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Школа здоровья Михаила СОВЕТОВА ВЫПУСК 24

Школа здоровья Михаила СОВЕТОВА ВЫПУСК 24

Channel: Школа Здоровья Михаила СОВЕТОВА

грудное вскармливание

ГВ

00:00:03

[music]

00:00:06

anatomy of the mammary glands is actually

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surprising that today there are so many people in the

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class because a topic that,

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frankly, you can google before

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making a request for anatomy of the mammary glands,

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see everything you need and I

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understand this perfectly well, so today we

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will try to constantly link this very anatomy

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with some of

00:00:37

our professional questions and

00:00:43

tie in the anatomy of the mammary glands

00:00:46

in general, the anatomy of the lactating mammary

00:00:50

gland and the topics of help with problems with

00:00:53

breastfeeding, let’s first

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tie it to the locality, tie

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our topic to the locality, so

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ask in the article if there will be a

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presentation later, yes, I can upload it to class,

00:01:08

what is it for, why do we need both

00:01:15

meanings that you and I see

00:01:18

in the picture, you know in general, partly

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why it’s good for a consultant to know

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anatomy, well, at least at some level,

00:01:29

and the anatomy of not only the mammary

00:01:31

gland with you we work with new ones,

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it happens that it doesn’t look very nice,

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as if you are trying to

00:01:43

explain something to the mother, let’s say some

00:01:46

movement of the hand or movement of the child to the

00:01:49

side of the chest or some movements when

00:01:51

pumping and when there are not enough words and you

00:01:55

begin to replace these words with

00:01:59

pronouns gwente with your hand there,

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touch there in fact, all this does

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not look very good and is not very

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easy to understand, this form of

00:02:14

communication, and especially if you and I

00:02:16

communicate with our mother on the Internet by phone, it is

00:02:20

much easier to immediately call there the upper

00:02:23

ideal square, the lower lateral

00:02:25

square, the square, and thus communication is

00:02:32

more productive let's

00:02:35

look at this diagram to see

00:02:38

what is written in purple circles and

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what do you think, please write your

00:02:46

opinion in the chat

00:02:49

from those systems that are listed here in

00:02:54

purple circles as in which system

00:02:59

would you put in first place in importance during lactation,

00:03:03

or maybe

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well let's say from three to first place by

00:03:09

2 by 3

00:03:11

list in what order would you

00:03:15

rank [music]

00:03:19

would you rank in importance these

00:03:22

systems so we have the lymphatic system the

00:03:26

nervous system of the alveoli and circulatory

00:03:30

systems of the mammary gland ducts and

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connective tissue

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support of the breast well look, there are

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different opinions, how consultants are usually neutral,

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and the future consultation

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puts the alveoli in the first place of honor,

00:03:51

milk production, well, here in this

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group, I see everything completely wrong, but I

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must say that there are many doctors here in

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this group, the vast majority, I would say

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so too perhaps that’s why there’s a

00:04:06

slightly different approach and let’s

00:04:12

see now that it’s actually

00:04:15

quite difficult to put something in

00:04:18

first place and you shared something because

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all the systems that the

00:04:24

mammary gland has are absolutely necessary

00:04:27

and important for each fund for let's

00:04:31

still start solve it's such an

00:04:35

amazing mini laboratory created by

00:04:38

nature itself amazing cells

00:04:43

that produce milk

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look if it's very simple if it's very

00:04:51

simple and let's say primitive and take pictures

00:04:53

on your fingers something happens in this

00:04:54

alveolus

00:04:57

alveolar cells are

00:04:58

taken like from Becker from which they will

00:05:02

build something in the year, like a Lego set, they

00:05:05

take these multi-colored and different

00:05:07

format Lego parts from the blood, water

00:05:13

reconstructs from the same set,

00:05:16

constructors they build, well, let’s say

00:05:20

it was a car before the galley cage,

00:05:24

disassembles it into separate cubes, Lego

00:05:27

builds in its own way it turns out to be a helicopter and

00:05:32

this is absolutely amazing, from the

00:05:34

components of the blood the cells make milk, it is the

00:05:41

cells that produce milk, we see, we

00:05:46

see from the outside there is a

00:05:51

flow of blood to the alveoli, we see from the inside the

00:05:55

producing cells of the epithelium, and we

00:06:00

will also discuss with you these stellate

00:06:02

muscle cells, look at the adjacent

00:06:09

pictures on the right illustrations

00:06:12

in lilac it painted

00:06:17

these cells in general, if you ever

00:06:19

see this prefix, it means

00:06:22

now it’s either about muscles or about

00:06:25

muscle cells of advancement such as

00:06:28

epithelial cells, they, under the influence of

00:06:31

oxytocin, seem to squeeze out, can

00:06:34

you imagine how I, like, with my hands, squeezed out

00:06:35

some kind of a piece of lemon tissue, yes,

00:06:38

they are built into the alveolar tissue, they

00:06:41

literally squeeze these

00:06:45

provoked lahu into the ducts and

00:06:48

throw everyone out under the

00:06:50

influence of oxytocin.

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By the way, it’s interesting that quite often

00:06:58

you can hear that with

00:07:01

lactostasis, yes, for

00:07:04

pumping for planting, take a leg,

00:07:09

as if the muscle is removed spasm and, as it were, the

00:07:13

breast releases milk before,

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but look at the leg, it’s drotoverin and

00:07:21

this substance is an antagonist of oxytocin,

00:07:24

that is, on the contrary, let’s shake the leg

00:07:27

stops working, dear kids, real

00:07:30

cells,

00:07:31

so it’s a very bad idea to

00:07:35

recommend and take no-shpa when pumping,

00:07:37

especially unacceptable when it’s done by a

00:07:39

consultant tell the chest to

00:07:44

better visualize to understand how

00:07:48

this alveolar cell works, how it

00:07:51

works, we can look at it, but on the

00:07:55

contrary, what happens if its

00:07:57

work is disrupted, what happens with

00:07:59

mastitis,

00:08:01

you and I see that guys, real

00:08:03

cells are damaged, the

00:08:09

penetration of various substances through the

00:08:11

damaged membrane increases, then There are also

00:08:13

medicines and some substances from the food that were

00:08:18

not dropped out before, that

00:08:22

is, the child was protected, let’s say some

00:08:26

dyes, chemical elements, additives

00:08:30

that were in the mother’s food

00:08:34

before, the alveolar walls protected the

00:08:38

milk, all of this is now gone, there are no blood

00:08:44

vessels, we see that everything continues

00:08:46

to work normally and not only the

00:08:52

protective properties are reduced, that is, a

00:08:54

special barrier does not allow the frame to penetrate

00:08:58

before, it did not allow various

00:09:00

substances to penetrate into the milk,

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spirin is impaired, but also the working

