一起辐射探伤事故中6名疑似受照人员的医学观察

目的 通过对一起辐射探伤事故中6名疑似受照人员的临床表现、外照射剂量估算及医学处理的总结,探讨事故成因及后果,为今后类似实践提供技术参考。 方法 疑似受照人员6名,结合病史问诊、体格检查及实验室检查分析其外周血淋巴细胞染色体“双着丝粒+环”畸变及外周血淋巴细胞微核;采用直接测量法估算物理剂量,计算累积剂量;采用焦虑自评量表、抑郁自评量表及卡特尔16项人格测验量表对疑似受照人员进行心理测试,评估其综合心理素质。 结果 6人临床表现上均有不同程度的不适主诉,体格检查未见明显异常,辅助检查发现几项异常结果,但均与辐射损伤无明显相关;有1人染色体分析细胞数1400中可见1个双着丝粒体,其余均未见异常畸变;物理剂量估算提示周围剂量当量率最大值为20.15 mSv/h,辐射累积剂量为0.67 mSv;心理测评结果表明有3名人员存在不同程度的焦虑与抑郁状态。 结论 6名疑似受照人员的各项结果均与电离辐射无关,均未受到急性大剂量电离辐射外照射,不会产生有临床意义的生物效应。     

胞质分裂阻滞微核法对辐射事故受照射人员的生物剂量估算

目的 探讨胞质分裂阻滞微核(CBMN)分析在估算辐射事故受照射者的生物剂量中的应用价值.方法 2008年山西太原辐射事故发生后16 h收集5名受照射者(1、2、3、4和5号)的外周血及I号的骨髓,进行CBMN分析,以微核(MN)频率估算生物剂量.对较严重的受照射者(1号)结合体外"co 1射线大剂量照射实验获得的核分裂...     

吉林192Ir源放射事故病人受照生物剂量(微核法)的估算

吉林１９２Ｉｒ源放射事故病人受照生物剂量（微核法）的估算蒋本荣姚波卢淑娟本文用胞浆分裂阻滞微核法（ＣＢＭＮ法），对吉林１９２Ｉｒ源辐射事故中１例受照者进行了生物剂量估算，结果与物理剂量、染色体畸变剂量及临床诊断完全一致，现将结果报告如下。１材料和方法...     

河南“4.26”~(60)Co源辐射事故患者早期分类诊断及医学处理

目的　总结 1999年 4月 2 6日河南发生的6 0 Co源辐射事故中 7名受照者的早期分类诊断和医学处理 ,探讨类似辐射事故的医学应急处理。方法　根据生物剂量和物理剂量的估算、受照者照后初期的临床症状和体征、照后外周血白细胞和淋巴细胞的变化做出初步诊断 ,并采取相应的救治措施。结果　 7例受照者的初期诊断与临床诊断一致 ,正确的早期分类诊断和医学处理有利于制定救治方案、判断预后 ,使患者顺利度过极期。结论　早期分类诊断应综合分析患者照后出现的症状、体征、外周血白细胞和淋巴细胞的变化 ;初期症状的发生尤其是呕吐开始的时间和严重程度不但与受照剂量有关 ,也受剂量率、受照部位、不均匀程度和个体差异等因素的影响 ;生物剂量和物理剂量的估算是早期分类诊断的基础 ,发生事故后应尽早开始。     

《荧光原位杂交分析染色体易位估算辐射生物剂量技术方法》解读

国家职业卫生标准——《荧光原位杂交分析染色体易位估算辐射生物剂量技术方法》是在收集整理、全面阅读了与该标准有关的国内外文献资料和我国现行有效的放射性疾病诊断标准,将资料汇总分析后经实验室反复验证的基础上制定的.此标准主要用于早先事故受照人员的生物剂量估算,为临床放射损伤的诊断提供科学依据.为了使放射性疾病临床工作者更好地理解、贯彻执行该标准,该文对标准的相关内容进行了解读.     

河南“4.26”60Co源辐射事故患者早期分类诊断及医学处理

目的：总结1999年4月26日河南发生的^60Co源辐射事故中7名受照者的早期分类诊断和医学处理,探讨类拟辐射事故的医学急处理,方法：根据生物剂量和物理剂量的估算,受照者照后初期的临床症状和体征,照后外周血白细胞和淋巴细胞的变化做出初步诊断,并采用相应的救治措施,结果：7例受照者的初期诊断与诊床诊断一致,正确的早期分类诊断和医学处理有利于制定救治方案,判断预后,使患者顺利度过极期,结论：早期分类诊断应综合分析患者照后出现的症状,体征,外周血白细胞和淋巴细胞的变化,初期症状的发生尤其是哎吐开始的时间和严重程度不但与受照剂量有关,也受剂量率,受照部位,不均匀程度和个体差异等因素的影响,生物剂量和物理剂量的估算是早期分类诊断的基础,发生事故后应尽早开始。     

