Myocardial infarction with nonobstructive coronary atherosclerosis is a term which emerged recently, but it is of great importance for current clinical practice. Under the mask of this diagnosis, not only ischemia-caused myocardial infarction is hiding, but also diseases with alternative mechanisms of myocardial injury. This review presents a definition of this term as well as differential diagnostic algorithm for diseases associated with increase in the myocardial injury markers. The role of magnetic resonance imaging is emphasized as it is the key method for diagnosis of cardiac diseases. Main principles of current recommendations in this regard are presented. Unsolved and undeveloped aspects of this problem are discussed. Directions for future research are outlined.

At a time of a wide use of coronary reperfusion for treatment of acute myocardial infarction, the microvascular phenomena significantly affecting the postinfarction state of the myocardium have been discovered. These phenomena include microvascular obstruction with a clinical presentation in the form of the no-reflow phenomenon and intramyocardial hemorrhage that strongly aggravate cardiac damage. The aim of this review was to analyze accumulated data on the prevalence, pathophysiology, diagnostic modalities, and approaches for prevention and treatment of microvascular injury.

The article describes the principles of ultrasonic diagnosis of acute cardiovascular events including focused echocardiography protocol. Authors present brief diagnostic ultrasound algorithms for some acute cardiovascular events and describe the clinical manifestations and the major echocardiographic signs to help the practical doctor to quickly establish the precise diagnosis in emergencies.

The review presents a comparative analysis of data from patients with myocardial infarction with non-obstructive coronary arteries. Data were obtained from the total register of acute coronary syndrome in the Krasnodar Krai and were compared with data of foreign registers.

Molecular imaging is a multimodal discipline for visualizing biological processes at the subcellular level in vivo. These diagnostic methods could be potentially used for screening and staging of cancer as well as for monitoring of treatment. Formerly, mostly anatomical information played key role in medical visualization. Now, molecular visualization allows improving diagnostic parameters of standard diagnostic methods. Molecular imaging allows not only for localization of tumor, but also for visualization of biological processes that influence tumor behavior and response to therapy. This review reflects the potential role of radionuclide methods and radiopharmaceuticals in diagnostic and assessment of tumor response. The paper covers indications and capabilities of dedicated nuclear breast imaging systems such as breast-specific g-imaging and positron-emission mammography. The accuracy of different methods was analyzed. The analysis showed that new technological solutions allow to significantly increase informativeness of examinations through improved spatial resolution compared to whole-body imaging cameras. Molecular imaging is useful for neoadjuvant chemotherapy response monitoring and is highly sensitive for prediction of non-responsiveness during treatment of breast cancer. The sensitivity of molecular breast imaging is comparable with that of magnetic resonance imaging, but has higher specificity. Molecular imaging may play a great potential role in the diagnostic algorithm for breast cancer.

Background. There are many quality indicators for evaluation of quality of care in patients with myocardial infarction in the USA and Europe, but no such indicators exist in Russia.
Material and Methods. This retrospective study included 475 STEMI patients, admitted within the first 12 hours during 2016. The baseline characteristics and treatment of our STEMI patients were compared with the OPERA register (France). The quality of care in STEMI patients was assessed using the quality criteria of the Association of Acute Cardiovascular Care of the European Society of Cardiology. Thrombolytic therapy, primary PCI, cardiogenic shock, pulmonary edema, acute LV aneurysm, and acute psychotic disorders were endpoints for a comparative assessment of quality of care in different age groups.
Results. The following was more frequent among patients of our center: female, history of MI, hypertension, dyslipidemia and smoker. Our patients were less likely to receive primary PCI and GP IIb/IIIa inhibitor, but more often thrombolytic therapy, LMWH, aspirin, inhibitor P2Y12, beta-blocker, ACEI/ARBs and statins. All eligible STEMI patients received reperfusion and recommended medication, but hospital mortality was higher than in the OPERA register (7.4% versus 4.6%; p<0.05). Senile STEMI patients are less likely to undergo invasive reperfusion due to severe comorbidity, dementia and acute psychotic disorders, which leads to a manifold increase in hospital mortality.
Conclusion. It is necessary to develop new devices for PCI of calcinated lesions, and methods for neuroprotection to overcome the existing barriers to ensure high-tech care in senile STEMI patients.

