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Restoration of Uranium Tailings in the Mountains: A Perspective from the State of the Skin in Persons Living in the Vicinity

Written By

Alena Isupova

Submitted: 24 July 2023 Reviewed: 09 November 2023 Published: 22 January 2024

DOI: 10.5772/intechopen.113915

Conservation, Exploitation and Restoration of Mountain Ecosystem IntechOpen
Conservation, Exploitation and Restoration of Mountain Ecosystem Edited by Ling Zhang

From the Edited Volume

Conservation, Exploitation and Restoration of Mountain Ecosystem [Working Title]

Dr. Ling Zhang, Dr. Shuli Wang and Dr. Liangying Liu

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Abstract

In our work, for the first time, the problem of long-term exposure (more than 50 years) to low doses of radiation to the human body was touched upon. Comprehensive studies of the content of radionuclides in water, soil, meat of cattle, and small cattle, carried out within the framework of the ISTC; prove the entry of radionuclides into the human body through food chains. For the period from 2003 to 2023, studies were conducted on the skin of people living in various regions of Kyrgyzstan. A total of 3650 people were examined. The main group (600 people) is represented by people living near uranium tailings. Analysis of the features of the course and manifestation of dermatoses showed the features of the course of skin pathology. The mean age of stigma manifestation was 32.7 ± 7.5 years compared to the control group 45.2 ± 10.3 years.

Keywords

  • radionuclides
  • internal exposure
  • skin
  • stigmas of age-related skin changes
  • body aging
  • skin aging
  • uranium tailings
  • skin microbiome
  • skin diseases
  • immunity
  • pyoderma
  • diagnosis of skin neoplasms
  • epiluminescence microscopy
  • dermatoscopy
  • uranium tailings
  • 25(oh)D
  • skin microbiota

1. Introduction

Problems of environmental safety and public health in technogenic zones located in the mountains are of great scientific and practical importance.

Radiation safety is the main issue of environmental safety and public health in Kyrgyzstan. The legacy of past activities in the mining and processing of uranium remains relevant in connection with the spread of industrial waste throughout the territory of the republic and border countries [1]. Depleted uranium (DU) obtained as a result of processing natural uranium makes a large contribution to environmental pollution [2].

On the territory of Kyrgyzstan (199,951 km2) there are 49 tailings and 80 rock dumps, where 70 million m3 of uranium production waste is buried. In industrial tailing waste, in addition to uranium, there are radioactive elements in high concentrations, such as radium - 226, thorium - 230, and radon - 222, as well as elements that were used as reagents in the processing of ore: Ca, Si, Pb, Cr, Mn, V, Ni [3]. Most of the tailings are located in the mountain ecosystem, above settlements, near river mouths, or seasonal water flows. The lack of control over the movement of industrial waste has a negative impact on individual components of the mountain ecosystem, including plants, animals, and humans [4, 5]. Climate change is possible under the influence of anthropogenic factors; projected global warming can increase the number and severity of natural disasters in the mountain ecosystem [6]. In emergency situations, there is a danger of transferring industrial waste to the territory of neighboring states. The peculiarities of the spread of industrial waste are largely related to the high mountainous relief of the republic, seismic activity, seasonal melting of glaciers and mudflows, and wind erosion of soils. An analysis of the situation shows that more than 26,000 people are in the zone of ecological catastrophe in Kyrgyzstan, about 2 million people in Uzbekistan, 900,000 people in Kazakhstan, and 700,000 people in Tajikistan [7].

According to studies, drinking water from artesian wells was characterized by an increased content of U (up to 10 μg/l) and some microelements (for example, As, Se, Cr, V, and F), especially arsenic. In the drainage waters of the tailings, uranium concentrations exceeded those recommended by WHO by more than 200 times, and a large scatter was observed in the change in the (234)U/(238)U isotope ratios. Another study showed that the ingestion dose of radioactive radiation for members of the critical group is from 10 to 30 mSv, and in an emergency scenario - 45 and 77 mSv for an adult and a child, respectively [8].

The concentrations of radionuclides and chemical elements in the water of Lake Issyk-Kul were generally low but unexpectedly high for arsenic. Uranium (U), As, and Ni were mostly present in all samples as low molecular weight particles (<10 kDa), indicating that these elements are mobile and potentially bioavailable. Soils at mining sites are enriched with uranium, arsenic, and other elements. In Kaji-Sai, hotspots with increased levels of radioactivity were easily found, where accumulations of radioactive particles were observed. The presence of particles carrying a significant amount of radioactivity and toxic microelements can be dangerous during strong wind events (wind erosion) [9]. According to Salbu B., Burkitbaev M. et al. field expeditions to the Kurdai mine (border of Kazakhstan, 23 km from Bishkek) showed a high content of man-made waste in water and soil. Uranium, As, Mo, and Ni were predominantly present in waters in the form of mobile low molecular weight forms, while a significant part of Cr, Mn, and Fe was associated with colloids and particles. It was noted that, due to the oxidation of ferrous iron in artesian groundwater, upon contact with air, iron serves as a sink of other elements, peak concentrations of uranium, radium, arsenic, and manganese isotopes are observed, and based on successive extractions, a significant part of U, Pb, and Cd can be considered mobile [10]. A similar situation with the impact of radionuclides and metals on the environment is observed at the former U-Taboshar and Digmay test sites in the neighboring republic [11].

