyroid neoplasms and thyroiditis, was expressed as cumulative incidence and risk ratios (RRs) with a dose-response expressed as excess risk ratio (ERR/Gy). RESULTS: The RR between thyroid radiation dose in the highest dose group and thyroid neoplasms increased from 3.4 (in the earlier analysis) to 7.5. The RR for thyroiditis increased from 1.1 to 2.7 with an ERR/Gy of 4.9 (95% confidence interval = 2.0 to 10.0). There were too few malignant thyroid neoplasms to estimate risk. CONCLUSIONS: Persons exposed to radioactive iodine as children have an increased risk of thyroid neoplasms and autoimmune thyroiditis up to 30 years after exposure.     

High incidence of micronuclei in lymphocytes from residents of the area near the Semipalatinsk nuclear explosion test site

The Semipalatinsk area is highly contaminated with radioactive fallout from 40 years of continuous nuclear testing. The biological effects on human health in this area have not been studied. Significant remaining radioactivities include long-lived radioisotopes of 238,239,400Pu, 137Cs and 90Sr. To evaluate the long-term biological effects of the radioactive fallout, the incidence of micronuclei in lymphocytes from residents of the area was observed. Blood was obtained from 10 residents (5 females and 5 males, aged 47 to 55 years old) from each of the 3 areas of Znamenka, Dolon and Semipalatinsk, which are about 50-150 km from the nuclear explosion test site. For micronucleus assay, PHA-stimulated lymphocytes were cultured for 72 h and cytochalasin B was added at 44 h for detecting binuclear lymphocytes. Five thousand binuclear lymphocytes in each resident were scored. The means of micronucleus counts in 1,000 lymphocytes in residents of Semipalatinsk, Dolon and Znamenka were 16.3, 12.6, and 7.80, respectively, which were higher than those of the normal Japanese persons (4.66). These values were equivalent to the results obtained from 0.187-0.47 Gy of chronic exposure to gamma-rays at a dose rate of 0.02 cGy/min. The high incidence of micronuclei in residents of the Semipalatinsk nuclear test site area was mainly caused by internal exposure rather than external exposure received for the past 40 years.     

Spatial distribution of soil contamination by 137Cs and 239,240Pu in the village of Dolon near the Semipalatinsk nuclear test site: new information on traces of the radioactive plume from the 29 August 1949 nuclear test.

The village of Dolon located about 60 km northeast from the border of the Semipalatinsk Nuclear Test Site in Kazakhstan is one of the most affected inhabited settlements as a result of nuclear tests by the former USSR. Radioactive contamination in Dolon was mainly caused by the first USSR nuclear test on 29 August 1949. As part of the efforts to reconstruct the radiation dose in Dolon, Cs and Pu in soil samples collected from 26 locations in the vicinity of and within the village were measured to determine the width and position of the center-axis of the radioactive plume that passed over the village from the 29 August 1949 nuclear test. Measured soil inventories of Cs and Pu were plotted as a function of the distance from the supposed center-axis of the plume. A clear shape similar to a Gaussian function was observed in their spatial distributions with each maximum around a center-axis. It was suggested that the plume width that contaminated Dolon was at most 10 km and the real center-axis of the radioactive plume passed 0.7-0.9 km north of the supposed centerline. A peak-like shape with the maximum near the center-axis was also observed in the spatial distribution of the Pu/Cs activity ratio, which may reflect the fractionation effect between Pu and Cs during the deposition process. These results support the recently reported results. The data obtained here will provide useful information on the efforts to estimate radiation dose in Dolon as reliably as possible. Health Phys. 94(4):328-337; 2008.     