The aim of this study was to evaluate the efficacy and safety of the manual thrombus aspiration in comparison with direct stenting in patients with ST-segment elevation myocardial infarction (STEMI) and totally occluded culprit arteries.
Material and Methods. Data were collected from the hospital database, which contained information about 1297 patients with STEMI who were admitted to the coronary care unit and underwent primary percutaneous coronary interventions. A total of 227 patients with totally occluded culprit arteries and partially or completely restored blood flow after wiring were included in the analysis. Altogether 25 patients after manual thrombus aspiration were compared with 202 patients after direct stenting. The groups were comparable by gender and age, and by the main clinical and angiographic characteristics.
Results. There were no differences in in-hospital outcomes. In the thrombus aspiration group, the rate of no-reflow phenomenon was higher insignificantly (8 vs 3.5%, р=0.259). There were no incidences of death and major adverse cardiac events in the thrombus aspiration group. No cases of stent thrombosis were registered in either of group.
Conclusion. The manual thrombus aspiration strategy in comparison with direct stenting in patients with STEMI and totally occluded culprit artery was not associated with improved clinical and procedural in-hospital outcomes.

Objective: to give a comparative characterization of myocardial infarction with and without obstructive lesion of coronary arteries.

Material and Methods. The study involved 4639 patients included in the first total register of acute coronary syndrome in the Krasnodar Territory for the first 12 months of register operation. A comparative analysis of patients with myocardial infarction with obstructive lesion and without obstructive lesion of coronary arteries was performed.

Results. Between November 2016 and November 2017, 4453 patients with myocardial infarction with obstructive coronary disease, including 2261 men (50.8%) and 2192 women (49.2%) were enrolled in the register. The mean age of patients was 68.3±12.03 years (69.3±3.42 years in men; 63.4±7.35 years in women). The criteria for myocardial infarction without obstructive coronary artery disease were present in 186 people (4.1%), including 72 men (38.7%) and 114 women (72.3%). The average age of the patients was 54.2±4.53 years; age of men with myocardial infarction without obstructive coronary disease was 56.3±3.52 years; age of women was 52.1±3.12 years. The article presents a detailed comparative analysis of demographic, medical history, clinical-instrumental, and laboratory data of these patient groups. 

Conclusion. Compared with patients who had obstructive coronary changes, the cohort of patients with myocardial infarction without obstructive lesions of the coronary arteries was younger and included more female patients; among the risk factors in this group, smoking and arterial hypertension were significant; the rates of newly diagnosed diabetes mellitus and Q-positive myocardial infarction were higher. According to the analysis of echocardiographic data, significant decrease in global contractility of the left ventricular myocardium was less common; analysis of laboratory data showed that patients more often had low platelet count.

The aim of the study was to identify clinical and laboratory features of the disease in patients with myocardial infarction with ST-segment elevation and C677T polymorphism in the methylenetetrahydrofolate reductase gene.
Material and Methods. A total of 81 patients with ST-segment elevation myocardial infarction were examined. Clinical, laboratory, instrumental, and statistical methods were used.
Conclusion. Among patients with ST-segment elevation myocardial infarction, the proportion of persons with homozygous carriership of polymorphic alleles in the MTHFR gene was 30% (genotype 677СС); and 58.02% (genotype 677СT) of patients were heterozygous carriers. Patients with homozygous carriership of polymorphic alleles in the MTHFR gene were characterized by higher values of Big endothelin-1 and homocysteine in serum compared with persons with genotype 677СС: 10.7 (4.5–14.5) pg/mL, 27 (20–28) μmol/L, and 2.7 (2.2–3.8) pg/mL, and 17 (14–20) μmol/L, respectively, p<0.05. A positive moderate force correlation was found between the carriership of polymorphic alleles MTHFR C677T and homocysteine levels (r=0.42, p<0.05) and Big endothelin-1 (r=0.45, p<0.05) in the cohort under study. In patients with homozygous carriership of polymorphic alleles in the MTHFR gene, myocardial infarction was significantly more often complicated by the development of recurrent coronary events in comparison with groups with heterozygous carriership and the absence of polymorphic alleles in this gene: 88.9% (n=8) versus 42.55% (n=20), χ2=6.5, p<0.05 and 28% (n=7), χ2=10.0, p<0.01 respectively.