00:09:07

function of these cells is also reduced

00:09:10

during inflammation

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and milk is produced, therefore less,

00:09:15

sometimes much less decrease in

00:09:22

these membranes and faces said mammary

00:09:27

gland or mammary glands,

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look what animals usually have,

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the number of holes on the nipple,

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it approximately corresponds to the

00:09:38

number of glands in this udder

00:09:45

or in the chest, or whatever this animal has, a

00:09:48

cow has a huge one, it’s big the time

00:09:51

of which we see, but sometimes up to 70

00:09:55

kilograms can lead productive cows,

00:09:57

and in fact, cows have 4 calves,

00:10:01

and each of these parts you name that

00:10:04

we see are huge, this is one simple

00:10:06

gland and one hole in each teat, a

00:10:09

horse has two simple glands 2 are combined

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into 1 and 2 holes in the nipple of

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approximately other animals, all this

00:10:19

looks exactly the same in humans, if you

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and I imagine this, the

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mammary gland is relatively

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small in volume, but the nipple produces

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many ducts, you can visualize it

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as if you hold one flower by the a leg

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in the case of a cow and a bouquet of a whole bouquet in

00:10:42

the case of the human mammary gland,

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that is, these are clusters of glands collected

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together, this plate here you can

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see the

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ratio of water, the hole in the nipple

00:11:01

and the number of simple glands combined

00:11:04

into one mammary gland

00:11:06

in different animals, see in humans

00:11:09

here 10- The 20th

00:11:11

hole in the nipple is indicated on this

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plate; I didn’t draw it; it was done by

00:11:20

zoologists and they took the data on the human

00:11:22

mammary gland from

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Cooper’s anatomy and now everything is a little different, so

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let it be like this in this table.

00:11:30

10-20 hole in the nipple is

00:11:34

interesting, look, well, approximately

00:11:40

dogs, well, relatively similar to the

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number of simple glands approaching a human, champions and

00:11:53

marsupial opossums and kangaroos,

00:11:57

some of them have a nipple,

00:12:01

some of them have a milky field, as it were, a prototype

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of a burnt one, and so these

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ducts open, there are a huge number of them, a

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system of complex areas, I’ll return it back in

00:12:14

composition

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milky the gland pattern teaches them this is due

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to the fact that they are not placental, that is, it is

00:12:21

completely immature to wait for the baby, the

00:12:24

placenta is not a tour and the baby is in the belly of the

00:12:28

marsupial until there

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is a supply of nutrients, the

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guy’s own tic experience and

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completely, as soon as the baby rocks,

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there is no placenta

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and the main reproductive strategy of

00:12:47

marsupials is precisely

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breastfeeding, so this is such a complex

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mammary gland, and you and I can

00:12:54

also see that the less mature a baby

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is born visually in some species,

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the greater the number of simple glands,

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the more complex the structure of the

00:13:05

mammary gland, the human baby

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is born almost prematurely and we

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see how important nature

00:13:15

considers it to be for him, this is the interest rate,

00:13:20

you were Viola ff, basically

00:13:26

milk is stored between pumping between

00:13:30

feedings,

00:13:32

previously it was believed that it was stored in the

00:13:34

lower expanded sections of the streams in

00:13:37

people, this was called street sinuses in

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animals,

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cisterns of productive dairy

00:13:48

animals, but Zoologists were the first to guess

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that this is not so, that it’s not in tanks, but how are you

00:13:56

still stored in the paw, but they carried out

00:14:00

experiments that are simply

00:14:02

unethical to conduct by a person, that is,

00:14:04

if you insert a catheter, the duct flows out into

00:14:07

1220 percent of the milk and 80 remains somewhere

00:14:13

else these 80 percent of milk can be

00:14:16

obtained after the oxytocin reflex in

00:14:19

an animal, it turns out that milk is stored

00:14:22

like water is a sponge, a capable sponge if we

00:14:25

imagine that in each of them there are

00:14:26

producing cells, it also produces

00:14:29

little, it is like a sponge and stored a little bit,

00:14:32

apparently under the influence of gravity flows flow out,

00:14:36

which is interesting to us. that when we

00:14:42

explain to Marie let’s say expressing before

00:14:45

or to a new consultant how to

00:14:47

express is very easy and simple and everything

00:14:50

is clear from the placement of the fingers if we

00:14:54

explain that this is the border of the range

00:14:58

approximately we’ll talk you put it on

00:15:01

like a pipette you press on the sinus and it’s

00:15:06

terribly convenient and comparison because

00:15:08

if we will call these sinus and dilated

00:15:11

areas of the ducts, but in fact

00:15:16

there are areas in the area,

00:15:18

if we look inside we will see that the

00:15:20

ducts expand before the entrance of the nipple and

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before the entrance and before the entrance the nipple

00:15:28

expands,

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so look everywhere where there is