乙肝病毒e抗体检测在乙肝病毒既往感染者中的临床价值

摘要:目的　CMIA定量检测血清抗HBe在HBV既往感染者中的临床价值。方法　微粒子酶免疫分析法定量检测HBV-M。结果　抗HBc阴性组的抗HBe阳性率为0,抗HBe阳性组的抗HBc阳性率为100.00%;抗HBe阳性组和抗HBe阴性组抗HBc中位值分别为为9.61S/CO和 8.81S/CO,二者具有统计学差异（P＝0.03,0.01＜P＜0.05）;抗HBe阴性结果中,＜2.00S/CO者占92.35%。结论　HBV既往感染者外周血抗HBe阳性提示抗HBc也呈阳性,抗HBc阴性也可提示抗HBe阴性;抗HBe阳性组的抗HBc水平总体上高于抗HBe阴性组的抗HBc水平;CMIA法采用竞争法检测抗HBe其阴性结果大多数小于2S/CO。     

防控日本福岛核事故对北京地区影响的组织管理体系

目的建立核应急监测的组织管理体系,以有效防控日本福岛核事故对北京地区的影响。方法明确应对福岛核事故的防控目标与应急工作方针,采取有效的防控途径与实施程序,依据有关核事故实况信息、应急处置条例和技术规程进行核监测工作的组织管理。结果严密的组织管理体系,为核事故污染监测和防控提供了保障;防控队伍较高的专业素质和应急能力,保障了各项核污染监测工作的有序进行;密切的信息沟通、适度的公众宣传,有效稳定了社会环境和民众心态。结论在防控日本福岛核事故对北京地区影响的工作中,北京市疾病预防控制中心(CDC)的组织管理体系发挥了应有的职能,并取得了积极的成效,但仍需实施长期的应对计划并采取更强有力的应对策略。     

Micronucleus test in freshwater fish species: an evaluation of its sensitivity for application in field surveys

Brown trout, Salmo trutta, European eel, Anguilla anguilla, and European minnow, Phoxinus phoxinus, three fish species inhabiting European freshwater ecosystems, were evaluated for their use as in situ pollution biomarkers using the micronucleus test in renal erythrocytes. Experimental exposure (by immersion) to different concentrations of cyclophosphamide, colchicine, and cadmium showed that brown trout are more sensitive to the three compounds than minnows and eels. In situ surveys of wild freshwater ecosystems with different levels of pollution showed that minnows and eels living in polluted sites do not present higher micronuclei averages than those caught in clean rivers systems, whereas micronuclei are induced in brown trout inhabiting polluted sites. Our results demonstrated the suitability of brown trout for in situ biomonitoring of freshwater ecosystems as well as for laboratory tests using the micronucleus test.     

Electronic monitoring and health promotion: an evaluation of the E-MOVO Web site by adolescents

The explosive increase in Internet accessibility and use offers unique opportunities for providing health information to adolescents via the Internet. The purpose of this evaluation study was to explore the opinions of adolescents regarding an Internet-based health monitoring instrument and its individually tailored electronic feedback so that recommendations for improvement can be provided. A self-administered evaluation questionnaire was completed by 672 adolescents aged 12-18 years the Dutch equivalent of the 8th and 10th grade of secondary education. Semistructured group interviews were conducted with 53 adolescents to obtain more in-depth information regarding the monitoring questionnaire and the individually tailored feedback. All the respondents preferred the electronic monitoring questionnaire to a paper and pencil questionnaire and the individually tailored feedback was appraised rather favorably. However, 28% of the respondents claimed that the information was not new to them and 39% indicated that the information failed to provide them with additional insight into their behavior. In order to increase the number of adolescents reached, we recommend (i) embedding monitoring and feedback in school curriculum, (ii) providing immediate feedback and (iii) adapting tailored messages to educational levels and age. Although several improvements can and should be made, we conclude that the Internet-based monitoring questionnaire and the individually tailored feedback were appreciated by adolescents and are therefore a promising method for engaging adolescents in health promotion.     

An assessment of drinking-water supplies on the Hanford site: an evaluation conducted at a federal nuclear facility in southeastern Washington state

Drinking water is supplied to most U.S. Department of Energy (DOE) facilities on the Hanford Site by DOE-owned, contractor-operated pumping and distribution systems. Water is primarily obtained from the Columbia River, but some facilities use water from on-site groundwater wells. Because of the large amount of radioactive and chemical waste produced, stored, and disposed of at Hanford, some people are concerned that waste materials are contaminating on-site drinking-water supplies. This paper describes the drinking-water facilities and treatment requirements on the Hanford Site and summarizes radiological and non-radiological water quality data obtained from water samples collected from each drinking-water system in use during 2001 and 2002. Monitoring data show that Hanford-produced radionuclides are measurable in some drinking-water samples. The only non-radiological contaminants detected either were by-products of the chlorination process or came from off-site agricultural activities. Contaminant level values were, in all cases, below state and federal drinking-water limits. This information will provide assurance to current employees and future site developers that drinking water on the Hanford Site is safe for public consumption.     

