RELATIVE TELOMERE LENGTH OF PERIPHERAL BLOOD LYMPHOCYTES AND STRUCTURAL AND FUNCTIONAL STATE OF THE LEFT VENTRICLE MYOCARDIUM IN CLEAN-UP WORKERS OF THE CHORNOBYL ACCIDENT WHO SUFFERED FROM STENOTIC CORONARY ATHEROSCLEROSIS

The objective was to analyze the relative telomere length (RTL) of peripheral blood lymphocytes depending onmyocardium structural and functional state in emergency workers (EW) of the Chornobyl accident who suffered fromcoronary arteries stenotic atherosclerosis.

MATERIALS AND METHODS

There were examined 60 male EW who operated at the Chornobyl nuclear power plant at1986 and 25 male non-irradiated persons (control group - CG) with coronary heart disease (CHD). Everyone EW andCG patients were almost healthy before the accident. During the period 2016-2021, they underwent a comprehen-sive clinical and laboratory examination, echodopplercardiographic examination and determination of RTL by fluo-rescent hybridization in situ using laser flow cytometry.

RESULTS

EW almost did not differ from CG according to its clinical characteristics, the presence of risk factors,indices of systolic and diastolic heart functions, as well as RTL. The analysis of variance showed that RTL was influ-enced by the fact of irradiation in combination with obesity (p = 0.020). At normal body weight, RTL average valuein CG was significantly higher than in EW (p = 0.023). According to the results of hierarchical cluster analysis of twovariables as RTL and end-diastolic volume normalized by body surface area (EDV/BSA), EW and CG patients togeth-er were divided into two subgroups. The first subgroup (1st cluster) differed from the second (2nd cluster) by signi-ficantly larger average values of left ventricle (LV) EDV and end-systolic volume (ESV) as well as EDV/BSA andESV/BSA, LV myocardial mass (MM) and MM/BSA, reduced ejection fraction (EF). In patients of the 1st cluster telom-eres were significantly shorter than in the 2nd one (10,3 ± 1.7 vs. 14.3 ± 2.0 at p = 0.000). The increase of myocar-dial mass and LV wall thickness caused the development of its hypertrophy. The number of people with hypertrophyLV was significantly higher among patients of the 1st cluster (91.6 vs. 67.2 %, p < 0.001) due to eccentric hypertro-phy LV. Accordingly, concentric hypertrophy LV was more common among patients in the 2nd cluster (24.6 vs. 4.2 %at p < 0.01). Patients of the 1st cluster was characterized by a more severe course of heart failure.

CONCLUSIONS

In patients who suffered from CHD with stenotic atherosclerosis of the coronary arteries and wereexposed to radiation 30-35 years earlier, having normal body weight, there was a reduction in telomere. Hierarchicalcluster analysis proved to be a good tool that allows by the value of RTL and EDV/BSA to separate the group ofpatients with the most severe clinical course of CHD and LV systolic dysfunction among patients with the samepathology.

Monsters with a shortened vertebral column: A population phenomenon in radiating fish Labeobarbus (Cyprinidae)

The phenomenon of a massive vertebral deformity was recorded in the radiating Labeobarbus assemblage from the middle reaches of the Genale River (south-eastern Ethiopia, East Africa). Within this sympatric assemblage, five trophic morphs—generalized, lipped, piscivorous and two scraping feeders—were reported between 1993 and 2019. In 2009, a new morph with prevalence of ~10% was discovered. The new morph, termed ‘short’, had an abnormally shortened vertebral column and a significantly deeper body. This type of deformity is common in farmed Atlantic salmon and other artificially reared fish, but is rare in nature. In the Genale Labeobarbus assemblage, the deformity was present exclusively within the generalized and lipped morphs. The short morph had between seven and 36 deformed (compressed and/or fused) vertebrae. Their body depth was positively correlated with number of deformed vertebrae. In another collection in 2019, the short morph was still present at a frequency of 11%. Various environmental and genetic factors could contribute to the development of this deformity in the Genale Labeobarbus, but based on the available data, it is impossible to confidently identify the key factor(s). Whether the result of genetics, the environment, or both, this deep-bodied phenotype is assumed to be an anti-predator adaptation, as there is evidence of its selective advantage in the generalized morph. The Genale monstrosity is the first reported case of a massive deformity of the vertebral column in a natural population of African fishes.

Cancer therapy and risk of congenital malformations in children fathered by men treated for testicular germ-cell cancer: A nationwide register study

BACKGROUND

Because of the potential mutagenic effects of chemo- and radiotherapy, there is concern regarding increased risk of congenital malformations (CMs) among children of fathers with cancer. Previous register studies indicate increased CM risk among children conceived after paternal cancer but lack data on oncological treatment. Increased CM risk was recently reported in children born before paternal cancer. This study aims to investigate whether anti-neoplastic treatment for testicular germ-cell cancer (TGCC) implies additional CM risk.