00:15:33

any expansion of anything of any

00:15:36

tube in the body from a linguistic point of view

00:15:39

can be called a sinus,

00:15:42

this is what is called expansion, there is, that

00:15:44

means there is a sinus, and we can say

00:15:48

put your fingers along the bottom somewhere opposite the

00:15:51

sinus, they stretch there, but according to

00:15:55

new research, milk is no longer stored in them,

00:15:58

this means that, well, sort of

00:16:05

now there is a new diagram of these ducts,

00:16:08

if earlier they showed huge

00:16:11

enlarged sinuses and you presented them and

00:16:13

said that you store milk in them and

00:16:15

now these forces are super smaller, milk is

00:16:18

not stored in them, but the sinus is there and

00:16:20

you can say this word, connective

00:16:26

tissue

00:16:28

is very- very important tissue in the mammary

00:16:31

gland because if we look

00:16:33

at the same cow of a productive

00:16:36

breed, a full time can weigh up to

00:16:39

70 kilograms. Can you imagine

00:16:41

how important and how important the

00:16:43

connective tissue is so that all

00:16:46

this meters of the

00:16:47

world falls so that when moving and does not

00:16:50

twist and does

00:16:51

not move out? contain the forms of the

00:16:55

connective tissue of the mammary gland in

00:16:58

humans, but basically it is read that

00:17:00

it is represented by ligaments of cooper

00:17:02

collagen and elastin in the mammary gland in

00:17:06

animals that are studied, that is,

00:17:09

cows and goats, their zoologists count

00:17:13

up to 7 types of connective tissue;

00:17:15

so many of them have not been described in the mammary glands in humans

00:17:20

but it seems that the problem is a lack of

00:17:25

research; they are that the human

00:17:28

mammary gland has

00:17:29

fewer types of connective tissue.

00:17:32

Unfortunately, human mammary glands like those of animals are not of such great interest

00:17:36

to researchers

00:17:38

than a

00:17:42

bad myth; industrial significance; let's

00:17:54

look at one mammary gland to another; to the

00:17:57

one in the photo on the left we see

00:18:01

engorgement after childbirth and look

00:18:05

here we can clearly see that the

00:18:07

nipple is supposedly flat, in fact, this is the

00:18:16

role of the connective tissue, and when the perry

00:18:19

stretches, say, with a hint or is not

00:18:23

removed by this milk, we see that the

00:18:27

connective tissue is slightly

00:18:29

tightened, the juice inside is that it

00:18:32

lacks but this plasticity to

00:18:35

be like in the right photo is

00:18:37

more pronounced, so quite often

00:18:40

when

00:18:42

in the maternity hospital, as they say, you have bad nipples,

00:18:44

your brain is for juice or retracted, in

00:18:48

fact, most often it’s not the nipple that’s bad, but

00:18:51

the problem is that Perry’s

00:18:54

milk tissue is stretched glands and not and not

00:18:59

so pronounced where let's

00:19:03

see there is even more clearly both of

00:19:08

these juices for applying they

00:19:10

are problematic undoubtedly someone the

00:19:16

juice which in the right photo is too

00:19:19

large too long on average from three

00:19:24

to seven millimeters the average nipple in a

00:19:27

woman on average 3 at when pumping or

00:19:30

feeding, it usually stretches out somewhere

00:19:32

gives 7,

00:19:34

but research on a large array of

00:19:37

models,

00:19:39

if over seven, what is the problem, look,

00:19:42

we have a child,

00:19:43

my thumb is the child’s tongue, he

00:19:47

should stand here on the border,

00:19:49

hallelujah, if a very large nipple,

00:19:52

the child only grabs the nipple that is,

00:19:54

this small mouth is not enough to

00:19:59

kind of move the upper one

00:20:03

through such a poor salting

00:20:04

to grab it where it is necessary, so with

00:20:07

long nipples,

00:20:09

most often the problem is with the law that

00:20:12

we see in the left photo,

00:20:15

perhaps here there are movable stretchable

00:20:18

areolas and this is a false inverted nipple with

00:20:22

truly inverted nipples,

00:20:24

everything is really very complicated, what

00:20:27

determines what the nipple will be is not at all

00:20:31

the amount of skin or tissue from which the

00:20:35

nipple itself consists, look, we can do

00:20:38

it

00:20:39

if the ligaments and connective tissue are

00:20:42

sufficiently elastic and movable,

00:20:44

stuck in

00:20:45

such an elongated one and for it to be

00:20:47

pulled in from the inside, then

00:20:49

it will be pulled in for the juice and there is another

00:20:52

option when the length of the canals

00:20:55

inside from the rocks is a little easy to be

00:20:57

short and then you won’t be able to

00:21:00

stretch out from scratch, but it’s also quite rare,

00:21:02

basically this is this property of the

00:21:03

elasticity of

00:21:05

connective tissue, an individual

00:21:07

property of connective tissue about a

00:21:11

specific woman, so Yulia asks

00:21:14

what to do with these nipples we

00:21:23

will definitely have classes about what to

00:21:25

do with different shapes of nipples this is a

00:21:29

very long conversation and interesting and the

00:21:32

classes are just on anatomy

00:21:34

I would really like to take a break your

00:21:36

favorite topic but we will call we won’t

00:21:39

pack today’s lesson the

00:21:41

most important thing is that we Today you and I

00:21:44

should see and understand that the anatomy of the

00:21:49

mammary glands and structural features and the

00:21:54

different anatomical structures of the

00:21:56

mammary gland

00:21:58

is not an abstract thing, not just a

00:22:04

theory,

00:22:05

all of this is very applicable in our work with you;

00:22:08

for us, this is all, of course, simply

00:22:11

colossally important; adipose tissue,

00:22:15

well, it seemed why not, of course, it

00:22:19

carries out some kind of support function,

00:22:21

and what other main function is

00:22:24

adipose tissue in the mammary gland? The beauty of the

00:22:26

amount of work, in fact, look, we

00:22:32

definitely talk about it;