河南“4.26”60Co源辐射事故的经过和早期物理剂量估算

早期物理剂量的估算在于快速、准确地给出可靠的剂量学数据,以往的经验表明,物理剂量估算能较好地反映损伤效应和预测病程。本例事故受照人员的物理剂量估算存在一定的困难,1是早期物理剂量估算时未获得放射源活度的数据;2是受照人员多、活动范围大、受照方式多;3是放射源在源棒中照射方向、几何位置多样,不确定因素多。尽管如此,这次事故处理中,在较短的时间内对7名主要受照人员的早期物理剂量进行了估算,为医学救治提供早期分类、分度诊断的依据。     

山东济宁辐射事故病人诊断问题的探讨

笔者总结“10．21”^60Co源辐射事故（以下简称“10．21”事故）病人临床救治中所遇到的诊断问题，提出早期分类诊断，分型分度分期诊断并结合物理剂量估算，生物剂量估算以及尸检所见综合判断，以解析生前变化。     

四名60Co源辐射事故受照者的生物剂量估算

四名~（６０）Ｃｏ源辐射事故受照者的生物剂量估算白玉书，侯祖洪，夏明桥，黄绮龙，关树荣，何玉庆淋巴细胞染色体畸变分析是估算受照剂量的一种可靠的生物学方法，国内外已有多例实际应用的报道［１～３］，都取得了相当满意的结果。淋巴细胞微核作为估算受照剂量的辅?..     

山东济宁60Co辐射事故受照人员的生物剂量估算

外周血淋巴细胞的染色体畸变是反映电离辐射损伤的良好指标。它不仅能反映辐射损伤和评价远后效应，而且可以估算事故条件下人员所受照的剂量，国内外已经有多例实际应用的报道，都取得了相当满意的结果。笔者对山东济宁“10．21”^60Co辐射事故两名受照者进行了染色体畸变分析，对病例B进行了生物剂量的估算，估算的生物剂量与临床诊断相一致（B被诊断为极重度骨髓型放射病）。病例A培养到73h，标本仍未见分裂象，难以给出剂量估算结果。报道如下。     

染色体易位分析在回顾性生物剂量重建中的研究进展

外周血淋巴细胞染色体易位分析用于日本原爆幸存者、早先核与辐射事故受照者回顾性剂量重建已有近40年的发展史,其应用价值已得到国际学界的广泛认可。随着mFISH、dGH等分子细胞遗传学技术的发展,国际上更多关注的是受到长期慢性低剂量暴露的放射工作人员、早年参加核爆炸实验的退伍军人和医疗照射受照者等暴露人群的生物剂量的估算与...     

Post-irradiation approaches to treatment of radiation injuries in the context of radiological terrorism and radiation accidents: a review

PURPOSE: Events of the recent past have focused attention on the possibility of radiological (nuclear) terrorism and on the implications of such terrorist threats for radiation accident preparedness. This review discusses recent advances in the knowledge about how radiation injuries from such events might be treated pharmacologically, and the practical barriers to clinical utilization of these approaches. CONCLUSIONS: A wide range of pharmacological approaches are being developed in the laboratory that could greatly expand the ability to treat acute and chronic radiation injuries. However, there are currently a variety of practical and legal barriers that would prevent the actual clinical use of most of the approaches. There are also the potential weaknesses in most of the current programmes for dealing with the consequences of radiation accidents or nuclear terrorism, including the absence of widespread radiation biodosimetry capabilities and the resulting inability to triage. If a major radiation accident or terrorist event occurs, the lack of biodosimetry and treatment capabilities will be compounded by widespread public fear of 'radiation'.     

Post‐irradiation approaches to treatment of radiation injuries in the context of radiological terrorism and radiation accidents: a review

Purpose: Events of the recent past have focused attention on the possibility of radiological (nuclear) terrorism and on the implications of such terrorist threats for radiation accident preparedness. This review discusses recent advances in the knowledge about how radiation injuries from such events might be treated pharmacologically, and the practical barriers to clinical utilization of these approaches.

Conclusions: A wide range of pharmacological approaches are being developed in the laboratory that could greatly expand the ability to treat acute and chronic radiation injuries. However, there are currently a variety of practical and legal barriers that would prevent the actual clinical use of most of the approaches. There are also the potential weaknesses in most of the current programmes for dealing with the consequences of radiation accidents or nuclear terrorism, including the absence of widespread radiation biodosimetry capabilities and the resulting inability to triage. If a major radiation accident or terrorist event occurs, the lack of biodosimetry and treatment capabilities will be compounded by widespread public fear of ‘radiation’.     