METHODS AND FINDINGS

In this nationwide register study, all singletons born in Sweden 1994-2014 (n = 2,027,997) were included. Paternal TGCC diagnoses (n = 2,380), anti-neoplastic treatment, and offspring CMs were gathered from the Swedish Norwegian Testicular Cancer Group (SWENOTECA) and the Swedish Medical Birth Register. Children were grouped based on +/- paternal TGCC; treatment regimen: surveillance (n = 1,340), chemotherapy (n = 2,533), or radiotherapy (n = 360); and according to time of conception: pre- (n = 2,770) or post-treatment (n = 1,437). Odds ratios (ORs) for CMs were calculated using logistic regression with adjustment for parental ages, maternal body mass index (BMI), and maternal smoking. Children conceived before a specific treatment acted as reference for children conceived after the same treatment. Among children fathered by men with TGCC (n = 4,207), 184 had a CM. The risk of malformations was higher among children of fathers with TGCC compared with children fathered by men without TGCC (OR 1.28, 95% confidence interval [CI] 1.19-1.38, p = 0.001, 4.4% versus 3.5%). However, no additional risk increase was associated with oncological treatment when comparing post-treatment-to pretreatment-conceived children (chemotherapy, OR = 0.82, 95% CI 0.54-1.25, p = 0.37, 4.1% versus 4.6%; radiotherapy, OR = 1.01, 95% CI 0.25-4.12, p = 0.98, 3.2% versus 3.0%). Study limitations include lack of data on use of cryopreserved or donor sperm and on seminoma patients for the period 1995-2000-both tending to decrease the difference between the groups with TGCC and without TGCC. Furthermore, the power of analyses on chemotherapy intensity and radiotherapy was limited.

CONCLUSIONS

No additional increased risk of CMs was observed in children of men with TGCC treated with radio- or chemotherapy. However, paternal TGCC per se was associated with modestly increased risk for offspring malformations. Clinically, this information can reassure concerned patients.

Prevalence and Characterization of Thyroid Hemiagenesis in Japan: The Fukushima Health Management Survey

BACKGROUND

Thyroid hemiagenesis is a rare congenital variant characterized by the lack of development of one thyroid lobe with no clinical manifestations.

METHODS

This study was performed to determine the prevalence and characteristics of thyroid hemiagenesis in a normal Japanese population. This cross-sectional study was performed from October 9, 2011, to April 30, 2015. In total, 299,908 children and young adults in the Fukushima Health Management Survey were examined to determine the presence of thyroid agenesis or hemiagenesis. Thyroid width, thickness, and length were measured in 292,452 of these subjects.

RESULTS

Thyroid agenesis was diagnosed in 13 subjects, and hemiagenesis was detected in 67 subjects (0.02%; 22.3/100,000 individuals). Although there was no significant sex-related difference (p = 0.067), the female:male ratio was 1.67:1.00. Females were significantly dominant in right hemiagenesis, while there was no difference in left hemiagenesis between males and females. The thyroid volumes at the 2.5th and 97.5th percentiles for age and body surface area were determined for each sex. Multivariate regression analysis showed that a large hemithyroid volume was independently associated with the presence of contralateral hemiagenesis (p < 0.001).

CONCLUSION

The prevalence of thyroid hemiagenesis in the present study is in agreement with that reported in other countries. The prevalence of right hemiagenesis was higher in females, and the larger contralateral lobe in patients with rather than without hemiagenesis may have been caused by a compensatory feedback mechanism to prevent hypothyroidism. In addition, the prevalence of hemiagenesis, especially right hemiagenesis, may be affected by sex-related factors similar to those in patients with an ectopic thyroid gland.

Maternal exposure to radiographic exams and major structural birth defects

BACKGROUND

An increasing number of radiologic exams are performed in the United States, but very few studies have examined the effects of maternal exposure to radiologic exams during the periconceptional period and birth defects.

OBJECTIVES

To assess the association between maternal exposure to radiologic exams during the periconceptional period and 19 categories of birth defects using a large population-based study of birth defects.

METHODS

We studied 27,809 case mothers and 10,200 control mothers who participated in the National Birth Defects Prevention Study and delivered between 1997 and 2009. Maternal exposure to radiologic exams that delivered ionizing radiation to the urinary tract, lumbar spine, abdomen, or pelvis were identified based on the mother's report of type of radiologic exams, organ or body part scanned and the month during which the exam occurred

RESULTS

Overall, 0.9% of mothers reported exposure to one of these types of radiographic exams during the periconceptional period. We observed significant associations between maternal exposure during the first trimester and isolated Dandy-Walker malformation (odds ratio = 7.7; 95% confidence interval, 1.8-33) and isolated d-transposition of the great arteries (odds ratio = 3.8; 95% confidence interval, 1.4-10.3). However, the result for isolated Dandy-Walker malformation was based on only two exposed cases.

CONCLUSION

These results should be interpreted cautiously because multiple statistical tests were conducted and measurements of exposure were based on maternal report. However, our results may be useful for generating hypotheses for future studies. Birth Defects Research (Part A) 106:563-572, 2016. © 2016 Wiley Periodicals, Inc.

Heritable Anomalies among the Inhabitants of Regions of Normal and High Background Radiation in Kerala: Results of a Cohort Study, 1988–1994

In a genetic epidemiological and fertility survey among 70,000 inhabitants in a high-background radiation region (HBRR) and normal radiation region (NRR) in Kerala, India, 985 persons were found to have heritable anomalies. Suggested etiologies for the anomalies were chromosomal and Mendelian, 15 percent; multifactorial, 60 percent; and congenital, 25 percent. There was a statistically significant increase of Down syndrome, autosomal dominant anomalies, and multifactorial diseases and an insignificant increase of autosomal recessive and X-linked recessive anomalies in the HBRR. The total fertility rate was 3.85 per couple; 9 percent of live-born children were reported dead. The rate of untoward pregnancy outcome—death of the offspring or presence of an anomaly in a living child—was 6.4 percent among the unrelated couples in the NRR, with one spouse born outside the area of current residence (“migrant”). Considering this as the base, the excess relative risks in the other groups are: “NRR-nonmigrant,” 35 percent; “HBRR-nonmigrant,” 69 percent; “NRR-consanguineous,” 76 percent; and “NBRR-consanguineous,” 157 percent. Ionizing radiation, consanguinity, and nearness of birthplace of the spouse are risk factors for the death of offspring and for anomalies. The higher risk among the “nonmigrant” couples may be due to geographic inbreeding. The findings are suggestive of an autosomal recessive etiology for the majority of the multifactorial anomalies.