汶川大地震3个月后灾区特殊人群的营养状况

目的 调查分析汶川大地震3个月后灾区婴幼儿、学龄前儿童、小学生、孕妇、乳母的营养状况.方法 2008年8月,在四川省茂县和绵竹、甘肃省康县和武都区部分乡镇村安置点,进行问卷调查、体格测量,同时测定血红蛋白含量,收集特殊人群的营养与健康状况信息,评价其营养状况.共调查36月龄以下婴幼儿236名,学龄前儿童48名,小学生368名,孕妇32名,乳母72名.调查了36月龄以下婴幼儿、学龄前儿童和小学生低体重率、生长迟缓率、贫血患病率、两周腹泻和呼吸道疾病患病率、食物摄入情况和营养相关疾病患病率,以及孕妇、乳母的贫血患病率、营养相关疾病患病率.结果 36月龄以下婴幼儿生长迟缓率为14.6%(34/236),贫血患病率为40.1%(61/236);两周内呼吸道疾病患病率为40.4%(95/236),腹泻患病率为30.2%(71/236).学龄前儿童低体重率为14.6%(7/48),生长迟缓率为14.6%(7/48),贫血患病率为39.6%(19/48).在校小学生生长迟缓率为6.3%(23/368),贫血患病率为12.2%(45/368).孕妇贫血率为53.9%(17/32).24.4%(18/72)的乳母患有贫血;45.8%(33/72)乳母的食物构成以谷类蔬菜为主,吃不到畜禽肉、水产类食品、蛋类、豆类及其制品、奶类及其制品的乳母分别为29名(40.3%)、32名(44.4%)、28名(38.9%)和53名(73.6%).结论 灾区特殊人群存在不同程度的营养不良状况,且膳食结构以植物性食物为主,肉类、蛋类和奶类的消费相对不足.     

Results of a cleanup and treatment test at the Nevada test site: evaluation of vacuum removal of Pu-contaminated soil

We have conducted experiments to evaluate the effectiveness of removing contaminated soils from the Nevada Test Site with a large truck-mounted vacuum cleaner. Our results show that this method is effective, relatively easy, and safe for equipment operators. With four passes of the truck-mounted vacuum, 92% of the 241Am (and the accompanying 239 + 240Pu) was removed and resuspension rates were reduced by more than 99%. The ecological impact was, however, serious in terms of soil erosion and destruction of small animal habitats. Compared to standard earth-moving techniques, vacuuming permits a significant reduction in the volume of soil collected to achieve the desired level of decontamination, and the volume reduction could result in cost savings for packaging, shipment, and burial. This cost savings would only be realized for projects involving decontamination of the top 5 cm of soil.     

The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation

Objective

To test whether two hospital-avoidance interventions altered rates of hospital use: “intermediate care” and “integrated care teams.”

Data Sources/Study Setting

Linked administrative data for England covering the period 2004 to 2009.

Study Design

This study was commissioned after the interventions had been in place for several years. We developed a method based on retrospective analysis of person-level data comparing health care use of participants with that of prognostically matched controls.

Data Collection/Extraction Methods

Individuals were linked to administrative datasets through a trusted intermediary and a unique patient identifier.

Principal Findings

Participants who received the intermediate care intervention showed higher rates of unscheduled hospital admission than matched controls, whereas recipients of the integrated care team intervention showed no difference. Both intervention groups showed higher rates of mortality than did their matched controls.

Conclusions

These are potentially powerful techniques for assessing impacts on hospital activity. Neither intervention reduced admission rates. Although our analysis of hospital utilization controlled for a wide range of observable characteristics, the difference in mortality rates suggests that some residual confounding is likely. Evaluation is constrained when performed retrospectively, and careful interpretation is needed.