00:22:33

adipose tissue because in terms of the number of

00:22:35

cells in the mammary gland, this is the

00:22:39

champion tissue of what? There are most of us in the

00:22:41

mammary gland,

00:22:42

if you count all the cells of all the

00:22:44

tissues that are there and rank them by a

00:22:46

huge margin, adipose

00:22:50

tissue comes out in first place even among the

00:22:53

thinnest people, let’s say, some kind of

00:23:00

structure we see and

00:23:03

what then the tissues drive away the

00:23:05

workload code based on the load on them when

00:23:08

working during lactation, here is a

00:23:12

quantitative preponderance of

00:23:13

adipose tissue, a rare picture like this

00:23:19

actually found in one of the studies

00:23:21

here we see how

00:23:26

adipose tissue and

00:23:28

connective tissue are combined in the mammary gland, you will forgive this

00:23:32

connective tissue these in silence this

00:23:34

adipose we see with this puzzle of glasses

00:23:38

how they alternate and how we also partially

00:23:44

see that it is not the adipose tissue itself that

00:23:48

maintains the shape of the mammary gland, but

00:23:52

if we can compare it like this, then it is as if it is

00:23:54

poured into such a lovely silk

00:23:59

mesh of connective tissue and

00:24:02

together they give accordingly feeding the

00:24:06

mammary gland,

00:24:07

adipose tissue in the lactating mammary

00:24:10

gland is

00:24:11

significantly less than in the period between

00:24:14

locations, we will definitely talk

00:24:20

about what happens during lactation and outside

00:24:24

lactation in the next lesson, somehow

00:24:27

we will have the

00:24:29

physiology of the mammary gland, but maybe it

00:24:31

will not be amiss to repeat there is such a

00:24:34

common mistake, a common

00:24:36

statement that when the

00:24:38

mammary gland prepares for lactation

00:24:40

of fat, this is how days are replaced

00:24:44

[music]

00:24:46

producing cells are replaced, but this

00:24:52

absolutely cannot be understood;

00:24:56

one type of cells cannot be replaced by other

00:24:59

types of plates,

00:25:00

which means that we have alveolar

00:25:02

cells, their number increases

00:25:06

pregnancy and during lactation

00:25:09

also increases,

00:25:10

they divide, alveolar cells

00:25:13

become a lot of adipose tissue, if

00:25:17

you can use such a word, it kind of

00:25:19

dies, if you saw how the leaves

00:25:23

take on trees in the fall,

00:25:26

what happens is apoptosis, programmed

00:25:29

cell death, this is normal, that is,

00:25:32

old cells sometimes die off

00:25:34

forever not In some cases, in

00:25:37

nature, in the spring, new buds will grow

00:25:41

and new leaves will unfurl; what will

00:25:45

happen after the end of

00:25:47

lactation will again be apoptosis of the

00:25:51

ciliary tissue; that is, these are

00:25:53

not alveolar cells; they will wither; their

00:25:56

number will decrease greatly, although it

00:26:00

will not decrease to that volume which was a long time

00:26:04

guys, there will still be

00:26:06

more of them, but the fat cells are

00:26:09

just increasing in number, but we

00:26:13

see that they do not replace, that is, they do not

00:26:16

degenerate the crib regularly and

00:26:19

back on some courses they still

00:26:23

say so,

00:26:26

but this does not happen, one type of cells

00:26:30

degenerates into a different type of cell and

00:26:32

maybe the lymphatic system does not have the pores

00:26:43

as it needs it in our mammary glands, we

00:26:47

see with you

00:26:49

swelling in the left photo,

00:26:53

sometimes this means the possibility and the

00:26:56

lymphatic system does not really

00:26:58

cope with the flow of fluid in the right

00:27:05

photo,

00:27:06

who who sees simply what is

00:27:10

happening here on the right is covered

00:27:13

please write who understands what we are

00:27:15

seeing here Yuli will attribute an abscess in

00:27:24

both cases,

00:27:25

as the lymphatic system works now, the

00:27:29

colors of being flowed, the

00:27:33

lymph nodes work with

00:27:35

transfer, the lymphatic vessels do not

00:27:37

really cope with the flow of fluid,

00:27:40

what then happens if we look

00:27:43

at on the right photo where there is an abscess

00:27:48

why the body is a capsuleer oval,

00:27:53

this duct contains

00:27:56

pus and literally

00:27:59

took it into such a capsule of white

00:28:02

film and does not allow the contents of the duct to

00:28:06

contact the rest of the

00:28:10

body tissue because the lymphatic

00:28:12

system beeped, I can’t cope with

00:28:15

what she was doing when the

00:28:18

woman we see in the promotional photo still had mastitis, the

00:28:26

lymph nodes were working very hard, which ensure the

00:28:29

flow of lymph from the area in which the

00:28:32

master was, the lymph nodes tried

00:28:37

to cleanse the lymph from

00:28:44

decay products and partly

00:28:51

microbes that caused this percentage of the

00:28:54

infection, but when the body realized that

00:29:02

too large a mass

00:29:04

cannot cope, then we see that the body

00:29:10

up to 20k is this infected

00:29:13

part, how can this help us, we

00:29:15

can help you if there is

00:29:18

mastitis, we already see that again the ducts of

00:29:21

some kind lived in Ravana and the

00:29:23

contents are infected, we can help

00:29:26

the body and remove

00:29:28

carefully express this content

00:29:31

then the lymphatic system and it is much

00:29:34

easier to cope with the remaining infection

00:29:37

even if there is something still left ducts

00:29:40

[music]