The aim of the study was to create a patient portrait, to evaluate prognosis, and establish the principles of therapy in patients with acute coronary syndrome without ST elevation with non-obstructive coronary atherosclerosis in comparison with the obstructive coronary atherosclerosis group.
Material and Methods. Data come from the acute coronary syndrome register REСORD-3 that was implemented in the Emergency Cardiology Department of Cardiology Research Institute, Tomsk National Research Medical Centre, along with 45 other centers in Russia. Patients with myocardial infarction without ST segment elevation who were exposed to coronary angiography were separated into two independent groups based on whether they had MINОСА or not: 148 persons with non-obstructive coronary atherosclerosis and 537 persons with obstructive coronary atherosclerosis.
Results. Non-obstructive coronary atherosclerosis group, compared to obstructive coronary atherosclerosis, comprised 75 women (50.7%) compared to 177 men (32.9%). Hypertension was detected less often in this group: 120 (81.1%) versus 475 (88.5%). The rates of diabetes mellitus were 16 (10.8%) versus 115 (21.4%) and the rates of smoking were 162 patients (30.2%) versus 32 (21.6%), respectively, in patients with and without non-obstructive coronary atherosclerosis. Non-obstructive coronary atherosclerosis group had significantly lower rate of individuals with diagnostic increase in cardiospecific enzymes. This may be indicative of non-prolonged myocardial ischemia that, in some cases, does not lead to necrosis. The final diagnosis of non-ST segment elevation myocardial infarction was significantly less confirmed in patients with non-obstructive coronary atherosclerosis (14.8 vs. 45.3%). However, in this group, the “other cardiac cause of hospitalization” was more frequent (29.7 vs. 2.2% of cases), which explains the need to continue the diagnostic search to exclude all possible causes of the chest pain. The variety of final diagnoses in patients with acute coronary syndrome with non-obstructive coronary atherosclerosis and “clean” coronary arteries should encourage a thorough analysis of the pathogenesis in each of these patients.
Conclusion. A typical acute coronary syndrome patient with non-obstructive coronary atherosclerosis without ST segment elevation was represented by a 59 (53:65)-year-old woman with traditional risk factors for coronary heart disease, but the incidence of each of these factors was less than in the obstructive coronary atherosclerosis group. Final diagnosis of non-ST segment elevation myocardial infarction was confirmed significantly less often in patients with non-obstructive coronary atherosclerosis. The mortality rates did not differ between groups and were minimal. Acute coronary syndrome patients with non-obstructive coronary atherosclerosis without ST segment elevation were less likely to receive ticagrelor and statins in hospital, but they were administered more often with fondaparinux. Patients with non-obstructive coronary atherosclerosis at discharge were less likely to be recommended to take antiplatelet agents, statins, and nitrates.

The aim of the study was to analyze the impact of the status of cardiac autonomic nervous regulation on the fragmentation activity, development and progression of heart failure, and the long-term prognosis in patients with early ST segment elevation myocardial infarction.
Material and Methods. The study included 143 subjects; 54 healthy volunteers were examined to identify normal values of heart rhythm variability parameters. The observation group comprised 89 patients with ST segment elevation myocardial infarction who underwent 24-hour ECG monitoring at day 7 to 9 as well as at 24 and 48 weeks with follow up assessment of heart rate variability and late ventricular potentials. At the time points, the levels of brain natriuretic peptide and highly sensitive C-reactive protein were determined. Patients underwent a 6-min walk test every 12 weeks. The development of repeated cardiovascular events has been monitored as an end-point. Patients were assigned to two groups according to results of heart rhythm variability analysis at day 7–9 after onset of ST segment elevation myocardial infarction: group 1 had normal heart rate variability; group 2 had increased sympathetic impact on rhythm.
Results. In group 1, a pronounced regression of the brain natriuretic peptide level was registered 24 week after onset of ST segment elevation myocardial infarction. The value of C-reactive protein decreased in all groups. A favorable transformation of the indices reflecting the fragmentation activity — high-frequency low-amplitude and root mean square — of the myocardium was recorded only in the group with normal heart rate variability parameters. The risk of repeated cardiovascular events during 48 weeks after ST segment elevation myocardial infarction was significantly higher in the group with dominant sympathetic activity than in the group with normal status of the autonomic nervous system.
Conclusion. Hypersympathicotonia in the acute period of ST segment elevation myocardial infarction was associated with an increased relative risk of repeated cardiac events and negatively affected the dynamics of laboratory parameters indicative of heart failure development and progression.