Insufficient security associated with free access to uranium tailings can pose a serious threat to the spread and use of radioactive components of former enterprises [12]. In many technogenic zones, cattle grazing was noted near burial grounds (Figure). Local residents visit open adits (Figure 3) and extract building materials and coal for the needs of the family.

Today in Central Asia there is a problem of limited data on water quality [13], taking into account climate change and the man-made introduction of humans into the mountain ecosystem. Climate change entails a change in the quantity and quality of water resources in the Central Asian republics [14]. On a global scale, the flow of rivers originating in the mountains increases in response to climate warming and the depletion of glaciers [15]. Large uncertainties in meteorological datasets remain a major obstacle to understanding the processes that cause changes at the interface between climate, glaciers, runoff, and mountain ecosystems as a whole [16].

A study by Hao et al. [17] proposes a new analytical framework for assessing the security of water, energy, and food (WEF) and the factors influencing them in five countries of Central Asia: Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan; Tajikistan. At the same time, four dimensions of security indicators are proposed: availability, self-sufficiency, productivity, and accessibility [17]. It is hoped that radiobiology and radioecology will be included in the study of factors affecting the safety of WEF. There is no better opportunity to study in detail the mechanisms of action, biological effects, kinetics in the body, and ways of excretion of radionuclides, as their wide application in medicine. Beta-particle emitters are used, however, a large radius of action (≥1 mm) can cause nonspecific irradiation of healthy cells [18]. Radionuclides emitting predominantly alpha particles have a narrowed exposure range to 50–100 μm [19]. Although it is known that the emitters of alpha particles decay along the decay chain, which leads to the appearance of several daughter particles, causing additional biological effects [20]. Auger electrons are very low-energy electrons emitted by radionuclides that decay by electron capture. This energy is transferred over distances ranging from nanometers to micrometers, resulting in a highly linear energy transfer capable of causing lethal cell damage. These high-energy deposits produce local dense ionizations that are highly destructive when the radionuclide is incorporated into nuclear DNA, the cell nucleus, or the cell membrane [21].

The International Atomic Energy Agency (IAEA) plays an important role in controlling the quality and mechanisms of action of radionuclides on a living organism. The Agency is pursuing the issue of “Preclinical testing of radiopharmaceuticals” to minimize the risk of unknown and undesirable effects [22]. Such work could make a great contribution to the problem of the health of people living in the zone of technogenic pollution for a long time, taking into account the cross-understanding of research topics and the symbiosis of sciences [23]. It is known that radionuclides penetrate into the internal environment of the human body with water, food, and also by inhalation of aerosols [24]. The clinical effects of exposure to DU, like other heavy metals, are manifested by nephrotoxicity [25], neurological symptoms, immunotoxicity, embryotoxicity [26], and hepatotoxicity [27]. Epidemiological [28] and experimental studies confirm an increased risk of neoplasms [29].

Assessment of radiological doses due to endogenous intake of radionuclides is calculated using biokinetic and dosimetric models [30]. IMBA is a set of software modules that implement current ICRP (International Commission on Radiation Protection) biokinetic and dosimetric models for intake and dose assessment. When calculating, IMBA applies the truncation rule for progeny in radioactive series [31], which limits the results of the study. There are recommendations of the ICRP in case of nuclear accidents, taking into account the scale and necessary radiological protection and, in the long term, the development of measures to restore the living conditions, working conditions, and quality of life of the affected communities. To achieve this goal, the ICRP emphasizes the critical importance of bringing all stakeholders together [32]. In our opinion, following this example, monitoring the situation at uranium tailings dumps and the safety of the population in technogenic zones should also become a priority for stakeholders and the state.

It is known that the incorporation of radionuclides into the internal environment of the body will not cause acute radiation sickness, but it can cause long-term internal exposure, leading to health consequences after several years or even decades. In this variant of exposure, the harmful biological effects of radiation do not have a dose threshold of occurrence and are stochastic. With increasing doses, it is not the severity of these effects that increases, but the likelihood (risk) of their occurrence [33]. The health risk can be quantified by the committed effective dose, which is defined as the cumulative effective dose from internal exposure 50 years (for adults) after the incorporation of the radionuclide [34]. In addition, uranium is a heavy metal (19.1 g/cm3) and therefore may have chemically induced toxic effects [34]. The mechanisms of heavy metal toxicity are quite complex [34]. The toxicity and absorption of uranium (concentration in the target tissue) depends on its soluble and insoluble forms [35]. The mechanisms underlying the toxicological effects of uranium on the human body are being studied [36].

Thus, active technogenic pollution of the environment as a result of the mining and processing of uranium, as well as the disposal of uranium waste, significantly disrupts the existing balance of the abiotic part of the mountain ecosystem and the biocenosis, which consists of the exchange of matter and energy. Our scientific research is devoted to studying the influence of “low doses of radiation”, “toxicological profile” of radionuclides on the state of the integumentary system, immunological status, and skin microbiota of communities living for a long time (more than 50 years) near uranium tailings in a mountain ecosystem.

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2. Research results

2.1 Territorial living conditions of a cohort of Kyrgyz in a mountain ecosystem

The research was carried out within the framework of the scientific project KR766 of the International Science and Technology Center (ISTC). To record the radiation level, the participants of the ISTC KR766 project expedition used a domestic radiometer SRP-68-01 type RPTU-01 with a BTGI-01 sensor, which allows recording gamma radiation at a discrimination energy level of 20 ± 5 keV and with a measurement range of exposure dose rate up to 3000 μR/h [5].