00:29:42

clean this amount and, accordingly, the

00:29:50

content of microbes of toxins, less

00:29:54

the body can cope on its own

00:29:57

scheme or current here is the diagram for me by the way I don’t

00:30:00

really like it because the

00:30:02

subclavian paths are not reflected here, but we see

00:30:07

that we see that the main flow of lymph goes to the

00:30:13

side of the armpit

00:30:14

so the axillary lymph node, in fact, this is

00:30:18

why I recommended the movement about the nipples of

00:30:22

the armpit, here is an example in addition to the river

00:30:28

mother and you and I can see if when

00:30:34

pumping make us aware of the surroundings, it

00:30:40

turns out that

00:30:44

what we would like our body to carry away is to

00:30:48

carry away the lymphatic vessels

00:30:52

from the area of stagnation,

00:30:55

it turns out that we, on the contrary, adjust and

00:30:57

the valves open towards the armpits,

00:31:00

that is, even if we massage towards the

00:31:03

side from the ska, as a rule, not something you can’t

00:31:07

advance there because the side with the ska

00:31:13

engine is quite difficult, that is,

00:31:16

watch the most important thing here is the video

00:31:18

of what we are proceeding from if we see a

00:31:20

full chest and an excellent stone,

00:31:23

you and I may think that perhaps there

00:31:27

is milk there until in

00:31:29

a number of cases this is Nila who saved by

00:31:32

lymphostasis, that is, in the breasts,

00:31:35

in addition to the block, there are also all sorts of different

00:31:39

other fluids, this is something that can

00:31:43

happen, it is not always necessary

00:31:44

milk and it can cause discomfort, it can also

00:31:47

be stagnation of lymph, there is also

00:31:50

intercellular fluid that can also

00:31:52

stagnate, we will attribute this more likely to the

00:31:55

connective tissue 20

00:31:57

stagnation intercellular fluid problems of

00:31:59

connective tissue,

00:32:01

so you and I can visualize that

00:32:04

in the breast, not only milk stagnates,

00:32:07

new and other fluids and, accordingly,

00:32:10

our strategy when working with lactostasis,

00:32:14

it includes this knowledge of the

00:32:23

innervation of the mammary glands,

00:32:25

here the asymmetry is quite clear, we

00:32:29

see Mars as a lack of milk and when

00:32:35

she looks at herself from

00:32:36

above, look from the mammary gland, it’s

00:32:42

eternal, it’s normal if you take this

00:32:45

woman into the mirror, she’ll look at herself

00:32:47

like a chamfer, it’s very clearly noticeable that

00:32:51

she

00:32:52

only has the right mammary gland working

00:32:54

properly

00:32:55

and to the left, and there is very little glandular

00:32:57

tissue asymmetry in the left mammary gland

00:33:01

much smaller in size and amazing,

00:33:06

as soon as this woman turns

00:33:07

sideways we see big big scars in

00:33:12

her chest, what is it, this is

00:33:16

heart surgery, which was done at

00:33:19

about 11 years old, and that is, puberty is

00:33:25

the period when the mammary glands begin to develop

00:33:27

and we are now with you

00:33:31

we will see that 4 jabber on the nerve innervates

00:33:34

everything a wonderful story

00:33:36

of course happens there and reinnervation is a

00:33:40

gradual rap sewer, but we see

00:33:42

that there was not enough resource to

00:33:47

normally ensure the normal development of the

00:33:50

mammary gland you are such an interesting

00:33:52

thing why we need to know in our

00:34:02

work how the mammary gland is innervated

00:34:06

because, for example, we can, for example, we

00:34:13

can well understand why with cracked

00:34:16

nipples

00:34:17

or with thrush, women complain of a

00:34:20

dull pain in the depths of the mammary gland,

00:34:23

as if there is a bruise, these are the same shootings that

00:34:27

are described with thrush, what

00:34:30

can there be lumbago and pain inside the

00:34:32

mammary gland

00:34:35

if it is damaged nipple skin from the ska,

00:34:39

this fourth intercostal nerve, it seems to

00:34:45

branch into all the structures of the

00:34:50

mammary gland, and look, I

00:34:53

once understood very clearly how it

00:34:56

works, I was lying on the grass at the dacha, they were on the

00:35:01

wrong shelf at the request

00:35:03

and the party organizer sat down at the nipple and you exceeded

00:35:05

the pinching format, he bit everything as

00:35:08

expected, but after a very short

00:35:10

time, it was the skin on the nipple that stopped

00:35:13

feeling anything and the sensation

00:35:15

moved under the shoulder blade, as if

00:35:17

someone had poked their fist under the shoulder blade

00:35:20

right where the root from

00:35:23

this 4th true nerve begins, but because

00:35:25

visual I saw very well what

00:35:27

happened before and understood that nothing could hurt my back,

00:35:34

everything happens so quickly before my eyes, so it’s

00:35:36

interesting to watch, and for some time I had

00:35:39

pain under the shoulder blade, and then these

00:35:41

field sensations moved into the depths of the

00:35:43

mammary gland, and here’s how he squeezed

00:35:46

something hard, as if there was a bruise, you have such a

00:35:50

feeling and the bottom and then usually after

00:35:53

some time, after how long to

00:35:55

imagine how an ant bite can be felt, the

00:35:57

tests passed, but so far in the perception that the

00:36:03

problem is in the skin from the ska, it has not yet

00:36:06

returned and we see that these painful

00:36:08

sensations cannot, as it were,

00:36:09

echo along the nerve endings

00:36:13

throughout this 4 lower than booked

00:36:16

when we hear about some painful

00:36:18

sensations in the depth of the chest under the shoulder blade,

00:36:21

sometimes it’s better to take a closer look at the

00:36:25

glasses and look at the nipple

00:36:27

as the child sucks some can without

00:36:30

damage, like a child, how the juice is injured,

00:36:32

because we see that, well, not

00:36:36

very well, sometimes these

00:36:38

painful sensations are localized where there is

00:36:40

damage to the mammary gland, beer and the

00:36:47

opposite approach quite often with

00:36:51

repeated lactostasis

00:36:53

with some unpleasant sensations in the

00:36:57

mammary gland can be suggested for the mother

00:37:01

to look at the condition of the back, here we

00:37:06

can also work with the position at the

00:37:08

breast, this is with postures with the comfort of the mother when

00:37:12

feeding, because if the toy sits

00:37:18

down like this, let’s say the child is

00:37:22

