[The status of large vessels in overweight and obesity according to ultrasound findings]. / Sostoyanie krupnykh sosudov pri izbytochnoi masse tela i ozhirenii po dannym ul'trazvukovogo issledovaniya.

AIM: To investigate the impact of overweight and obesity on the structure and function of large arteries in apparently healthy individuals; to estimate the magnitude of atherosclerotic lesions of the vessels. MATERIALS AND METHODS: Sixty-one apparently healthy individuals with varying weights were randomly examined. All the examinees were divided into 3 groups according to their body mass index (BMI) and blood pressure (BP). They all underwent ultrasonography of the brachiocephalic arteries at the extracranial level, as well as the abdominal aorta and femoral arteries. RESULTS: The overweight and obese persons have increased diameters and thickness of the intima-media complex of the common carotid arteries and aorta. These changes are maximally pronounced in obesity in conjunction with high normal BP (systolic BP, 130-139 mm Hg; diastolic BP, 85-89 mm Hg). At the same time, there is a reduction in blood flow velocities and an increase in arterial wall stiffness. More marked structural and functional changes are observed in persons with abdominal obesity. The femoral artery belonging to muscular ones exhibited no structural changes, but displayed reduced blood flow velocities in obesity concurrent with high normal BP. In all the groups, the spread of atherosclerotic plaques is equal; the latter are recorded in one third of the examinees. However, the degree and incidence of vascular atherosclerosis are higher in overweight and obesity concurrent with high normal BP. CONCLUSION: The overweight and obese persons without cardiovascular diseases were found to have eccentric remodeling of elastic and muscular-and-elastic vessels: the carotid arteries and aorta in conjunction with increased intima-media thickness, reduced blood flow velocities, and atherosclerotic vascular changes. These changes are most pronounced in the obese persons with high normal BP. In all the groups, atherosclerotic changes are encountered mainly in the brachiocephalic arteries at the extracranial level.

[FORMATION OF CLINICAL MENTALITY--AN IMPORTANT COMPONENT OF POST-GRADUATE MEDICAL TRAINING].

The notion of clinical mentality is considered from the standpoint of its semantic meaning and significance for efficient medical activity. The main signs and implications of this notion are determined. It is shown, based on pedagogical methods (observations, conversations, solution of clinical problems, testing, etc.), that clinical mentality forms after 10 years of work in a given field. Criteria are proposed for distinguishing between health providers with and without clinical mentality. The free association method demonstrated that 37% of the doctors with a period of clinical work over 10 years have peculiarities of clinical mentality described as "internal medical mentality". Clinicians with the experience of work over 15 years exhibit empathy as a component of clinical mentality. The methods are proposed for the formation of clinical mentality during post-graduate education taking account of the modern differentiation of medical disciplines and the necessity to reconcile standards of medical aid and their application on an individual basis.