Sex ratio at birth: scenario from normal- and high-level natural radiation areas of Kerala coast in south-west India

Newborns were monitored for congenital malformations in four government hospitals located in high-level (ambient dose >1.5 mGy/year) and normal-level (≤ 1.5 mGy/year) natural radiation areas of Kerala, India, from August 1995 to December 2012. Sex ratio at birth (SRB) among live singleton newborns and among previous children, if any, of their mothers without history of any abortion, stillbirth or twins is reported here. In the absence of environmental stress or selective abortion of females, global average of SRB is about 1050 males to 1000 females. A total of 151,478 singleton, 1031 twins, 12 triplets and 1 quadruplet deliveries were monitored during the study period. Sex ratio among live singleton newborns was 1046 males (95 % CI 1036-1057) for 1000 females (77,153 males:73,730 females) and was comparable to the global average. It was similar in high-level and normal-level radiation areas of Kerala with SRB of 1050 and 1041, respectively. It was consistently more than 1000 and had no association with background radiation levels, maternal and paternal age at birth, parental age difference, gravida status, ethnicity, consanguinity or year of birth. Analysis of SRB of the children of 139,556 women whose reproductive histories were available suggested that couples having male child were likely to opt for more children and this, together with enhanced rate of males at all birth order, was skewing the overall SRB in favour of male children. Though preference for male child was apparent, extreme steps of sex-selective abortion or infanticide were not prevalent.

Maternal occupational exposure to ionizing radiation and major structural birth defects

BACKGROUND

Ionizing radiation (IR) is known to be carcinogenic and mutagenic, but little is known about the association between maternal occupational exposure to IR and birth defects.

METHODS

We studied 38,009 mothers who participated in the National Birth Defects Prevention Study and delivered between 1997 and 2009. We assessed odds ratios [ORs] for the association between maternal occupations with potential exposure to IR and 39 birth defects.

RESULTS

We observed significant odds ratios (ORs) for isolated hydrocephaly (adjusted OR [AOR], 2.1; 95% confidence interval [CI], 1.1-4.2), isolated anotia/microtia (AOR, 2.0; 95% CI, 1.0-4.0), isolated colonic atresia (crude OR, 7.5; 95% CI, 2.5-22.3), isolated omphalocele (AOR, 2.3; 95% CI, 1.1-4.6) and isolated anencephaly (crude OR, 0.23; 95% CI, 0.06-0.94). We also observed a nonsignificant OR for birth defects in aggregate (AOR, 2.0; 95% CI, 0.9-4.6) among mothers with potential occupational exposure to fluoroscopy.

CONCLUSION

We assessed 39 birth defects, observing that maternal occupations with potential exposure to IR were associated with a significantly increased risk for 4 birth defects and a significantly protected risk for 1 birth defect. These results should be interpreted cautiously because our measurement of exposure is qualitative, some of these associations may be due to occupational exposures that are correlated with IR and some may be due to chance. However, these findings serve as the first evaluation of these relationships in a large study and may be useful for generating hypotheses for future studies.

Blastopathies and microcephaly in a Chornobyl impacted region of Ukraine

This population-based descriptive epidemiology study demonstrates that rates of conjoined twins, teratomas, neural tube defects, microcephaly, and microphthalmia in the Rivne province of Ukraine are among the highest in Europe. The province is 200 km distant from the Chornobyl site and its northern half, a region known as Polissia, is significantly polluted by ionizing radiation. The rates of neural tube defects, microcephaly and microphthalmia in Polissia are statistically significantly higher than in the rest of the province. A survey of at-birth head size showed that values were statistically smaller in males and females born in one Polissia county than among neonates born in the capital city. These observations provide clues for confirmatory and cause-effect prospective investigations. The strength of this study stems from a reliance on international standards prevalent in Europe and a decade-long population-based surveillance of congenital malformations in two distinct large populations. The limitations of this study, as those of other descriptive epidemiology investigations, is that identified cause-effect associations require further assessment by specific prospective investigations designed to address specific teratogenic factors.

Radiation risk of individual multifactorial diseases in offspring of the atomic-bomb survivors: a clinical health study

There is no convincing evidence regarding radiation-induced heritable risks of adult-onset multifactorial diseases in humans, although it is important from the standpoint of protection and management of populations exposed to radiation. The objective of the present study was to examine whether parental exposure to atomic-bomb (A-bomb) radiation led to an increased risk of common polygenic, multifactorial diseases-hypertension, hypercholesterolaemia, diabetes mellitus, angina pectoris, myocardial infarction or stroke-in the first-generation (F1) offspring of A-bomb survivors. A total of 11,951 F1 offspring of survivors in Hiroshima or Nagasaki, conceived after the bombing, underwent health examinations to assess disease prevalence. We found no evidence that paternal or maternal A-bomb radiation dose, or the sum of their doses, was associated with an increased risk of any multifactorial diseases in either male or female offspring. None of the 18 radiation dose-response slopes, adjusted for other risk factors for the diseases, was statistically significantly elevated. However, the study population is still in mid-life (mean age 48.6 years), and will express much of its multifactorial disease incidence in the future, so ongoing longitudinal follow-up will provide increasingly informative risk estimates regarding hereditary genetic effects for incidence of adult-onset multifactorial disease.