Aim: to study the dynamic of echocardiographic parameters in patients with acute coronary syndrome associated with anxiety and depressive disorders during the therapy by innovative Russian drug containing release-active antibodies to the brain-specific protein S-100 (Tenoten) in-hospital and during six months of treatment.
Material and Methods. 54 patients with acute coronary syndrome associated with anxiety and depressive disorders were randomized into 2 groups: patients of group 1 were administered with anti-anxiety medicament Tenoten, 6 tablets per day in addition to the therapy for acute coronary syndrome; group 2 received placebo. All patients underwent echocardiography at inpatient and outpatient stages six months after randomization.
Results. Clinically significant anxiety and subclinical depression were detected in patients of both study groups. The intake of anti-anxiety drug Tenoten for six months contributed to anxiety reduction, myocardial contractility improvement, and a decrease in the left ventricular volume indices. Negative changes were observed in comparison group: a decrease in the left ventricular ejection fraction, increase in volume indices, and decline in the left ventricular relaxation.

Conclusion. Administration of Tenoten at a dose of six tablets per day to patients with acute coronary syndrome in combination with affective disorders resulted not only in improvement of a mental status, but it also contributed to suppression of the left ventricular remodeling processes.

Aim. To study cardiac micropotentials registered by the hardware and software complex with nanosensors in patients with myocardial infarction for the early detection of life-threatening conditions.
Materials and Methods. The pilot study included 29 patients with acute myocardial infarction who had life-threatening complications such as heart rhythm disorders, the development of acute left ventricular failure, or clinical death prehospitally or at admission to the coronary care unit. The diagnosis of myocardial infarction was established and treatment was carried out according to the national guidelines for the management of patients with myocardial infarction, including the methods of myocardial revascularization.
Results. During hospitalization, eight patients developed cardiogenic shock and died. 21 patients survived and were included in the comparison group. At admission, all patients underwent high-resolution electrocardiography using the originally developed hardware and software complex with nanosensors. The micropotentials on the ST segment of the electrocardiogram were recorded for 30 s in three leads on-line. The numbers of micropotentials in the studied groups were analyzed. The analysis of the number of micropotentials within certain ranges of amplitude and duration registered on high-resolution electrocardiogram showed a decrease of the micropotential number in group of patients who died from cardiogenic shock compared with the group of survived patients.
Conclusions. The results of this pilot study of cardiac micropotentials are preliminary and require further accumulation of data as well as a search for new criteria for diagnostics, prognosis, and evaluation of the treatment efficacy in patients with myocardial infarction.

Percutaneous coronary interventions have become a key method of revascularization in patients with coronary artery disease. Contrast-induced nephropathy is one of the main complications in patients who undergo coronary angiography and percutaneous coronary intervention. Loading doses of statins are often used for the purpose of nephroprotection. However, a clear available algorithm for prescribing statins for the prevention of acute contrast-induced kidney injury has not been identified. 

The purpose: to evaluate the effectiveness of high loading doses of statins (atorvastatin and rosuvastatin) to prevent acute contrast-induced kidney injury in patients with chronic ischemic heart disease during planned endovascular treatment.
Material and Methods. Patients with clinical manifestations of FC II and III angina pectoris and hemodynamically significant stenoses of the coronary arteries were referred for a planned endovascular myocardial revascularization. Two groups of patients were assigned based on the intake of synthetic statins: atorvastatin and rosuvastatin. Before the endovascular intervention, patients were administered with high loading doses of statins. All patients underwent general clinical examination, routine assessment of creatinine levels, other blood tests, assessment of glomerular filtration rate, and control of lipid profile of blood.
Conclusion. The incidence rate of contrast-induced kidney injury in patients with coronary artery disease, administered with loading doses of rosuvastatin, in the course of planned percutaneous coronary intervention was lower compared with the loading therapy of atorvastatin: 3.33 and 12.12%, respectively. On average, an increase in creatinine concentration to the maximum level occurred more often in the group of patients administered with a loading dose of atorvastatin than in the other group administered with a loading dose of rosuvastatin (14.3 versus 8.1%, p=0.024). A decrease in renal function in terms of GFR of less than 60 mL/min/1.73 m2 on day 5 was observed in 12 patients (34.3%) in the first group versus 9 patients (27.3%) in the second group. Therapy with loading doses of rosuvastatin before endovascular myocardial revascularization was more effective than treatment of patients with atorvastatin. 

