Aim. To identify clusters of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) depending on the laboratory data, including platelet function tests.Material and methods. The study included 109 patients hospitalized in the cardiology department with NSTE-ACS. All patients underwent a standard examination, including a complete blood count. In addition, the platelet function was assessed using impedance aggregometry with various inducers (adenosine diphosphate (5 and 10 μmol/L), collagen (2 μmol/L)). We assessed the P-selectin expression level using flow cytometry. Patients were followed up for 6 months. As a statistical method, we performed сluster analysis by K-means algorithm.Results. We registered 18 adverse outcomes (myocardial infarction, unstable angina) during 6-month follow-up. Cluster analysis revealed 3 clusters. The first cluster included 39 (36%) patients with higher monocyte values and lower hemoglobin values, probably indicating chronic inflammation and a tendency towards anemia. The second cluster included 13 older patients (12%) with high comorbidity and high platelet function. Both the first and second clusters recorded 23% adverse outcomes. Third cluster, on the contrary, included mostly younger patients with fewer comorbidities, which had more favorable course of ACS (no signs of platelet hyperaggregation, chronic inflammation and anemia). This cluster included more than half (n=57, 52%) of all patients; adverse outcomes at 6 months in these patients developed 2-fold less frequently than in the other clusters (11% vs 23%).Conclusion. Among patients with NSTE-ACS, groups differing in laboratory parameters were identified, based on which clusters were formed using the k-means method. Clusters with high levels of platelet functional activity, monocyte count and low hemoglobin values included older patients with severe comorbidity and showed a tendency towards more frequent adverse outcomes of the disease.

Spontaneous coronary artery dissection (SCAD) is defined as a spontaneous dissection of the coronary artery wall that occurs independently of atherosclerosis, percutaneous coronary intervention, or mechanical trauma. Its distinctive feature is high prevalence in young women. This condition is associated with pregnancy and hormonal changes. A number of risk factors have been identified, including vascular pathology (most commonly fibromuscular dysplasia), other hereditary connective tissue disorders, systemic inflammatory diseases, migraine, and thyroid diseases. Nevertheless, the precise mechanisms of the pathophysiological relationship remain to be elucidated, and risk factors cannot be identified in all patients, indicating the complex and incompletely understood nature of the disease. The present article presents a case series on the development of SCAD in women and a review of the predisposing factors for the disease.

Training staff in personalized medicine implies modernisation of the traditional learning model that is to incorporate a curricular thread spanning all the stages (pre-university, undergraduate, post-graduate) of a doctor’s professional development.The article presents the experience of the Institute of Medical Education of The Almazov National Medical Research Centre in training personnel prepared to implement the principles of personalized medicine in domestic healthcare.

This article provides an overview of the use of gamification in teaching radiology to the generation Z medical students. It highlights the need to adapt medical education to the digital preferences of the new generation. The article emphasizes the importance of gamification in enhancing student motivation and improving the quality of education, and discusses the use of various gaming techniques, such us serious games and virtual reality-based games, as well as student radiology competitions. Current challengesof integrating gamification in the curriculum of medical universities are also discussed.

Aim. To reveal the features of monocyte response in myocardial infarction (MI) in pa­­tients with type 2 diabetes (T2D). Material and methods. The study included 121 patients with MI and T2D as follows: 76 — with target glycated hemoglobin (HbA 1c ), 45 — with elevated HbA 1c values. In addition to the standard examination, all patients underwent a blood test for HbA 1c on day 1 of MI, while on days 1, 3, 5, and 12±1, monocyte subpopulations were assessed by flow cytometry. Results. Patients with target HbA 1c were older than patients with elevated HbA1c levels. In the group with target HbA 1c , the number of CD16(+) monocytes on the 1st day of MI was significantly higher: 61,38 (39,2; 100,08) cells/µl vs 35,7 (28,98; 40,33) cells/µl, p=0,03; on the 3rd day of MI, the number of "intermediate" CD14(+)CD16(+) monocytes was higher: 74,82 (71,78; 83,2) cells/µl vs 25,90 (14,04; 57,12) cells/µl, p=0,03, while the CD16(-) to CD16(+) monocyte ratio on the 3rd day of MI was lower: 8,32 (6 ,87; 10,03) vs 10,81 (8,90; 21,10), p=0,04. At the same time, in the group of patients with target HbA 1c values, the level of CD16(+) monocytes on the 3rd day of MI was significantly higher in patients aged <71 years compared with patients ≥71 years: 104,55 (63,64; 149,7) cells/µl vs 55,20 (36,92; 76,59) cells/µl, p=0,03. Conclusion. In patients with T2D and target HbA 1c values, compared with patients with elevated HbA 1c , the inflammatory response in MI is associated with higher levels of CD16(+) monocytes on days 1 and 3 of MI, which is more typical for people aged <71 years.