Congenital malformations of the urinary system in children born to exposed parents according to Congenital and Hereditary Diseases Department data

OBJECTIVE

To analyze the frequency and structure of the urinary system malformations in children born to parents exposed to radiation.

MATERIAL AND METHODS

The study included 1,139 children with various congenital malformations of the urinary system, which were examined and treated in the Department of Congenital and Hereditary Diseases from 2000 to 2011. The standard clinical, laboratory, instrumental and radiographic methods were applied to verify the diagnosis.

RESULTS AND CONCLUSIONS

1. The proportion of children with congenital malformations of the urinary system among all examined in the Department of Congenital and Hereditary Diseases in the 12 years was 68.24%. 2. The congenital malformations accounted for 31.16%, small anomalies for 68.31%, and their combinations for 4.57% among all malformations of the urinary system. 3. Such complications as a secondary pyelonephritis occurred in 4.39% of cases and developed mainly in children with obstructive uropathy.

[Principal inferences from studies of radiobiological effects for radiation protection purposes]

The most recent Recommendations (Publication 103) issued by the International Commission for Radiological Protection (ICRP) are based on the data that have been published since 1990 up to now. The basic task of the ICRP Committee 1 was to formulate the key implications of studies on radiobiological effects for the purposes of radiological protection. Presented in the paper are the new achievements in the field of biology, radiobiology and radiation epidemiology which were taken into account by the ICRP in the process of Publication 103 preparation. The Recommendations provide present-day values of weighting factors for radiation exposure and tissue weighting factors, as well as radiation detriment and radiogenic risk factors for cancer and genetic diseases. Also considered are tissue reactions to radiation exposure, consequences of in utero exposure and the risks of developing non-cancer diseases for exposed individuals. It should be noted that the key inferences and recommendations are to a considerable degree related to biological effects accounted for by acute and chronic exposure to ionizing radiation in the range of small doses (up to 100 mSv).

[Autonomic homeostasis of children born to parents irradiated in the result of the Chernobyl catastrophe with isolated abnormal chords of the left ventricle]

156 children of the main group (were born to parents irradiated in the result of Chernobyl disaster), in which according to Doppler echocardiography isolated abnormal chords of the left ventricle (AHLV) identified, 44 children of control group and 50 children of referent group were involved in the study Analysis of indicators of operational regulation of heart rate in children of primary group indicate the existence of autonomic dysregulation, which has the maximum expression in children with a threshold number of isolated abnormal chords. Evidence of autonomic dysregulation in children born to parents irradiated in the result of the Chernobyl disaster with isolated AHLV requires primary and secondary prevention to reduce the frequency of unfavourable clinical course.

[Congenital malformations among offspring of the liquidators of the consequences from Chernobyl accident]

The frequency and the structure of congenital malformations at children of the liquidators of the consequences from Chernobyl accident, undergone to an external scale gamma-irradiation in dozes up to 25 cGy. In total is surveyed 2379 newborn at which is revealed 318 intrauterine development defects. The received results are compared to the earlier published data on birth of congenital malformations in families of the fathers who have undergone to an irradiation in connection with professional activity at the enterprises of a nuclear industry, with emergency irradiation, with irradiation as a result of explosions of nuclear bombs in Japan, and are discussed from positions of the basic rules (situations) of radiating genetics. Total frequency, the frequency of forms 21 of inherent defects of development, taken into account in the International register of congenital malformations and frequency 9 forms heaviest of congenital intrauterine development defects with the high contribution mutation components at children of the liquidators authentically is higher than on the average on Russian Federation. The dependence of the frequency congenital malformations at children from dozes of an irradiation of the fathers--liquidators is revealed. The curve of dependence of the frequency of congenital malformations from time, past after work up to copulation carries arched character with peak of rise of frequency of congenital malformations in 2-3 years and decrease in 6-7 years.

The evidence of radiation effects in embryos and fetuses exposed to Chernobyl fallout and the question of dose response

Current legal frameworks for radiation exposure limits are based on the risk models of the International Commission on Radiological Protection (ICRP). In Publication 90 (2003), ICRP presents a safe (threshold) dose range of up to 100 mSv for radiogenic effects resulting from in utero exposure and bases this conclusion on the findings in Hiroshima and Nagasaki. However, a variety of observations of congenital malformations, fetal loss, stillbirths and infant deaths, as well as of Down's syndrome and other health defects in children after the Chernobyl accident exposures suggest that the A-bomb survivor data are incomplete. The Chernobyl findings are generally marginalized or even denied because of the low values of the estimated human exposures and the inconsistency of the results with the accepted risk models. One explanation for the observations is that physical dosimetric models have underestimated the effective exposure. This possibility is supported by biological dosimetry in the contaminated regions. The assumptions about effects after in utero exposure by incorporated radionuclides need to be revised.

Elevated frequency of abnormalities in barn swallows from Chernobyl

Ever since the Chernobyl accident in 1986, that contaminated vast areas in surrounding countries with radiation, abnormalities and birth defects have been reported in human populations. Recently, several studies suggested that the elevated frequency of such abnormalities can be attributed to poverty and stress in affected human populations. Here, we present long-term results for a free-living population of barn swallows, Hirundo rustica, demonstrating the presence of 11 morphological abnormalities in populations around Chernobyl, but much less frequently in an uncontaminated Ukrainian control population and three more distant control populations. The presence of these abnormalities in barn swallows is associated with reduced viability. These findings demonstrate a link between morphological abnormalities and radiation in an animal population that cannot be attributed to poverty and stress. The most parsimonious hypothesis for abnormalities in animal and human populations alike is that the effects are caused by the same underlying cause, viz. radiation derived from the Chernobyl accident.