Scientific research covered the territories of the geochemical provinces of Min-Kush, Mailu-Suu, and Kadzhi-Sai of the Republic of Kyrgyzstan. The country’s territory is located within two mountain ecosystems. Its northeastern part lies within the Tien Shan, and the southwestern part lies within the Pamir-Alai. Kyrgyzstan is 93% mountainous and mostly lies on land, located at an altitude of 1000–7400 m. The average altitude above sea level is 2750 m. More than 40 percent of the country’s territory is at an altitude of more than 3000 m, and three-quarters of this is covered by permanent snow or glaciers, with 600 glaciers covering an area of 6578 km2 [37].

The geochemical province Min-Kush (“thousand birds”) is located in the spurs of the Moldo-Too ridge in the geographical zone of the Central Tien Shan, at an altitude of 2200 to 2500 m above sea level (Figure 1). The figure shows a mountain ecosystem, where a settlement is located in a gorge along the river, and uranium tailings are located in the upper reaches of the mountains. Background radiation levels in the urban area of Min-Kush compared to ecologically “clean” areas of the republic (18–22 μR/h) are increased: three times higher (60–61 μR/h). Thus, at the gates of the Tuyuk-Suu tailings dump, the background radiation level was 60–61 μR/h, on the territory of the Rudnik hotel - 60 to 61 μR/h, in the water flowing from the adit. No. 8–61-61.5 μR/h.

Figure 1.

The geochemical province of Min-Kush.

Geochemical province Kadzhi-Sai (Figure 2) on the southern shore of Lake Issyk-Kul, at an altitude of 1750–1978.9 m above sea level. Figure 2 shows a populated area with uranium tailings and rock dumps located above it.

Figure 2.

Geochemical province of Kaji-Sai located near the mountain lake Issyk-Kul.

On the right of the photo, you can see the entrance part of the adit. It is important to note that the adits remained unguarded for a long time. The entrance to the adits is open (Figure 3) and accessible to animals, residents, including children.

Figure 3.

The entrance to the mine adits is open.

Figure 4 shows rock dumps, and on the right is a fragment of wastewater from a uranium tailings pond. Our expedition vehicle is visible in the background. The radiation level here is from 600 to 1000 μR/h.

Figure 4.

The rock dumps and uranium tailings.

Figure 5 shows a large wastewater flow from a uranium waste disposal site toward a populated area and mountain lake in this mountain ecosystem.

Figure 5.

Mudflow passing through the territory of the uranium tailing dump toward residential areas and the lake.

Mountain rivers and mudflows violate the integrity of uranium tailings and thereby spread man-made pollutants throughout residential areas, fields, gardens, and pastures, and these waters end up in Lake Issyk-Kul.

In 1948, there was a uranium ore processing plant here. Uranium oxide was extracted from the ash of brown uranium-containing coals of the Sogutinsky deposit after their combustion (uranium oxide was extracted by leaching from the ash). In the Kadzhi-Say geochemical province, the radiation level is relatively low and ranges from 18 to 40 μR/h, but the uranium content in the surface waters of the Kadzhi-Say tailings pond, as well as on the southern shore of Lake. Issyk-Kul, adjacent to the province, is 1–2 orders of magnitude higher than on the opposite shore of the lake. If in the water of the northern shore of Lake Issyk-Kul the uranium content is about 0.3–4.94 × 10–5 g/l, then in the region of the Kadzhi-Sai province this figure is 2–60 times higher. A total of 11.7 × 10–5 g/l of uranium was found in tap water from the well of the Khan-Saray boarding house, compared to tap water in the village of Komsomolsky, Chui region, where the radioecological laboratory is located, containing uranium 1.3 × 10–5 g/l.

The geochemical province Mailu-Suu (Figure 6) is located in the Jalal-Abat region on the slopes of the Fergana Range at an altitude of 1100–1200 m above sea level. This is the largest uranium province, in which a uranium processing plant operated from 1946 to 1967, and its waste was stored along the right and left banks of the Mailu-Suu River. After the closure of the mining plant, 23 uranium tailings and 18 dumps of substandard uranium ores remained in the region. 1.9 million m3 of spent uranium ore are buried in this area.

Figure 6.

Former uranium mining site of Mailuu-Suu [38].

The radiation background of gamma radiation in the geochemical province of Mailu-Suu ranged from 16 to 600 μR/h, and according to the regional department of the Ministry of Emergency Situations of the Kyrgyz Republic, in some areas, it reached up to 1000 μR/h, i.e. exceeded the radiation levels existing in clean zones by 2–4 times, and in anomalous points by 20–50 times.

2.2 Analysis of food products obtained from livestock farming in a mountain ecosystem near uranium tailings

The expedition members examined the organs of large and small livestock in the three main uranium provinces of the republic. Uranium content in the organs of Min-Kush cows: 0.001–5.54 mg/kg wet weight. In the city of Mailu-Suu, it is 0.002–0.212 mg/kg and in the city of Kadzhi-Sai - 0.002-0.537 mg/kg wet weight.