Background. Platelets play a key role in the pathogenesis of acute coronary syndrome (ACS). In recent years, the amount of data on the advisability of using the platelet function test (PFT) in the appointment of antithrombotic therapy has been growing. Objective. To access PFT in patients with unstable angina and various comorbidities. Design and methods. The study involved 74 patients with the diagnosis of unstable angina. All patients underwent standard clinical examination, PFT (impedance aggregometry with ADP and collagen), assessment of Charlson comorbidity index. Results. The most frequent comorbidities were: hypertension (95 %), type 2 diabetes mellitus (30 %), excessive body weight (35 %), multifocal atherosclerosis (22 %), smoking (24 %). Half of the patients (n = 36) had high level of comorbidity. Patients with a comorbidity index of 5 or more had high platelet aggregation on the 3rd day of hospitalization. Elderly patients, smokers, as well as patients with diabetes mellitus type 2 and multifocal atherosclerosis also had higher values of platelet activity, which may be associated with unfavorable prognosis and risk of recurrent events. Conclusion. We revealed association between PFT and comorbidities both with risk factors or diseases alone and in its integral assessment using the Charlson comorbidity index. Among the individual risk factors, smoking, diabetes mellitus and multifocal atherosclerosis were the most important, which confirms their direct role in the pathogenesis of thrombotic complications.

Successful education of modern students requires great immersion of teachers in a process that is constantly changing, acquiring new properties, and meeting new challenges. So, digital technologies, online learning are already a natural communication environment, and students are motivated for self-development and self-expression. The traditions of the Russian medical school, together with modern trends in the development of education, create the prerequisites for the application of the most successful forms of education that develop the thinking and skills necessary for professional activity. In this article, the authors presented the experience of organizing training under the specialist’s program on the basis of the Department of Neurology and Psychiatry with the clinic of the Institute of Medical Education of the Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation. Conclusions are formulated on the basis of the results of questioning teachers and students on the main characteristics of the educational process. The role of interactive and distance technologies is analyzed: online learning methods, video lectures, digital services, and other digital technologies. An analysis of the role of independent education, the most successful forms of knowledge testing, features of the development of communication skills, and the possibilities of mastering the competencies necessary for professional activity are presented. Separately, the interest of students in scientific work, the activity of participation in the student scientific club, the possibility of growth of interested students in professional and pedagogical aspects are analyzed. The presented data illustrated the success of the first experiment on the training of doctors on the basis of a scientific institution.

Aim. To evaluate the functional state of mitochondria isolated from peripheral blood mononuclear leukocytes using flow cytometry in patients with chronic heart failure receiving ubidecarenone (coenzyme Q).Materials and methods. The study included 53 patients with chronic heart failure who had experienced myocardial infarction. The patients were divided into two groups: group 1 received optimally chosen standard therapy, while group 2 received optimally chosen standard therapy and ubidecarenone (“Kudevite”). The mitochondrial membrane potential was evaluated by flow cytometry using propidium iodide and 3,3′-dihexyloxacarbocyanine iodide (DiOC6(3)). The levels of coenzyme Q were determined using high-performance liquid chromatography with ultraviolet (UV) detection.Results. A direct correlation was established between the coenzyme Q levels in the blood plasma and the percentage of DiOC6(3)-positive cells (R = 0.39; р < 0.05) in the patients with chronic heart failure. In group 1, no significant differences in the coenzyme Q levels and the percentage of DiOC6(3)-positive and DiOC6(3)-negative cells before and after the therapy were observed. In group 2, a significant increase in the proportion of DiOC6(3)-positive cells and a significant decrease in the percentage of DiOC6(3)-negative cells were revealed.Conclusion. The increase in the functional activity of mitochondria in the patients with chronic heart failure receiving ubidecarenone was identified. Flow cytometry can be used to evaluate the functional state of mitochondria and observe the efficiency of the selected therapy.

The materials highlight the experience of digital transformation and educational adaptation to the conditions of the novel coronavirus infection. The report presents new formats for organizing training sessions and practical training, tested in V.A. Almazov National Medical Research Center.

At the end of the last century and, especially, in the first two decades of the 21st century, a significant technological breakthrough took place in clinical laboratory diagnostics in Russia. The transition from manual techniques to high-tech and high-performance automated systems has changed the potential of laboratory medicine. The laboratory has become a high-tech, rapidly developing branch of medical organizations. Following the changes in technology, the range of diagnostic tests began to alter, while the list of laboratory tests available grew. These dynamics are growing every year. Simple routine techniques, practiced for all patients, are complemented by more specific tests. The place of conventional routine tests has been determined by many years of practical experience, while modern analyzers allow the use of tests with a high evidence value of recommendations, which, in the context of evidence-based medicine, enable the clinician to conduct a personalized diagnostic search. At the same time, in order to use all the possibilities of laboratory medicine, the discipline Clinical Laboratory Diagnostics should be included in educational programs at different stages of a doctor's training.

The organization of training for medical students from the point of view of the formation of an individual trajectory is important, taking into account the mastery of related competencies. There are certain mechanisms for the implementation of an individual educational trajectory, including the features of building an educational program and curriculum, tools for integration with scientific research, and practice of simulation training.