Facts and controversies about radiation exposure, part 2: low-level exposures and cancer risk

In this 2-part article, the authors address the need to put in perspective the risks of radiation exposure in the rapidly changing field of radiology, considering the current state of knowledge of effects at low levels. The article is based on the content of the refresher course RC 516 presented at the Radiological Society of North America's 2005 annual meeting. In part 1, the authors presented a brief review of epidemiologic studies, a discussion of typical radiation doses experienced in medicine by both patients and professionals, and the description of practical approaches to reduce unnecessary exposures. Part 2 addresses a special concern for the unborn and discusses advisory and regulatory cancer risk estimates based mainly on epidemiologic studies. The limitations of epidemiologic studies at low-level exposures and recent new findings in radiobiology, some of which are summarized, challenge the notion that any amount of radiation causes adverse effects.

[Genetic effects in the liquidators of consequences of Chernobyl Nuclear Power Plant accident]

The purpose of the present research was the estimation of probable genetic consequences at the liquidators of the consequences of Chernobyl accident in 1986-1987. The research is made on two groups of the liquidators. The first group included the liquidators taking place on the account in the branch register and working now at the enterprises of a nuclear industry. The second group included 902 liquidators of consequences of Chernobyl accident in 1986 constantly living in the Ryazan area and which are taking place on permanent observation the account in regional hospital. For an estimation of probable genetic effects analyzed the data on frequency and outcomes pregnancy of the wives of the liquidators, on condition and on diseases of newborn, on switching intrauterine development defects (IDD). The analysis carried out depending on dozes of an irradiation: up to 5 cGy; 5-10 cGy and 10-25 cGy. Received materials testify, that at the liquidators, at a doze of an external irradiation 10-25 cGy, the determined effects--period long sterility, kept at a part them till 3 years come to light. The set of the received data, such as depending from the dose increase of frequency of spontaneous abortions and of inherent defects of development of newborn, the increase of frequency diseases of newborn and share newborn with low weight, allows to make a conclusion about an induction of genetic effects in sexual cells of the liquidators of consequences of Chernobyl accident at dozes of an external irradiation more than 10 cGy. Taking into account high biological efficiency of alpha-radiation (K = 20), and of beta-radiation (K = 2-4), the equivalent effective doze male gonads (testes) in 3-5 times is higher, than estimated only from external gamma-radiation.

Health effects resulting from the Chernobyl accident

This article reviews the health effects of the Chernobyl accident. The clearest effect to be seen to date is the dramatic increase in thyroid cancer in children. The evidence for increased leukaemia is less clear, but there are indications of increased leukaemia incidence in Russian clean-up workers. There is also evidence of increases in breast cancer, cataract and cardiovascular disease. However, to date the largest public health problem caused by the accident is the mental health impact.

Korean atomic bomb survivors' report on the present status and health of their children: a mail questionnaire survey

A mail questionnaire survey on the present status and health of children of Korean survivors of the 1945 atomic bombing of Japan was conducted in 2004. In total, 1,115 Korean A-bomb survivors' reports on demographic factors and the health of their children (n = 4,079) were analysed. In 2004, 293 of their children were reported to have died and 3,786 children still living. Among the deceased children, the cause of death was unidentified in 64 per cent of cases. The most frequently reported cause of death was infectious disease (9.6%). Most of the deaths (51%) were reported to have occurred in children less than ten years old. The most frequently reported congenital disorders among living children were mental retardation (0.18%) and congenital bone disorders (0.18%). Further study and administrative support are needed to more accurately determine the status of Korean A-bomb survivors and their children.

Paternal occupational exposure to radiofrequency electromagnetic fields and risk of adverse pregnancy outcome

BACKGROUND

During the last decades, public concern that radiofrequency radiation (RFR) may be related to adverse reproductive outcomes has been emerging. Our objective was to assess associations between paternal occupational exposure to RFR and adverse pregnancy outcomes including birth defects using population-based data from Norway.

METHODS

Data on reproductive outcomes derived from the Medical Birth Registry of Norway were linked with data on paternal occupation derived from the general population censuses. An expert panel categorized occupations according to exposure. Using logistic regression, we analyzed 24 categories of birth defects as well as other adverse outcomes.

RESULTS

In the offspring of fathers most likely to have been exposed, increased risk was observed for preterm birth (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.03, 1.15). In this group we also observed a decreased risk of cleft lip (OR: 0.63, 95% CI: 0.41, 0.97). In the medium exposed group, we observed increased risk for a category of "other defects" (OR: 2.40, 95% CI: 1.22, 4.70), and a decreased risk for a category of "other syndromes" (OR: 0.75, 95% CI: 0.56, 0.99) and upper gastrointestinal defects (OR: 0.61, 95% CI: 0.40, 0.93).

CONCLUSION

The study is partly reassuring for occupationally exposed fathers.

[20-year morpholoogical findings in the study of medical aftereffects of the Chernobyl accident]

Presented are the results of morphological studies of radiation sickness, congenital malformations and malignant tumors which have developed in Chemobyl victims. Until now consequences of the accident remain a subject of practical and research medicine. Scope of relevant topical problems the pathologists will have to investigate in the future is discussed.