lying on his back, she inserts the breast into him and

00:37:24

look at yourself what’s happening with me

00:37:28

look at the dump with your back, there is

00:37:31

a load on my spine, how

00:37:34

tight my back muscles can be, the

00:37:36

nerve endings can be overstrained,

00:37:40

and thus, in addition to the fact that the

00:37:46

pain sensations will still be

00:37:49

transmitted to the mammary gland, a

00:37:54

not very pleasant thing can happen,

00:37:56

look,

00:37:58

after all, the oxytocin reflex when

00:38:00

it works with you, many people

00:38:03

put innervation in first place, you and I

00:38:06

understand that even this nerve signal

00:38:08

for milk to be released is

00:38:11

ensured, of course, this

00:38:14

is ensured by the nervous system, but this

00:38:16

activity and if the signal is not transmitted very well,

00:38:18

both nerve endings

00:38:23

due to some problems with the back due to a

00:38:27

clamp in the back due to the spine, then in my

00:38:32

orbit the real cells may

00:38:34

not work so well with the release of oxytocin, that

00:38:40

is, such a varnish may be disrupted,

00:38:43

maybe all this can be compared, but not in vain with

00:38:47

some swamps,

00:38:48

you see stagnant when there is too

00:38:52

much of this fluid, the

00:38:54

outflow of lymph does not happen very well because this

00:38:57

process is also innervated by the valleys,

00:39:00

in fact, the vessels are the lymph nodes, they are

00:39:03

also controlled by the nervous system and children are

00:39:09

a little differently, since they are the muscles of

00:39:12

the arm, that is, the

00:39:16

process is arranged a little differently there control, but

00:39:19

nevertheless, this is innervation and mil

00:39:24

epithelial cells, they work precisely

00:39:27

under the control of the nervous system,

00:39:30

respectively, if the innervation is disturbed,

00:39:35

if there is no clamping, this is

00:39:37

hello often and stagnation of milk may

00:39:41

decrease milk production, deteriorate

00:39:43

breast emptying, they are only developing the

00:39:48

mammary glands, these are the things I

00:39:53

see your questions, well, I drop them at the

00:39:55

moment when we turn on the recording,

00:40:00

the blood supply to the mammary gland is a very

00:40:05

very important thing, there is even

00:40:07

a hypothesis, we know that

00:40:09

most women do not have symmetrical mammary glands

00:40:13

1 mammary gland is larger and, as a rule,

00:40:17

produces more milk

00:40:20

according to statistics in the left mammary gland,

00:40:23

many attribute this to the fact that it is

00:40:26

closer to the heart, there is better blood supply,

00:40:28

such a team of theories has been proven,

00:40:31

however, it is possible that there is something in this that is

00:40:37

surprising, that in order to produce one

00:40:40

unit of milk, we first

00:40:41

talked about how the mammary gland needs to be

00:40:44

disassembled into constructor and

00:40:46

reassembles the elements of the roof

00:40:49

and to pick up there, let’s say there is evidence of

00:40:53

milk, you need to pass 400,500

00:40:56

units of blood there regarding this

00:40:58

trip to milk, many mothers notice that

00:41:04

these vessels on their

00:41:06

chest are enlarged, a tribute to this immediately swollen, what is

00:41:09

this, should it be treated, should it be treated? it’s not

00:41:12

necessary, but mothers are very pleased when

00:41:16

you explain about this

00:41:19

milk-blood ratio, that is,

00:41:21

these vessels of the mammary gland begin to work with a huge load,

00:41:25

we don’t know how this happens in women,

00:41:28

but they’ve already measured everything for cows too,

00:41:31

see what’s interesting in a cow and

00:41:35

more productive, yes, some cows make up

00:41:38

to 3 liters of milk a day, the other two buckets

00:41:43

were interesting to zoologists, that is, they

00:41:47

put a device in the vessels

00:41:53

that measures blood flow and measured

00:41:56

the amount of milk, but can you imagine the

00:41:59

cows that are more productive, that is,

00:42:01

they give more milk, they have about the same

00:42:03

amount the same blood passes through the blood

00:42:07

vessels, which is ensured by the

00:42:09

work of the mammary gland,

00:42:10

but the productivity of extraction is different,

00:42:12

that is, the same amount of material comes in,

00:42:18

but the mammary gland of youth is a

00:42:20

productive cow,

00:42:22

it uses it much more efficiently,

00:42:24

they produce more milk per unit

00:42:26

passed through the blood vessels, so

00:42:29

people did not eat so no one knows, but we can

00:42:32

also assume something like this, the ducts,

00:42:39

this is the picture that we see,

00:42:42

it lasted more than a hundred years, the

00:42:46

Cooper model and Cooper poured wax into the

00:42:51

ducts of a not living model,

00:42:54

he was not a living model, someone made

00:42:58

a preparation, discovered 22 straight channels

00:43:02

inside with ska and the number of holes in the

00:43:05

nipple was more than

00:43:08

[music]

00:43:09

or rather the number of holes at the tip of the

00:43:11

holes from the rocks was more than the channel of the

00:43:13

nipple

00:43:14

this was not explained in any way super just

00:43:16

noted the new three-dimensional ultrasound

00:43:21

they show us that the diameter of the Turk is

00:43:23

increasing understand how the diameter is

00:43:29

increasing worn the mustache is not visible from

00:43:31

the legends and the pelvis increases in Russian food

00:43:33

and in Russian, another thing is that there is no

00:43:37

such place where milk is accumulated and stored,

00:43:39

as I already said, there are no sinuses,

00:43:43

perhaps the drive of these wax

00:43:47

modeling was taken for sinuses as

00:43:49

places of accumulation and expansion of the ducts of this

00:43:55

already even this one carried out

00:44:00

presented first is the case of this

00:44:05

model for years now, I’m afraid that 1215 it is

00:44:10

perceived as a lot and in

00:44:12

comparison with the study of copies, but

00:44:16

we also have an even newer study of the

00:44:19

breast model photo ap why

00:44:24

studies of the ducts are now appearing, this is

00:44:27

due to the work of oncologists, it was found out

00:44:31

that

00:44:33

what is cancer basically it is

00:44:37

formed as if in a certain duct

00:44:40

given on the walls of the ducts, you can

00:44:43

predict the development of oncology

00:44:46

because in the ducts in which the tumor will develop

00:44:50

there is initially a different

00:44:56

[music]