核与辐射事故应急药物储备研究进展

在当前国际形势下,存在核战争和核恐怖发生的可能性,核与辐射事故应急不可懈怠。世界卫生组织(WHO)于2023年1月27日发布出版物,更新了应对辐射和核紧急情况建议储备的药物清单,这是自2007年以来的首次更新。出版物里建议的药物储备清单,包括防止或减少辐射影响的药物,以及在受照后用于治疗损伤的药物。围绕该药物清单,从核与辐射事故应急、应急药物储备概况、一些国家的药物储备和当前的思考等几个方面进行综述,以期为我国核与辐射事故应急医学救援提供参考。     

Infrastructure to support ultra high throughput biodosimetry screening after a radiological event

Purpose:?After a large-scale radiological event, there will be a pressing need to assess, within a few days, the radiation doses received by tens or hundreds of thousands of individuals. This is for triage, to prevent treatment locations from being overwhelmed, in what is sure to be a resource limited scenario, as well as to facilitate dose-dependent treatment decisions. In addition there are psycho-social considerations, in that active reassurance of minimal exposure is a potentially effective antidote to mass panic, as well as long-term considerations, to facilitate later studies of cancer and other long-term disease risks.

Materials and methods:?As described elsewhere in this issue, we are developing a Rapid Automated Biodosimetry Tool (RABiT). The RABiT allows high throughput analysis of thousands of blood samples per day, providing a dose estimate that can be used to support clinical triage and treatment decisions.

Results:?Development of the RABiT has motivated us to consider the logistics of incorporating such a system into the existing emergency response scenarios of a large metropolitan area. We present here a view of how one or more centralized biodosimetry readout devices might be incorporated into an infrastructure in which fingerstick blood samples are taken at many distributed locations within an affected city or region and transported to centralized locations.

Conclusions:?High throughput biodosimetry systems offer the opportunity to perform biodosimetric assessments on a large number of persons. As such systems reach a high level of maturity, emergency response scenarios will need to be tweaked to make use of these powerful tools. This can be done relatively easily within the framework of current scenarios.     

分子生物学水平的生物剂量学指标研究现状

生物剂量学指标在核事故受照人员剂量估算及辐射生物效应研究中具有重要作用,而现有的染色体畸变分析不能满足大量快速检测的需求。因此,寻找快速、简便、高通量的生物剂量学指标成为放射生物学研究的热点。随着分子生物学技术与理论的飞速发展,有关生物大分子的辐射效应研究亦不断深入,分子生物学水平的生物剂量学指标的研究主要围绕电离辐射所致的DNA损伤、基因表达水平和蛋白质水平改变展开。笔者就近年来分子生物学水平的生物剂量学指标的研究进行综述。     

乌克兰四零八军区医院抢救切尔诺贝利核电站事故伤员的经验

切尔诺贝利核电站事故发生后,先后有30万左右的军人参加事故救援.本文介绍了乌克兰四零八军区医院对切尔诺贝利核电站事故伤员救治工作的任务.介绍了医疗救援三个阶段的时间划分、任务重点、兵力的投入及其结构组成.介绍了医院内部专门科室的建立、对受照剂量为0.25～0.50Gy的594例伤员健康状况的分析,其血液学改变的发生率随受照剂量增加而增多.介绍了参与救治工作医师们研究的主要内容,强调要考虑小剂量辐射对心血管系统和胃肠道的远期效应.根据救治工作的经验,分析了救治过程中存在的问题.     

核与辐射突发事件的医学救援

核与辐射突发事件是指突然发生的、由放射性物质或其他放射源造成或可能造成严重影响公众健康的紧急事件.一旦发生核与辐射突发事件,放射线在对机体损伤的同时,还会对人员造成心理和精神压力,导致一系列的社会心理效应.核与辐射突发事件的医学救援的关键是采取有效措施,最大限度地减轻核与辐射突发事件造成的人员伤害,维护社会稳定.本文从核与辐射突发事件发生后的人员防护、现场抢救、各类伤害的处置原则以及公众心理效应预防等方面作一阐述.     

Candidate protein biodosimeters of human exposure to ionizing radiation

PURPOSE: To conduct a literature review of candidate protein biomarkers for individual radiation biodosimetry of exposure to ionizing radiation. MATERIALS AND METHODS: Reviewed approximately 300 publications (1973 - April 2006) that reported protein effects in mammalian systems after either in vivo or in vitro radiation exposure. RESULTS: We found 261 radiation-responsive proteins including 173 human proteins. Most of the studies used high doses of ionizing radiation (>4 Gy) and had no information on dose- or time-responses. The majority of the proteins showed increased amounts or changes in phosphorylation states within 24 h after exposure (range: 1.5- to 10-fold). Of the 47 proteins that are responsive at doses of 1 Gy and below, 6 showed phosphorylation changes at doses below 10 cGy. Proteins were assigned to 9 groups based on consistency of response across species, dose- and time-response information and known role in the radiation damage response. CONCLUSIONS: ATM (Ataxia telengiectasia mutated), H2AX (histone 2AX), CDKN1A (Cyclin-dependent kinase inhibitor 1A), and TP53 (tumor protein 53) are top candidate radiation protein biomarkers. Furthermore, we recommend a panel of protein biomarkers, each with different dose and time optima, to improve individual radiation biodosimetry for discriminating between low-, moderate-, and high-dose exposures. Our findings have applications for early triage and follow-up medical assessments.