[The effect of Chernobyl accident on the development of non malignant diseases]

The early medical complications of Chernobyl accident include post radiation disease, which were diagnosed in 134 subjects affected by ionizing radiation. 28 persons died during the first 100 days after the event. The increase occurrence of coronary heart disease, endocrine, haematological, dermatological and other diseases were observed after disaster in the contaminated territories. We also discussed the impact of ionizing radiation from Chernobyl accident on pregnancy and congenital defects occurrence. Changes following the Chernobyl accident, as the inhabitants migration from contaminated regions, political and economic conversions, led to depression, anxiety, and even to "epidemic" of mental diseases. Increased suicide rate, car accidents, alcohol and drug abuse have been observed in this population. Nowadays vegetative neurosis is more often diagnosed in Ukrainian children. Epidemiological studies were conducted on the ionising radiation effect on the health and on the dose of received radiation after Chernobyl accident face numerous problems as the absence of reliable data regarding diseases in the contaminated territories.

Pulmonary abnormalities associated with occupational exposures at the Savannah River Site

BACKGROUND

A program of medical evaluation for former Savannah River Site (SRS) workers at health effects due to exposures to hazardous or radioactive agents was conducted.

METHODS

This study includes data from 1,368 participants aged 45 years or older who were assessed regarding work-history and exposures to industrial agents. According to the standard industrial classification (SIC), participants were employed in five of the SIC divisions. Based on the International Labour Office Classification of Radiographs, two categories of pleural and parenchymal abnormalities were evaluated by a single radiologist. The SRS results were compared with the second national health and nutrition examination survey (NHANES II) results.

RESULTS

The odds ratio of the SRS male aged 45-75 compared to NHANES was 2.4 for pleura abnormalities and 0.8 for parenchymal abnormalities. Using logistic regression, the highest-risk worker division was construction (OR = 2.76); asbestos exposure was clearly associated with pleural abnormality (OR = 2.15).

CONCLUSIONS

Pulmonary abnormalities were higher in former SRS workers than that in general population. Asbestos and possibly other exposures were related to pulmonary disease in this population.

Teratogenicity of depleted uranium aerosols: a review from an epidemiological perspective

BACKGROUND

Depleted uranium is being used increasingly often as a component of munitions in military conflicts. Military personnel, civilians and the DU munitions producers are being exposed to the DU aerosols that are generated.

METHODS

We reviewed toxicological data on both natural and depleted uranium. We included peer reviewed studies and gray literature on birth malformations due to natural and depleted uranium. Our approach was to assess the "weight of evidence" with respect to teratogenicity of depleted uranium.

RESULTS

Animal studies firmly support the possibility that DU is a teratogen. While the detailed pathways by which environmental DU can be internalized and reach reproductive cells are not yet fully elucidated, again, the evidence supports plausibility. To date, human epidemiological data include case examples, disease registry records, a case-control study and prospective longitudinal studies.

DISCUSSION

The two most significant challenges to establishing a causal pathway between (human) parental DU exposure and the birth of offspring with defects are: i) distinguishing the role of DU from that of exposure to other potential teratogens; ii) documentation on the individual level of extent of parental DU exposure. Studies that use biomarkers, none yet reported, can help address the latter challenge. Thoughtful triangulation of the results of multiple studies (epidemiological and other) of DU teratogenicity contributes to disentangling the roles of various potentially teratogenic parental exposures. This paper is just such an endeavor.

CONCLUSION

In aggregate the human epidemiological evidence is consistent with increased risk of birth defects in offspring of persons exposed to DU.

Unanswered questions: the legacy of atomic veterans

The Department of Veterans Affairs identifies 195,000 servicemen as being involved in the occupation of Hiroshima and Nagasaki, with an additional 210,000 personnel participating in 200 post-war nuclear tests. In 1995, the Institute of Medicine declined to recommend a study of the reproductive outcomes of Atomic Veterans. This article revisits the Institute of Medicine decision. Health effects and legislation provide the framework for a critical analysis of the Japanese data as it applies to Atomic Veterans. It explores the role of traditional hypothesis testing in legislative decisions and offers an in-depth exploration of paternal contributions to adverse reproductive events. It emphasizes the risks faced by reproductive age males when exposed to environmental hazards such as ionizing radiation.

[Medical and biologic consequences of human chronic exposure to radiation]

The author considered medical consequences of radiation accidents on Industrial Association "Mayak" (radioactive waste discharge into Techa river and accident in 1957). Results of longstanding observations helped to evaluate health state of people exposed to radiation and their descendants.

Cancer, reproductive abnormalities, and diabetes in Micronesia: the effect of nuclear testing

Many suggest that cancer and other diseases in Micronesia have been caused by nuclear testing in the Pacific. The 50-year commemoration of the March 1, 1954 Bravo thermonuclear test has rekindled interest in this area. This paper explores the documentation for, and the plausibility of, claims for disease causation by nuclear testing. Given the sheer volume of testing that the US conducted in the Pacific, it appears plausible that excess cancer would have occurred in areas of Micronesia other than the Marshall Islands. An excess of birth abnormalities in the Marshall Islands has been documented. While diabetes is not a radiogenic disease, and other cancers are generally less radiogenic than leukemia or thyroid cancer, the social and cultural effects of nuclear testing specifically, and the strategic uses to which Micronesia has been put generally, have had roles in the social production of disease. Integration into a globalized, cosmopolitan economy-with attendant phenomena such as the importation of tobacco, alcohol, foods of poor nutritional value, and new cultural morés-are also factors.

Myelodysplasia and Radiation

Reasons are given why myelodysplasia should be considered in any assessment in humans of radiation exposure as an etiological factor for the development of leukemia.