00:44:58

bacterial environment, that is, the micro

00:45:00

peony there differs compared to

00:45:04

healthy ducts and now most

00:45:09

studies are being carried out non-invasively, that

00:45:12

is, instead of a puncture, when it is possible that

00:45:14

something will be placed there, repeated tissues

00:45:18

try to

00:45:20

get to the source of the tumor through a natural hole, to

00:45:24

take, for example, a biopsy

00:45:26

or look, take it for analysis, this

00:45:29

microbiome of the

00:45:32

mammary gland has a natural

00:45:34

hole and it would seem that this is it, go in and

00:45:37

take it at night the big question is this

00:45:40

hole in the nipples, it will lead to that

00:45:42

same duct will lead somewhere else, that is,

00:45:46

and oncology is allocated for research,

00:45:49

but very large funds are

00:45:51

much more than just for

00:45:53

research on the tone of the mammary gland,

00:45:55

well, let’s say so out of scientific interest, out of

00:45:58

scientific curiosity or in relation to

00:46:02

the story of breastfeeding about

00:46:04

such a cassation study, therefore, a

00:46:07

large number of excellent

00:46:09

studies of the ductal system

00:46:11

were given to us by oncologists, well done, what do they

00:46:15

want, they want to find the way from the

00:46:17

hole in the nipple to the

00:46:19

duct of their tumors, and now they are looking for a revision of the

00:46:25

anatomy of the nipples of the milk ducts, so

00:46:28

boldly called the study of 2004

00:46:31

and there were still revisions, that is, this is not

00:46:35

the last hurricane, the oncologist is interested

00:46:37

in the nipple, their ducts, it is beneficial

00:46:41

because we will also learn much more about

00:46:44

this, the breast is proposed to be considered

00:46:48

as a set of such systems,

00:46:50

why is everything so complicated because we

00:46:52

do not have a flower, we have a bouquet and It is impossible to put the

00:46:55

pistil and stamen of another from the stem of one flower. You

00:47:00

need to understand where whose

00:47:03

stem is. Preliminary studies

00:47:06

show that hormone levels

00:47:09

vary, see yourself and

00:47:12

different microbiomes. By the way, during lactation, it can

00:47:16

even be seen that milk of a slightly

00:47:19

different color is released from different

00:47:22

ducts. We can assume that

00:47:25

repeated lactostasis is repeated.