The uranium content in the organs of small ruminants (lambs) in the city of Min-Kush ranges from 0.005 to 2.44 mg/kg, in the city of Mailu-Suu - 0.03-0.107 mg/kg, in the city of Kadzhi-Sai - 0.001–0.048 mg/kg. The uranium content in integumentary tissues (skin, horns, hooves) ranges from 0.003 to 0.18 mg/kg wet weight.

Figure 7 shows the grazing of large and small livestock on natural pastures, part of the territory of which includes unprotected tailings ponds and mountain dumps. On the right, you can see grazing animals among the rock dumps. In the center of this figure, the water flow passing through the rock dumps is clearly visible.

Figure 7.

Pastures and hayfields in the mountain ecosystem of Kyrgyzstan.

Thus, the material we obtained convincingly proves that radionuclides enter the body of animals and humans through food chains.

2.3 General characteristics of uranium burial sites in the mountain ecosystem of Kyrgyzstan

Thus, waste from production and industrial equipment with a total volume of about 400,000 m3 is buried on the territory of the republic. After the cessation of the activities of mining enterprises for the extraction and processing of uranium, 35 of the 49 tailings dumps that formed turned out to be ownerless. Of the 80 dumps of substandard uranium ores, 25 are abandoned.

Mountain rivers and mudflows violate the integrity of uranium tailings and thereby spread man-made pollutants throughout residential areas, fields, gardens, pastures, and these waters end up in rivers and lakes, which causes enormous damage to the mountain ecosystem as a whole. Foothills and mountain settlements suffer from the presence of uranium tailings and rock dumps.

2.4 Methods for studying communities living near uranium tailings in a mountain ecosystem

During the period from 2003 to 2023, 3650 people living in various regions of Kyrgyzstan were examined. The risk group is people living near uranium tailings in the mountains; the comparison group – people living in radionuclide-free areas.

The skin was examined using standard methods. Initially, the condition of externally unchanged areas of the skin was assessed, and then the lesions were described. Skin color and the presence of de- and hyper-pigmentation were determined, indicating the place where these changes were most pronounced; elasticity, turgor, and hydration (normal, dry, moist skin). If rashes were present, their nature (inflammatory or non-inflammatory), symmetry, extent of the process, localization of the rash, and damage to open or closed areas of the skin were assessed.

To analyze clinical and epidemiological studies, a specially designed card was filled out based on information obtained from the study of outpatient records, clinical and instrumental methods for studying the skin of selected groups. During the interview, a questionnaire consisting of 54 questions was filled out. Clinical assessment of pigmented skin lesions was carried out according to the ABCD rule (R. Friedman) [39].

Epiluminescence microscopy of skin neoplasms was performed using a Heine Delta 20 dermatoscope (K-256.27.376, Heine Optotechnik, Germany), an emersion medium (Dermatoscopy Oil, K-00.34.005, Heine Optotechnik, Germany), a recording device - a Nicon 5300 digital camera (Japan); photo adapter designed for contact with a HEINE DELTA 20/Nikon Coolpix writing device (K-00.34.235, Heine Optotechnik, Germany). A dermoscopic assessment of melanocytic pigmented skin lesions was performed using “pattern analysis” [40]. Panoramic skin scans were taken under standard conditions.

2.4.1 Immunological studies

Immunological studies included the study of T- and B-links of immunity, the phagocytic activity of neutrophils, and the system of mononuclear phagocytes. The content of T- and B-lymphocytes and subpopulations of T-cells in the blood was determined by the method of indirect surface immunofluorescence with monoclonal antibodies of the IKO series, a “shortened” panel was used to identify CD markers: CD3+ (T-lymphocytes); CD4+ (helper T-lymphocytes); CD8+ (cytotoxic lymphocytes); CD20+ (B-lymphocytes). The study of mononuclear phagocytes was carried out using the following methods: (1) Determination of the phagocytic activity of monocytes in a test with monodisperse latex particles with a diameter of 1.0–2.0 μm; (2) Nitroblue tetrazolium test in monocytes (NBT-test); (3) Adhesion of monocytes; (4) Spreading of monocytes; (5) Determination of the total luminescence index (SIL) of monocyte lysosomes; (6) In some cases, lipid inclusions were detected in the cytoplasm of monocytes using a luminescent probe 3-MBA (3-methoxybenzanthrone). In parallel, the phagocytic activity of neutrophils and the intensity of their reduction of nitroblue tetrazolium were studied. (7) The calculation of the relative and absolute content of monocytes in the peripheral blood was carried out according to the generally accepted method.

2.4.2 Study of skin microflora

To study the quantitative and qualitative composition of the skin microflora, 67 skin samples were studied on Korostelev’s medium, and 53 samples were taken by washing. The respondents were conditionally divided into three groups: (1) residents of the clean zone (28 people); (2) residents of the technogenic zone (30 people); (3) ormer miners of a uranium mine (28 people).

When studying the ecology of the skin of the examined groups, appropriate methods of material selection were used. The isolation of microorganisms from their natural habitat - human skin - was carried out by washing and imprinting, which made it possible to count viable microcolonies or clusters of bacteria located on the surface of the skin (a quantitative method for studying surface microflora). This method refers to direct methods of collecting material and is convenient and easy to perform. When using the direct method, slides with Korostelev’s medium (per 100 ml of meat peptone agar, 0.5 ml of a 1.5% alcohol solution of bromothymol blue) were tightly placed for 2 seconds on the surface of the skin of the shoulder, placed in petri dishes and incubated in a thermostat at a temperature of 37°C 24 hours. One cup of medium not in contact with the skin was left in each dish to control airborne flora that may enter when the lid is opened (usually airborne flora does not grow on this medium for 24 hours at 37°C). To differentiate bacteria by biological properties, 1% mannitol was added to Korostelev’s medium with bromothymol blue solution.