The concept of metabolic syndrome as a cluster of risk factors for type 2 diabetes and cardiovascular diseases has undergone a number of evolutionary transformations over the past years. Incorporation of autonomic nervous system dysfunction into the pathogenesis of metabolic syndrome opens an opportunity for inclusion of a number of clinical entities in the cluster of metabolic syndrome as they mutually affect the course and clinical manifestations of pathologies involved in metabolic syndrome. To confirm this notion, a cross-sectional transverse study of a continuous sample of 158 patients with metabolic syndrome was performed. The study showed that, in the presence of metabolic syndrome, the incidence of cardiac autonomic neuropathy reaches 37.5%. A number of features of gastroesophageal reflux disease in patients with metabolic syndrome were found in the structure of complaints where regurgitation predominated. Fibrogastroduodenoscopy demonstrated endoscopically negative form of the disease in 38%, and, according to high DeMeester index by daily pH-metry, the alkaline reflux was present in patients in lying position over 25% of time. Young men with metabolic syndrome had high incidence of prostatic enlargement (increased prostate size and volume) as well as high incidence of the IPSS questionnaire  score corresponding to the initial manifestations of prostatic hyperplasia in the presence of insulin resistance and normal androgen levels. The study showed that dysfunction of the autonomic nervous system (along with insulin resistance) was the main converging point in the development of metabolic syndrome. This suggests that cardiac autonomic neuropathy, lower urinary tract symptoms, and gastroesophageal reflux disease may be included in the metabolic syndrome cluster. 

The microsocial factors associated with parent family, reference group, and groupmates affect the development of addictive and mixed anxiety-depressive disorders in students. Students, carriers of each of microsocial risk factors, were characterized by specific motives for psychoactive substance use and specific non-adaptive realizing coping associated with social support modules (26.1%) and prognosis of the stress situation development (21.7%). At the same time, the impact of microsocial risk factors might be weakened by adaptive moderating coping, which manifested in the modules of distraction from the stressful situation (20.6% of cases) and the emotional response to the situation (15.7%). Also, in the realizing and moderating copings, the module of rational assessment of a stressful situation (17.4% of cases for realizing coping and 14.7% for moderating coping) was of value.

The clinical efficacy of combined neuroprotection with citicoline and cortexin in the acute period of ischemic stroke is discussed in the paper. A retrospective analysis of 127 cases with a primary ischemic stroke was carried out. For unbiased evaluation of the severity of the condition, extent of the focal neurological deficit and the assessment of the dynamics in clinical indicators, the National Institute of Health Stroke Scale was used; the degree of functional recovery was assessed by the modified Rankin Scale; the cognitive status score was measured by the MMSE scale. The obtained data suggest the effectiveness of combined neuroprotection with cortexin and citicoline in the acute period of ischemic stroke in comparison with monotherapy.

Aim: the purpose of this publication is to demonstrate the safety and efficacy of the endovascular method of treatment for long-existing, neglected, and fairly common congenital heart defects such as an atrial septal defect with high pulmonary hypertension.
Material and Methods. We present a clinical case of the successful X-ray endovascular treatment of a 48-year-old female patient with a high pulmonary hypertension diagnosed with congenital heart disease, atrial septal defect. Clinical and instrumental examination included standard resting electrocardiography, echocardiography, and catheterization of the right heart and the pulmonary artery. Surgical treatment consisted in an X-ray endovascular implantation of the 40-mm atrial septal defect closure device via the transfemoral access. Post-operative follow up care lasted for 15 months.
Results. Echocardiography study showed the left ventricular ejection fraction of 53 mL; congenital heart disease was characterized by 2.5-cm secondary central atrial septal defect and a variable pressure release. Pulmonary artery systolic pressure was 120 mmHg. Catheterization of the right heart and the pulmonary artery showed blood flow with the presence of leftto-right shunting equal to Qp/Qs=2.0/1. An X-ray endovascular atrial septal defect surgery was conducted in an X-ray operation room via a standard transfemoral access. The surgery consisted in X-ray endovascular atrial septal defect occlusion with an implantation of an atrial septal defect closure device with 40-mm neck diameter. Intraoperative echocardiography study showed that the closure device was placed correctly with no signs of residual bleeding. The final echocardiography performed in three days showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 83 mmHg. Hospital stay lasted for three days. Follow-up echocardiography study at 15 months showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 46 mmHg.
Conclusion. There are currently two types of treatment: open surgery such as suturing or plastic  urgery with extracorporeal blood circulation and X-ray endovascular occlusion of the atrial septal defect by implantation of a special device. The X-ray endovascular treatment of an atrial septal defect with a closure device implantation is a highly effective and safe procedure. The main advantages of this method are as follows: surgery does not require anesthesia, incision, and heart-lung bypass whereas reimplantation and repositioning of the device is always feasible. 