Background. The processes of inflammation and repair in the area of myocardial infarction (MI) are carried out and regulated by various populations of immune cells, including monocytes, lymphocytes, and NK-cells. The success of myocardial recovery after infarction and the risk of developing acute heart failure (AHF) depend on their adequate interaction. The presence of type 2 diabetes mellitus (T2DM), in which chronic low-gradient inflammation occurs, can affect the monocytic and lymphocytic response in MI, which may contribute to the development of AHF.Objective. to assess the features of monocytic and lymphocytic responses in patients with MI T2DM complicated by the development of AHF.Design and methods. The study included 121 patients with MI T2DM (38 of them with AHF). The control group included 59 patients without diabetes mellitus (including 13 patients with AHF). For all patients within 1 day, on days 3, 5 and 12 of MI, the total number of monocytes and lymphocytes, the monocytes-to-lymphocytes ratio (MLR), subpopulations of monocytes and T-lymphocytes with NK cells (T&NK-cells) were determined by flow cytometry.Results. In patients with T2DM, the number of monocytes of different subpopulations did not differ depending on the development of AHF. In patients without T2DM with MI, complicated by AHF, compared with patients without AHF, on day 3, the number of CD14(+)CD16(-)monocytes was higher: 1018 (824; 1144) vs 593 (557; 677) cells/μL, p <0,01, and on days 3 and 5, the number of CD16(+) T&NK-cells was lower: 122 (95; 275) cells/μL and 307 (220; 406) cells/μL, respectively (p = 0,03); (117 (61; 228) and 437 (408; 545) cells/μL, respectively, p < 0,01. On the 12th day of MI in patients with T2DM and AHF lymphocytes and CD16(+)T&NK-cells counts were lower in comparison with patients without AHF: 1856 (1245; 1975) cells/μL and 2294 (1827; 2625) cells/μL, respectively, p = 0,04; 268 (128; 315) cells/μL and 344 (226 ; 499) cells/ μL, respectively, p = 0,04.Conclusion. In patients with T2DM, the development of AHF is associated with a low number of lymphocytes in the absence of a pronounced monocytic response. In non-diabetic patients, the development of AHF is associated with an increase in CD16(-)monocytes and a lower number of CD16 (+) T&NК-cells.

We identified insufficient awareness of patients about risk factor and symptoms of myocardial infarction in both groups. Respondents without acute coronary syndrome were better informed and had fewer modifiable risk factors. Low awareness of risk factors for myocardial infarction leads to their inadequate correction. In most cases, insufficient knowledge of symptoms causes delays in the patient 's decision to see a doctor, and, therefore, delays in qualified care.

We described key approaches to the realization of the pilot project, which is being carried out in Almazov National Medical Research Centre in order to implement basic medical education in close integration of science and education.

The aim of the study was the self-assessment by medical students of the level of IT competence and the identification of factors that influence this level. A survey of 52 2nd year students of the Faculty of Medicine was carried out. 42% of students plan to combine work as a medical practitioner and research. Self-assessment of competence in the field of information technology showed a good command of the search engines Google and Yandex, individual Microsoft Office applications, insufficient knowledge of Exell and Access. Selfassessment of competence is higher among students who plan to engage in research work.

Background . The incidence of non- ST -segment-elevation acute coronary syndrome (NSTEACS) is especially high in elderly. In such patients, concomitant diseases are more common and there is a higher risk of complications, which emphasizes the relevance of the study of frailty syndrome and outcomes in NSTEACS. Objective . The aim of the study was to analyze the effect of frailty on the course of nonST-segment elevation acute coronary syndrome and outcomes in elderly and senile patients. Design and methods . 126 patients with non- ST -segment elevation acute coronary syndrome at the age of 61 to 90 were involved into the study. Follow-up was carried out during 1 year; clinical endpoints were mortality and recurrent acute coronary syndrome. All patients were divided into 3 groups according to the frailty index by M. Hoover et al.: the first group — 49 patients with frailty syndrome (38,9%), the second — 47 (37,3%) with pre-frailty and 30 patients (23,8%) without frailty. Results . Geriatric syndromes, cognitive impairment, depression, decreased basic and instrumental activity were more often in patients with frailty. They also had more complications, such as bleeding, arrhythmias and early post-infarction angina. During 1-year followup 5 patients with frailty (10.2%), 5 patients (10.6%) with pre-frailty, and 2 patients (6.6%) without frailty had adverse outcomes. When analyzing the influence of age and frailty on the development of adverse outcomes (death, repeated ACS), a higher contribution of age was revealed. Conclusion . Patients with ACS and frailty have a higher risk of adverse outcomes. Some of the reasons are various geriatric syndromes, changes in emotional and cognitive status and more frequent complications. Age and frailty were crucial for the development of adverse outcomes. However, senile age was of higher importance for the outcomes.