Microbes that did not decompose mannitol formed colonies colored in the color of the medium—dark green (Figure 8), and those capable of fermenting it— bright yellow. (Fermentation of mannitol is one of the signs of microbial virulence.)

Figure 8.

Microbiological studies were carried out in the laboratory of the Department of Microbiology of KSMA.

Figure 8 shows preparations with colonies of skin microflora of examined individuals living near uranium tailings dumps and in the “clean zone”. The appearance of plates of Korostelev’s medium with colonies of skin microflora (yellow colonies - mannitol-positive, green colonies - non-fermenting mannitol).

A washing method in which dispersion of aggregates is achieved and individual cell counting is subsequently possible, which makes it possible to study the deep microflora of human skin. In this method, a rod was placed in 1 ml of 0.85% saline solution, and a stencil with an area of 1 cm2 was applied to a sterile cotton swab. Further seeding of the material was carried out on artificial nutrient media. To study microbes from the skin of subjects, cultures were obtained in the form of homogeneous populations (pure cultures) by dispersing mixtures onto other media of varying consistency, both to isolate the colony and to preserve the culture or to study its enzymatic properties. Isolated microbial cultures were identified by studying the morphological characteristics of bacterial colonies and the nature of growth on solid and liquid nutrient media. Biochemical features include the ability of microorganisms to ferment glucose, lactose, sucrose, maltose, and hexahydric alcohol mannitol. The pure culture was sown in a loop onto the “variegated row” media. The results of the work to identify the isolated culture based on morphological and physiological characteristics were presented in a standard form.

2.4.3 Serum 25(OH)D level testing

The level of 25(OH)D in nmol/l was studied on a Cobos e-801 analyzer (Roshe, Italy) using the enzyme immunoassay method. Coefficients of variation for 25(OH)D ranged from 4.0% to 6.1%, indicating the validity and reliability of the measurements. Internal quality control is confirmed by the program (TIQCON) of Roshe, Italy.

2.4.4 Data collection and use of variables

All subjects signed informed consent to participate in the study. All ethical standards and principles of confidentiality were maintained during the study in accordance with the principles of the World Medical Association Declaration of Helsinki, as amended in 2000, “Ethical Principles for Medical Research Involving Human Subjects.”

2.4.5 Statistical analysis

Statistical analysis was performed using PASW Statistics 21.0 (SPSS Inc., IBM, Chicago, USA). Descriptive statistics are presented as mean, standard deviation (SD), and standard error (SE). The statistical significance of the variables was determined using Pearson’s chi-squared test. All tests are two-tailed, and p < 0.05 was considered statistically significant. The contingency coefficient phi Cramer̕ s V was used to assess the relationship of nominal data, where the value varies between 0 and 1, with “0” indicating no relationship between the row and column variables, and a value close to 1 indicating a high degree of relationship between these variables. To assess the effect of exposure to a risk factor, attributable risk (AtR), risk ratio (RR), and potential harm index (NNT) were calculated for each variable. For all variables, a 95% confidence interval (95% Cl) was calculated. Statistical significance was determined using the Cochran and Mentel-Henzel test, where p < 0.05 was considered statistically significant. After the Bonferroni correction (when >2 groups were set), the significance level would be p < 0.01.

2.5 Health indicators

2.5.1 Incidence analysis

In children of the geochemical uranium provinces of the cities of Kaji-Sai, the cities of Min-Kush, the cities of Mailu-Suu up to 14 years old (650 people), based on the diagnoses made in outpatient cards and annual reports according to the data for formation No. 12, it can be seen that in the first place are respiratory diseases - 58% (of which 48% are acute respiratory infections); in second place - diseases of the oral cavity and teeth, then blood, skin, endocrine system. In the adult population (800 people), diseases of the digestive system (52%), and respiratory organs (47%) are in the first place, then, in combination with the previous nosological groups, diseases of the cardiovascular and genitourinary systems. Comorbidity in the adult population was noted in 38% of cases. Complaints. In children, in the first place are frequent colds, dryness, peeling and redness of the skin, itching, aggravated after water procedures, and the presence of pigmentation. In adults, asthenic conditions, especially in the afternoon, pain in muscles and joints for no apparent reason, frequent headaches, and aching in nature. On the part of the skin, there are complaints of early graying of hair, in some from the age of 13–14 years, severe dryness of the skin, itching, aggravated after the use of soap and detergents, poor wound healing, the presence of neoplasms.

2.5.2 Skin condition of residents of technogenic zones and former miners of a uranium enterprise

In children of younger preschool age, viral diseases of the skin and mucous membranes, superficial pyoderma, and nonspecific hand dermatitis were more often recorded; in middle and older preschool age in 36% of cases, a combination of signs was revealed: xerosis and peeling of the skin; itching of the skin of varying severity, aggravated by sweating; erythematous-squamous rashes on the skin of the elbows and in the popliteal fossae; in school-age children, the following combination of symptoms was revealed in 27% of cases: erythematous-squamous rashes with lichenification, severe dryness, peeling and itching of the skin, forehead peteriasis, cheilitis, nonspecific hand dermatitis in spring and summer, nonspecific dermatitis of the feet in winter. In 18.6% of cases, a bacterial infection joins the violation of the epidermal barrier. Many children have a reaction from the mucous membranes of the nose, larynx, and cornea of the eye to the flowering of plants, especially wormwood. This is manifested by redness of the eyes, tearing, sneezing, a sensation of scratch in the throat, and in some cases a dry cough.