The aim was to study early outcomes in patients with suspected acute coronary syndrome without ST elevation who were transported by emergency to the vascular center.
Material and Methods. We studied medical records from 396 patients with suspected acute coronary syndrome without ST elevation. A telephone survey of patients or their relatives was conducted within two months after the emergency call.
Results. In-hospital diagnosis of acute coronary syndrome was confirmed only in 30.6% of patients with suspected acute coronary syndrome without ST elevation admitted to the vascular center. Cardiologists in the vascular center were ruling out diagnosis of acute coronary syndrome without ST elevation based on data of clinical examination and electrocardiography. During the following two months, 6.4% of the patients with ruled out diagnosis of acute coronary syndrome called emergency again; 2% of the patients were admitted with acute coronary syndrome to the vascular center; and 2.4% of the patients died at home.
Conclusion. In real clinical practice, the assessment of myocardial necrosis biomarkers has been used not enough in cases of suspected acute coronary syndrome without ST elevation.

Objective: to determine the associations of attitudes towards their health and family stress in men and women of an open urban population.
Material and Methods. To carry out a one-stage epidemiological study on an open urban population using the “random numbers” method, a representative sample of the population was drawn from the electoral lists of citizens of the Central Administrative District of Tyumen in the number of 2000 people, 250 people in each sex-age group (25–34, 35–44, 45–54, 55–64 years). The study was conducted with a response rate of 77.7% (85.0% among men and 70.3% among women) according to rigidly standardized epidemiological methods. As part of the cardiological screening for the WHO  MONICAMOPSY program algorithms, a survey was conducted on the “Knowledge and Attitude to Your Health” questionnaire, and some parameters of the population’s attitude to their health and family stress were analyzed.
Results. In general, in the Tyumen population, women demonstrated a more responsible attitude towards their health. In the presence of stress in the family, readiness for urgent measures in case of pain or discomfort in the heart area was ambiguous: higher among women in an emergency situation (with one or frequent conflicts in the family during the last 12 months, and also in the absence of conditions for home recreation ), and vice versa, in the situation of recurring conflicts (with several conflicts in the family during the last 12 months), the tendency to regular visits to the doctor under stress was observed among men.
Conclusion. Analysis of the factors of chronic social stress in relation to the attitude towards the prevention of heart disease in the open population showed that the program of primary prevention of CVD, in addition to information technologies, should include correction of factors of chronic social stress, in particular, stress in the family among men and women of working age.

The purpose of the study was to analyze the state of satisfaction of the population in the provision of medical services and to observe the changes taking place in this area in connection with the start of the national project “Lean Polyclinic”. The studies were conducted in the form of a questionnaire survey of patients of two medical institutions, namely: the Regional Public Health Institutions “Children’s City Hospital No. 2” and “B. I. Alperovich City Clinical Hospital No. 3”.
The material of the study was the responses on paper of the interviewed patients. The average indicators of patient satisfaction with the received medical services were determined by means of statistical calculations. The survey was conducted at the start of the project in May‑July of 2017 and again in October‑December of 2017.
Results. The initial survey revealed the presence of such problems as insufficient number of automated workplaces; heavy workload of the doctor when working in the Medical Information System of the Tomsk Region; imperfection of the card filing cabinet; insufficient number of racks for storing outpatient cards, front-office and back-office were located in the same room and did not have a partition, which created noise and interfered with the work of call-center operators; the need to contact the registry to get the outpatient card when the visit was previously assigned; difficult orientation of patients in the clinic; long-term preventive examination of children aged 1 year; mixed flows of healthy and sick patients; and lack of personnel. The repeated survey reflected the changes that occurred in connection with the start of the “Lean Polyclinic” project: the number of detected violations tended to decrease, which indicated the improvement in the quality of services and the improvement in the organization of medical personnel work.
Conclusion. Thus, the present study established that the use of lean production technologies contributed to the quality of medical services and it had a beneficial effect on the processes of organizing the work of medical institutions. 

The article represents the biography of the famous Tomsk cardiologist Yaroslav Stepanovitch Vasiltsev (1935–2006) and his contribution to the study of heart defects, myocardial infarction, heart failure, and their treatments. The authors give a brief review of his organizational, scientific, medical, and educational activities.