Spaltgeburtenrate in Bayern vor und nach dem Reaktorunfall in Tschernobyl

BACKGROUND

Cleft lip and palates (CLP) occur with a frequency of between 1 and 2 cases in 1000 live births and thus belong to the most frequent congenital anomalies. In the former German Democratic Republic (GDR), records covering 1967-1989 for CLP newborns show a 9.4% increase of the prevalence of CLP from 1987 to 1989, possibly due to Chernobyl. DATA AND STATISTICAL METHOD: In Bavaria, all congenital malformations in children's hospitals have been recorded from 1984 to 1991. Among these data, 1324 cases with CLP were found. A spatial-temporal analysis aimed at uncovering a possible association of the CLP occurrence with the Chernobyl fallout on a district level, as well as a synoptic analysis of the GDR and Bavarian data, were carried out.

RESULTS

In Bavaria, from October 1986 to December 1990, the CLP frequency increased by 9.5% (p=0.10) relative to the trend as computed from the remaining years. The association of CLP rates with fallout on a district level is reflected by a significant relative risk (RR) per kBq/m(2) of RR=1.008 (p=0.03). A synoptic analysis of the Bavarian data and the GDR data restricted to the overlapping time window from 1984 to 1989 discloses a simultaneous significant jump of the CLP prevalence by 8.6% (p=0.02) after 1986.

CONCLUSION

The presumption of a long-term increase of CLP after exposure to Chernobyl fallout is corroborated by the analysis of the Bavarian congenital malformation data.

Risk of selected birth defects by maternal residence close to power lines during pregnancy

AIMS

To evaluate selected birth outcomes from a published Norwegian cohort study in a nested case-control design with improved exposure data.

METHODS

Two controls matched for sex, year of birth, and municipality were selected randomly for children with the following defects: central nervous system (CNS) defects, cardiac defects, respiratory system defects, oesophageal defects, and clubfoot. The distances between maternal addresses, during pregnancy, and power lines were obtained from maps mainly of scale 1:5000. The magnetic fields in the residences were estimated based on distance, current, voltage, and configuration.

RESULTS

The highest increased risks were seen for hydrocephalus (OR 1.73, 95% CI 0.26 to 11.64) and for cardiac defects (OR 1.54, 95% CI 0.89 to 2.68).

CONCLUSION

This study does not support the hypothesis that residential exposure to electromagnetic fields from power lines causes any of the investigated outcomes.

[Remote effects of the Chernobyl accident: evaluation of the maxillodental status of the children]

Examinations of children exposed to the Chernobyl factor showed deterioration of the maxillodental status, presenting as a decrease in the incidence of normal-for-age status in comparison with children from the control group. The incidence of dental abnormalities in children whose parents participated in the Chernobyl accident aftermath is increased by 240,09%. The determination of remote effects of the Chernobyl accident for the health status of Russian children requires a differentiated approach and deserves a special study.

Nachkommen präkonzeptionell bestrahlter Eltern

BACKGROUND

Many young adults with cancer of good prognosis seek advice from their doctors, because they are concerned about their ability to have children and about potential hereditary diseases in the children conceived or fathered after cancer therapy.

PATIENTS AND METHODS

Results of repeated examinations of 61 children over a period of 20 years are reported. One of their parents had received radiotherapy for malignant disease (only three had additional chemotherapy). Radiation doses to the gonads ranged from 0.01 to 2 Gy. The most frequent indications for radiotherapy were Hodgkin's disease (n=25), seminomas (n=7), thyroid cancer (n=3), and malignant melanomas (n=3)

RESULTS

There was a trend to premature birth with 52.5% of the babies born before term. Yet, all had normal birth weight and delivery was inconspicuous. The skeletal maturation was retarded, but development was still in the normal range of German children. There were no chromosome aberrations, normal mental and intellectual development, and no malignancy among these children. A trend to an increased frequency of developmental disturbances and four moderately severe malformations were observed; however, no direct association with radiation treatment could be demonstrated. One child had a balanced translocation (5;17) which it inherited from the unirradiated parent.

CONCLUSION

During the first consultation of young adult cancer patients, before the start of treatment, the problems of fertility and of therapy-induced mutations and hereditary diseases as well as developmental damage of the offspring need to be addressed directly by the radiation oncologist. Decisions on cryoconservation of sperm, fixation of the ovaries and dosimetry of the gonads during radiotherapy have to be made before the start of treatment. The rate of radiation-induced hereditary diseases and developmental damage in the children conceived or fathered after curative radiotherapy of one parent is estimated to increase by <0.1% (after gonadal exposure of 1 Gy). However, at present, heritable damage potentially induced by chemotherapy cannot be adequately quantified yet.

The children of atomic bomb survivors: a synopsis

When the atomic bombing of Hiroshima and Nagasaki occurred in the summer of 1945, most members of the public presumed that many of the children conceived by the survivors would be grossly deformed or seriously damaged in other ways as a consequence of radiation-induced mutations. Although the experimental data then available, largely limited to studies of Drosophila melanogaster, the common fruit fly, did not support this perception, the limitations of the data and the depth of public concern warranted a careful follow-up of the children born to the survivors. To this end a surveillance was begun in 1947 of all pregnancy outcomes after 20 weeks of gestation in these two cities. Over the half century subsequent to the initiation of this surveillance, some 80-odd thousand pregnancy outcomes have been studied and a variety of potential indicators of mutational damage measured. This report summarises the findings of these studies and offers an estimate of the genetic risk based on these findings.