In the adult population, a bacterial infection of the skin comes to the fore, dyschromia is in second place, then benign neoplasms, and photodermatosis, as one of the common causes of skin pigmentation disorders in the examined individuals; in the future - atrophic changes in the skin and its appendages, fungal skin lesions, vascular atrophic poikiloderma.

A feature of bacterial infections of the skin in residents of technogenic zones and miners is the torpidity of the course with a predominance of the hemorrhagic component and mild infiltration. Chronic ulcerative pyoderma is present in 3.1% of cases; miners in 43% of cases with deep pyoderma did not have a pronounced pain syndrome. In 10% of patients, the course of the disease exceeded 15 years, relapses were observed 3–5 times a year. Among fungal infections, infiltrative-purulent forms of the beard area (in men) and pubis, onychomycosis, candidiasis, and multi-colored lichen prevail. In some patients (15.7%), the course of multi-colored lichen was of a generalized nature. Usually, multi-colored lichen occurs against the background of increased sweating, which was not observed in the examined individuals. When examining the integumentary system of a person, increased dryness of the skin (xerosis) was noted, the hair of 48% of the inhabitants of technogenic zones and 78.2% of the miners were dry, dystrophic, and 8.3% had diffuse alopecia. Patients. In 39% of cases, various types of nail dystrophy were noted. At a young age, koilonychia, onychomadesis, micronychia are more often observed; in 3%, canal-like dystrophy of the nail plates of the thumbs is detected. Onycholysis, onychoshisis, and onychogryphosis are more often observed in people over 30 years old in 4.1% of residents of technogenic zones and 13.9% of former miners. Thinning of the skin and the presence of a pronounced vascular pattern of the skin were noted. In 9% of cases, in combination with skin dyschromia. In Bishkek residents, such skin changes are sporadic. It is interesting to note that against the background of dry and atrophic skin, hyperplastic processes were observed in the form of warts, papillomas, and seborrheic keratomas.

2.5.3 Bacterial contamination of the skin in residents of uranium geochemical provinces and former miners of a uranium enterprise

Violation of the epidermal barrier under conditions of environmental instability leads to quantitative and qualitative changes in the commensal flora of the skin (Table 1). Violation of skin microbiocinosis entails a more severe course of skin diseases due to contamination with pathogenic flora (Figure 9).

Groups by number colonies on medium plates Korosteleva1
Control group living in a clean area
(n = 28)		2
Persons living in conditions of technogenic pollution
(n = 30)		3
Miners
(n = 28)
0–50, %88.9 ± 2.357.6 ± 3.128.6 ± 1.9
51–100, %11.1 ± 1.419.2 ± 2.221.4 ± 2.0
Over 100, %023.1 ± 1.935.7 ± 2.5
Solid growth, % of them mannitol-positive bacteria (in % of the total number)0
14.8 ± 2.9		0
53.8 ± 3.4		14.2
57.1 ± 2.2

Table 1.

Level of bacterial contamination of the skin in residents of uranium geochemical provinces and former miners of a uranium enterprise (M ± m).

p < 0.01.

Figure 9.

Species composition of skin microflora in residents of the uranium geochemical province and former miners of the uranium enterprise.

Continuous growth was observed in 23.1 ± 1.9 and 35.7 ± 2.5 with a predominance of mannitol-positive flora in 53.8 ± 3.4 and 57.1 ± 2.2 in the demonstration group and in the group of miners, respectively, which indicates a violation of skin microbiocinosis (Table 1).

Healthy skin is characterized by a high population of commensal flora and low species diversity (Figure 9); a shift in species diversity of the skin flora is one of the signs of a violation of microbiocenosis.

2.5.4 Immune system

Normally, the ratio of T- and B-lymphocytes is 70–80%/10–15% of blood lymphocytes. In residents of the clean zone, this ratio changes from normal values toward a decrease in T-lymphocytes. Similar changes are occurring with the residents of the geochemical province. It is known that the phenotype of the subpopulation of T-helper cells (helpers) is represented by antigens CD3, CD4, and T-cell receptor antigens HLA class II. These lymphocytes recognize foreign antigens processed by macrophages, activate the mechanisms of activation of B lymphocytes, and produce antibodies (Th2). At the same time, the population of CD3 cells decreases, which leads to a decrease in the activity of T-cell immunity (Figure 10).

Figure 10.

Indicators of cellular immunity in residents of a uranium geochemical province located in a mountain ecosystem and former miners of a uranium enterprise in comparison with the control group.

A simultaneous increase in the number of cytotoxic blood lymphocytes (CD8) leads to inhibition of the activation function of T- and B-lymphocytes and their reactions. Our observations show a tendency toward a decrease in the functional activity of B-lymphocytes and a decrease in the CEC in the studied groups (Figure 10). The population of B lymphocytes is the precursor of plasma cells that form protective antibodies of an immunoglobulin nature. Once activated by an antigen, B lymphocytes form memory cells, which allows the body to quickly synthesize large quantities of antibodies when repeated immunization with the same type of antigen.

A distinctive feature of the decrease in humoral immunity in residents of geochemical provinces in the mountain ecosystem and former miners was a characteristic decrease in the concentration of serum IgM and IgG, apparently associated with the depletion of the function of B-lymphocytes at the final stage of their differentiation stage, i.e. plasma cells (Figure 11). Circulating immune complexes and immunoglobulins in residents of a uranium geochemical province in a mountain ecosystem and former miners of a uranium enterprise in comparison with the control group.

Figure 11.

Circulating immunoglobulins (Ig) in residents of a uranium geochemical province located in a mountain ecosystem and former miners of a uranium enterprise in comparison with the control group.

The indicator of the nitroblue tetrazolium test (Table 2) decreases, which reflects the state of the bactericidal peroxidase systems of the cell and correlates with the formation of superoxide radicals, which is distorted by the relative lack of O2 in the inhaled air.

Indicators1
Control group living in a clean area
(n = 28)		2
Persons living in conditions of technogenic pollution
(n = 30)		3
Miners
(n = 28)
MonocytesNeutrophilsMonocytesNeutrophilsMonocytesNeutrophils
Phagocytic index, %59.1 ± 4.270.3 ± 2.952.09 ± 1.5362.3 ± 1.351.21 ± 2.2764.75 ± 0.8
Phagocytic number2.2 ± 0.93.3 ± 0.71.89 ± 0.092.31 ± 0.071.83 ± 0.192.25 ± 0.17
Integral phagocytic index1.3 ± 0.012.3 ± 0.020.99 ± 0.061.45 ± 0.060.92 ± 0.111.54 ± 0.11
Nitroblue tetrazolium test, %85.3 ± 0.390.1 ± 0.276.09 ± 1.3681.5 ± 0.9177 ± 2.0985.75 ± 1.1
Average cytochemical coefficient1.3 ± 0.041.7 ± 0.011.0 ± 0.051.46 ± 0.071.06 ± 0.011.41 ± 0.09
Adhesion, %37.4 ± 2.720.61 ± 1.221.53 ± 1.46
Spreading, %29.2 ± 3.114.62 ± 0.8114.1 ± 0.83
Total luminescence index of lysosomes329.8 ± 162188.55 ± 8.5202.08 ± 8.7

Table 2.

Functional indicators of blood monocytes and neutrophils in residents of the uranium geochemical province and former miners of a uranium enterprise (M ± m).

p < 0.01.

The lysosomal apparatus of mononuclear phagocytes is closely related to the processes of catabolism, the work of which is enhanced by radiation (Table 2). At the same time, we took into account that the content of lysosomes in the cytoplasm of monocytes is a reflection of oxygen-independent mechanisms for the destruction of microorganisms, which also indicates a deterioration in the functional activity of monocytes. Thus, among residents of technogenic zones and former miners of a uranium plant, both mechanisms of bactericidal activity—oxygen-dependent and oxygen-independent—function at an extremely low level, not completely protecting the body from infection. Both indicators—“adhesion” and “spreading” are significantly reduced, which once again confirms the low functional activity of monocytes (Table 2).

We have established a clear connection between skin barrier disorders and skin microbiome dysbiosis with immune dysregulation and high sensitization to environmental allergens, which is manifested by a variety of skin symptoms characteristic of residents of technogenic zones.

2.5.5 Skin tumors in the risk group

Epidermal tumors - 58.2% (95% CI 56.5–59.9); melanocytic formations - 4.51% (95% CI 3.8–5.24); non-tumor pigmentation - 10.7% (95% CI 9.6–11.7); vascular tumors 17.7% (95% CI 15.8–18.5); fibrous formations 5.2% (95% CI 4.4–6.0); from nervous, muscular and adipose tissue 3.3% (95% CI 2.6–3.9). Melanoma and non-melanoma cancer 1.5% (95% CI 1.06–1.93) [41].

Calculation of Pearson’s chi-square coefficient showed the existence of a relationship between the risk factor and the frequency of occurrence of the main stigmas of geranthogenesis in people living near uranium tailings. The calculation of the contingency coefficient phi Cramer̕ s V showed the strongest relationship with the risk factor for seborrheic keratoses - 0.627. For other statistically significant variables, the association strength is moderate (from 0.3 to 0.6). This gives grounds to assert that these signs can serve as criteria for assessing the influence of a risk factor on age-related skin changes. The NNH calculation indicates that 1 out of 3 residents of the risk group may develop early age-related stigmas [42].

2.5.6 Study of serum 25(OH)D level using enzyme immunoassay

The average level of 25(OH)D in the blood serum of the examined was 38.7 ± 1.0 nmol/l (95% CI 36.6–40.7 nmol/l), and there were no statistically significant gender differences (p = 0.066). Seasonal fluctuations were established - from 30.2 ± 1.9 nmol/l (95% CI 26.3–34.1 nmol/l) in winter to 46.6 ± 1.9 nmol/l (95% CI 42.8–50.3 nmol/l) in autumn (p = 0.0001). The level of 25(OH)D less than 50 nmol/l was detected in 71.3 ± 2.6% (95% CI 66.1–76.5%) of cases, 50–75 nmol/l — in 24.6 ± 2, 5% (95% CI 19.7–24.5%) of cases, more than 75 nmol/l in 4.1 ± 1.2% (95% CI 1.8–6.4%) of cases [43].