Radiogenic risks from hysterosalpingography

The aim of this study was to determine ovarian dose, effective dose and associated radiogenic risks from hysterosalpingography (HSG), and to provide data for the estimation of radiogenic risks related to HSG studies performed in any laboratory. The fluoroscopy time, number of radiographs taken and entrance surface dose were measured in a series of 78 consecutive patients undergoing HSG as part of their infertility work-up. Organ-dose values per radiograph and per minute of fluoroscopy were separately determined using an anthropomorphic phantom and thermoluminescence dosimetry. The radiogenic risk for deleterious effects on a possible future embryo and the radiogenic risk for cancer induction on the patient undergoing HSG were estimated. The average HSG procedure in our laboratory involves a mean fluoroscopic time of 0.3 min and a mean number of radiographs of 3.2. The dose to female gonads from an average HSG procedure was 2.7 mGy and the patient effective dose was 1.2 mSv. The risk for radiogenic anomalies in a future embryo of the woman undergoing an average HSG procedure and the risk for radiogenic fatal cancer induction in the exposed woman were estimated to be less than 10(-3) of the correspondent nominal risks. Radiation risks from a typical HSG are low, but they may be elevated if fluoroscopic and/or radiographic exposures are prolonged for any reason. Present data allow the estimation of radiogenic risks associated with HSG procedures performed in other laboratories with use of different equipment, screening time and number of radiographs taken.

Genetic effects of radiotherapy for childhood cancer

Radiation-induced heritable diseases have not been demonstrated in humans and estimates of genetic risks for protection purposes are based on mouse experiments. The most comprehensive epidemiologic study is of the Japanese atomic bomb survivors and their children, which found little evidence for inherited defects attributable to parental radiation. Studies of workers exposed to occupational radiation or of populations exposed to environmental radiation appear too small and exposures too low to convincingly detect inherited genetic damage. In contrast, survivors of childhood cancer form the largest group of people exposed to high doses of ionizing radiation before reproduction and offer unique advantages for studying trans-generation effects. A wide range of gonadal doses are possible, several comparison groups are readily available (including siblings), and there is a strong willingness among cancer survivors to participate in health studies. Cancer patients also have detailed medical records that facilitate both the accurate estimation of gonadal doses and the assessment of potentially confounding factors, such as intercurrent illness, personal and family medical histories, lifestyle characteristics such as tobacco use, and circumstances at delivery. An international study is nearing completion of over 25,000 survivors of childhood cancer in the United States and Denmark who gave birth to or fathered over 6,000 children. Doses to gonads are being reconstructed from radiotherapy records with 46% over 100 mSv and 16% over 1,000 mSv. Adverse pregnancy outcomes being evaluated include major congenital malformations, cytogenetic abnormalities, stillbirths, miscarriages, neonatal deaths, total deaths, leukemia and childhood cancers, altered sex ratio, and birth weight. The main analyses are based on dose-response evaluations. Blood studies of trios (cancer survivor, spouse or partner and offspring) have been initiated to evaluate mechanistic evidence for the transmission of any radiation-induced genetic damage such as minisatellite mutations. Markers of cancer susceptibility such as chromosomal radiosensitivity and genotype profile will also be examined. In the United States series to date, 4,214 children were born to cancer survivors among whom 157 (3.7%) genetic diseases were reported in contrast to 95 (4.1%) reported conditions among 2,339 children born to sibling controls. In the Denmark series the comparable figures were 82 (6.1%) birth defects among 1,345 children of cancer survivors and 211 (5.0%) among 4,225 children of sibling controls. Coupled with prior studies, these preliminary findings, if sustained by ongoing dose-response analyses, provide reassurance that cancer treatments including radiotherapy do not carry much if any risk for inherited genetic disease in offspring conceived after exposure.

Residence near power lines and the risk of birth defects

BACKGROUND

There has been some concern that exposure to electromagnetic fields may cause birth defects. We studied risks of birth defects by residential exposure to 50-Hz magnetic fields from power lines.

METHODS

We estimated the distance between residence and power lines for 161,844 Norwegian residences, and their corresponding magnetic fields in the period 1980 to 1997. Risks of 24 categories of birth defects were compared across exposure levels, adjusting for social and demographic variables.

RESULTS

Among those living near power lines, the greatest reductions in risk were for cardiac defects (odds ratio = 0.5; 95% confidence interval = 0.3-0.9) and respiratory defects (0.4; 0.2-0.9). The largest increase in risk was for esophageal defects (2.5; 1.0-5.9). Other associations were weaker and had wide confidence intervals.

CONCLUSIONS

There was little evidence that residence near power lines affected the risk of birth defects. The observed decreased risks of cardiac and respiratory defects and the increased risk of esophageal defects should be interpreted with caution given the number of endpoints, the imprecision in the calculations of the distance from the residence to the power line, and the limited information on pregnant women's change of residence.

[Cytogenetic effects in children exposed to low doses of ionizing radiation]

The obtained data indicate that frequencies of different types of cytogenetic anomalies in investigated children groups living in radionuclide contaminated territories and children irradiated in utero have complicated patterns. The frequency of chromosomal anomalies in the investigated groups of children exceeds the average population level. At the same time, no statistically significant differences in frequencies of various types aberrations between groups of children were revealed.

Health transitions, fast and nasty: the case of Marshallese exposure to nuclear radiation

The concept of health transitions assumes that health status improves with the introduction of western medicine. In this paper I demonstrate that the health of the people of Rongelap, Marshall Islands, has undergone serious damage as a result of nuclear testing, and that women in particular have suffered unduly. Exposure to nuclear radiation over a period of almost fifty years has been recognised by US authorities as a major contributory cause to the high rates of cancers and birth defects suffered by the Rongelap people. Women's reproduction has been severely affected, as evidenced by the many stillbirths and small stature of children born alive. Two generations have been exposed to both background radiation and to radiation ingested with the local foods on which they rely in the absence of other food sources. Clean up has commenced only after this and other communities sought compensation from the United States. The Rongelap people will live with the effects of radiation for generations to come. This transition to ongoing health problems is thus a negative outcome of modern health transition.