2.5.7 Discussion

Communities living for a long time (more than 50 years) in conditions of technogenic pollution are characterized by daily endogenous intake of increased amounts of toxic and radioactive substances (radionuclides) through the food tract, transdermally and aerogenously. Arguing about the pathogenetic mechanisms of the emergence of features of a number of skin pathologies of people living near uranium tailings in a mountain ecosystem, we assume that the endogenous intake and gradual removal of radionuclides from the body does not lead to a rapid onset of effect, but over time causes a number of epigenetic effects that manifest themselves phenotypically. Our assumptions are confirmed by a number of works in the field of environmental epigenetics [44, 45, 46, 47].

A significant role in the development of the “effect” is played by the characteristics of the barometric pressure of the atmosphere in the conditions of a mountain ecosystem. Thus, the combined effect of ionizing radiation and natural hypoxia in a mountain ecosystem modifies the radiosensitivity and radioresistance of the body, changing oxidative metabolism. When studying this issue, it is necessary to take into account a number of provisions of classical radiobiology, one of which is the “oxygen effect” [48]. This effect has been known to science for a long time, but recently it has been studied in more detail not for protection, but, on the contrary, for a more effective effect on tumor cells during treatment with ionizing radiation at high partial pressure of oxygen [48].

Thus, it is important to take into account the modifying effect of hypoxia in mountainous areas when developing algorithms for carrying out therapeutic and preventive measures among people exposed to endogenous exposure to low doses of radiation.

The identified severe deficiency of vitamin D in people living in geochemical provinces in the mountain ecosystem maintains the pathological condition of the skin. The hormonal form of vitamin D, in addition to regulating calcium homeostasis, has important pleiotropic effects mediated through the vitamin D receptor (VDR) and affects almost all body functions [49]. Its regulatory ability influences the proliferation and differentiation of keratinocytes [50], as well as innate and adaptive immunity [51], thereby helping to restore the epidermal barrier and protective properties of the skin.

The next important component of the skin that we studied in our work is the skin microbiome. The health of the human integumentary system largely depends on its quantitative and qualitative characteristics [52]. It should be noted that the skin microbiome is very sensitive to changes in environmental factors. Its changes lead to damage to the skin. But, on the other hand, thanks to increased adaptive abilities, the skin microbiota is able to positively influence the immunological mechanisms in the skin and have a regulatory role aimed at the protective properties of the skin under normal conditions [52, 53].

Under conditions of technogenic pollution, a damaged epidermal barrier cannot be a favorable habitat for saprophytic microbiota. Such conditions close the “pathological circle” by promoting the colonization of the skin by pathogenic flora. Thus, in our study, we prove that damage to the epidermal barrier under conditions of technogenic pollution determines the characteristics of the manifestation of dermatoses, their course, frequency of occurrence, and the presence of comorbidity. At the same time, depletion of the skin’s reserve capabilities and disruption of its regenerative abilities lead to premature aging of the skin and the development of skin tumors.

When creating an algorithm for the treatment of skin diseases, it is necessary to take into account the influence of technogenic impacts and the specific living conditions in the mountain ecosystem of Kyrgyzstan.

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3. Conclusions

Analysis of the structure, prevalence, clinical and anamnestic features of the course, and manifestations of dermatoses showed a high frequency of infectious dermatoses with a deeper protracted course, especially in former miners of uranium enterprises. The current situation is a reflection of immunodeficiency states, as indicated by our immunological studies, where the inhibition of the activation function of T- and B-lymphocytes clearly correlates with a decrease in the production of immunoglobulins, as well as with a decrease in the number and functional activity of mononuclear phagocytes and neutrophils (Figures 11, Table 2). This situation is exacerbated by a change in the microbiological profile of the skin (Table 1) toward the predominance of pathogenic flora (Figure 10). The average age of manifestation of gerantogenesis stigmas (steatosis, keratoderma of the palms and soles, dyschromia, diffuse hair thinning, early graying, senile lentigo, seborrheic keratosis, senile angiomas) was 32.7 ± 7.5 years compared with the control group 45,2 ± 10 years. A relationship was found between the risk factor and the frequency of occurrence of the main age-related stigmas in people living near uranium tailings in mountainous conditions. The influence of risk factors on the likelihood of age-related stigma from 37% ± 2.82% (95% CI 31.5% - 42.5%) to 63.2% ± 2.81 (95% CI 57.7% - 68, 7%), in addition to the probability that exists for persons who have not been exposed to a negative factor. Violations of the epidermal barrier, a decrease in skin resistance to environmental factors, and the presence of dystrophic changes in the skin appendages suggest structural and functional changes in the human integumentary system as a result of a long-term, predominantly endogenous, intake of radionuclides into the internal environment of the body.

Comorbidity in dermatological pathology is associated, on the one hand, with a violation of the skin barrier, and on the other hand, with changes in the main links of cellular and humoral immunity toward immunosuppression.

Based on the data obtained, it is necessary to develop therapeutic and preventive measures to provide practical assistance to residents of uranium geochemical provinces, which can be a model in the event of a radiation hazard.

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Written By

Alena Isupova

Submitted: 24 July 2023 Reviewed: 09 November 2023 Published: 22 January 2024

© 2024 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.