00:47:27

mastitis, of course, we are talking to you about the fact

00:47:30

that this is connected with emptying with the way the

00:47:32

baby is captured and the juice and this is what

00:47:37

we can change, this capture

00:47:39

so that the ducts are more evenly aligned, but

00:47:42

nevertheless it is obvious that the microbiome is different in

00:47:46

different ducts in a woman especially if

00:47:48

this is the second lactation and there is already a different child,

00:47:51

he sucks differently, they changed

00:47:53

the attachment, but it is clear that mastitis and

00:47:55

again and again in the same area,

00:47:57

many interesting things arise here, many

00:48:01

mysteries of what we do not know, I would like to

00:48:03

know more to take this into

00:48:06

account in our profession, this

00:48:14

slide could have been inserted into the innervation section,

00:48:19

but I chose to place it in the

00:48:23

ducts section because it is even more

00:48:25

amazing and beautiful; plastic

00:48:29

surgeons tell us how the

00:48:34

mammary gland is restored after

00:48:37

surgery; what actually happens is that

00:48:42

regeneration occurs has been known

00:48:44

for a long time or even four millimeters per year, the

00:48:50

nerve endings of the

00:48:53

mammary gland are restored,

00:48:54

if sensitivity was lost, the

00:48:57

board of the halos after the operation is important

00:49:03

how much time has passed, but when the mother,

00:49:06

after plastic surgery, gave some kind of

00:49:10

operation on the mammary gland,

00:49:12

they ask, but will I breastfeed? We

00:49:15

ask how long it has passed time

00:49:16

because if it’s five years, then the

00:49:19

very likely answer is yes, most of the

00:49:23

structures have already been restored, but what’s

00:49:25

surprising is that the river sewerage

00:49:28

ducts are able to recover, as

00:49:31

if they regrow, that is, these

00:49:33

ducts you and the structures are

00:49:34

not very good, they’re very cool, like a

00:49:39

lizard’s tail, they are capable of

00:49:42

recovery, we’ll talk more about

00:49:47

why this happens when we

00:49:49

talk to you in the next

00:49:51

lesson about the physiology of lactation, but for

00:49:56

me, for example, it was surprising to learn

00:49:58

that the ducts are also established,

00:50:00

because earlier we said that no Larisa

00:50:04

grows from the pair

00:50:06

or new ones grow, both then

00:50:10

there are cells

00:50:12

from which new ones are built and grow,

00:50:16

these ductal structures are based on well,

00:50:19

like in a matrix that is laid down at

00:50:21

birth which increases ubercart

00:50:25

they are very, very healthy divided and

00:50:30

simple at the same time

00:50:32

new matrices are laid and even from the research of

00:50:38

oncologists over a period of time this is also in general, it’s

00:50:41

quite new, we haven’t seen this

00:50:43

skirt before, and we haven’t seen it before, and we haven’t seen

00:50:48

how the ducts

00:50:52

come out of the nipple, the fact is that we will also

00:50:55

look at it in the next lesson, but

00:50:57

let’s turn a little to mba rheology of the

00:50:59

mammary gland, this is juice, they

00:51:02

are laid in different ways embryos, that is,

00:51:04

initially it is a derivative of different

00:51:08

structures and look where the

00:51:13

ducts exit, the path, the usual ducts,

00:51:17

the collectors, I collect several small

00:51:20

ducts and open on the surface from the

00:51:23

side, direct ducts, one duct straight

00:51:27

from, as it were, clusters of glands

00:51:31

coming out to the nipple, some ducts

00:51:35

open, cut and the mother asks

00:51:37

what it is I’m leaking milk and there is

00:51:42

such an answer, it’s wrong, it’s

00:51:44

leaking from the Montgomery gland, the gland is leaking into the

00:51:46

yard of the world, then the separate gland in it is completely

00:51:48

completely different and

00:51:50

only the secretion that produces the Montgomery gland can flow out of it,

00:51:52

milk

00:51:55

cannot, but what we see we see the duct

00:51:57

which for some reason once in Europe is great and

00:51:59

opened not on the nipple but on the arial

00:52:02

and there are blind ducts which, well, that is, the

00:52:06

alveoli also begin to work after

00:52:09

childbirth, but quite quickly and goodbye example is

00:52:12

blind and their ducts are, for example, an

00:52:13

additional lobe axillary dart

00:52:16

ducts are most often blind how

00:52:21

this image was obtained that we saw on the

00:52:23

previous slide by micron, the

00:52:28

preparation was cut off and then

00:52:33

the graph was torn and restored 3d

00:52:36

on a computer compress with the help of

00:52:39

computer technology we got this

00:52:42

three-dimensional modeling board yes, that

00:52:46

is, but they are the tip of the body from the

00:52:48

subcutaneous level you can follow the link

00:52:53

that I have in my warehouse

00:52:57

to look at this study of him and all

00:53:00

this cannot be included in such a short

00:53:02

presentation, it is very big, terribly

00:53:04

interesting, there are a lot of pictures of the conclusions,

00:53:08

excellent,

00:53:09

from the same study, only seven

00:53:13

of the 34 ducts ended at the

00:53:15

hole in the nipple this these these this not

00:53:18

euro what if outside on average in all sorts of

00:53:21

different women if you collect a bunch of them they have

00:53:23

70 34 this is oh in the model that

00:53:27

was studied in another model most likely

00:53:30

it won’t be like that you and I can see

00:53:34

one hole on the nipple often there may be one

00:53:37

like one hole and the other 7,

00:53:41

for example, splash these construction sites, does

00:53:43

this mean that we are dealing with one simple

00:53:46

gland like a cow, no, we can

00:53:49

look at this model, that somewhere

00:53:51

earlier they unite and as a result, here is

00:53:54

one such outlet, why do

00:54:00

n’t I emphasize that the one under study models, can

00:54:04

you imagine when they

00:54:08

often ask for some reason, the mother asks the question

00:54:10

how many holes should there be and

00:54:12

Sasuke’s poison or how many ducts enter the

00:54:14

nipple, you and I go into the park and see

00:54:17

bushes and trees in this park and then

00:54:21

the child asks you mom how

00:54:23

much branches

00:54:24

of a bush and how well

00:54:27

trees branch in general and you say, son,

00:54:31

let’s find out which bush has a

00:54:33

hawthorn, for example, we approach the entrance, they

00:54:37

are planted with hawthorn and we will see that the

00:54:39

bushes have

00:54:40

different habit, one species is vice so

00:54:43

that you can make a hedge out of it,

00:54:45

any one sticks out a thin stick made of mandrel with

00:54:48

twigs is good at the apple tree, the child tells you

00:54:52

and we approach you like an

00:54:55

apple orchard and introduce that one apple tree with

00:54:58

its crown covered a

00:54:59

huge flat surface of the cake,

00:55:02

the other one is growing strongly, that

00:55:06

is, even within

00:55:08

one plant breed, we cannot

00:55:11

say how many there are not many branches there,

00:55:13

and even more so within the whole

00:55:17

species, and in the same way, if you and I

00:55:19

visualize this structure, how

00:55:22

these ducts grow there, how many alveoli they have,

00:55:26

and in each cluster we don’t know, we

00:55:29

need to look at this woman, that

00:55:31

is three types, all like the crown of old

00:55:35

apple trees, maybe not, maybe two

00:55:37

stems, but still the

00:55:40

productivity is no less, I say this

00:55:44

because quite often in the initial

00:55:47

courses, beginners want to know the exact number,

00:55:50

give us a table,

00:55:52

how much of this and that and how it branches

00:55:54

is alive and there are no exact figures, and even the

00:55:59

average that the

00:56:02

researchers derive, it is most likely unlikely to

00:56:07

put the plum on tracing paper

00:56:09

like tracing paper on the parameters of a particular

00:56:11

woman, most likely it is the average residential

00:56:14

parameters below it will flow into this perfectly

00:56:19

surface with what is interesting that

00:56:26

10 percent hole in the nipple, on average,

00:56:30

10 percent is not a hole that

00:56:33

opens its milk ducts and the

00:56:36

sebaceous and sweat glands,

00:56:38

in our picture it is a black

00:56:40

dot that can still be seen that the diameter of the actual

00:56:45

opening of the milk ducts

00:56:47

varies significantly, these green dots about the

00:56:50

sebaceous or sweat glands did not say

00:56:53

anything about it knew it became

00:56:55

possible to establish only in

00:56:58

this 3D study where they looked at the micron to see

00:57:01

what the RKK leads there, this dot

00:57:04

is marked in black or green why it’s

00:57:07

interesting at the end of lactation often

00:57:10

mothers call and say oh I’m all in

00:57:12

some white dots what This is what we started

00:57:15

to think before: whether you people are caustic or not,

00:57:17

it’s possible to drink the milk just like it’s solidifying there, most

00:57:20

likely we see sebaceous and sweat

00:57:24

glands that begin to

00:57:27

work like this and

00:57:28

this is not a blockage of the milk duct with a white

00:57:32

dot, often when pumping we think,

00:57:35

well, I see a white one period, I read in the

00:57:38

literature that it is white. yes, the fact that he closed

00:57:41

the hole and needed how to remove it and the

00:57:44

milk will flow is

00:57:45

brilliant, we see the sebaceous gland,

00:57:51

inflammation on the nipple, the frequency of the mother

00:57:54

asks yes, it could be a feather, it

00:57:56

could be an inflammation of the sebaceous gland, not

00:57:59

necessarily the duct, and it’s surprising that

00:58:03

with this inflammation, the outflow of milk is not

00:58:05

disturbed correct because it has nothing to

00:58:08

do with that tray, here we also

00:58:13

see sato reusa smith, it’s

00:58:17

quite old from 77 years of

00:58:20

research, it’s also very detailed and

00:58:22

they also draw a conclusion about

00:58:23

the existence, but here there are 2 excellent students of

00:58:26

different types of hole milk

00:58:30

ducts and holes sebaceous glands

00:58:38

this is the colored one where we started colored

00:58:41

this Cooper model the

00:58:42

openings of the sebaceous glands are not described and for

00:58:46

more than a hundred years no one thought that there

00:58:48

could also be sweat and sebaceous glands on the nipple

00:58:52

the only one we remember is the small riddle stage

00:58:54

that Cooper left us that

00:58:56

the hole is larger than the

00:58:59

channels go into the nipple, and apparently this

00:59:02

explains part of the hole; it’s

00:59:04

not the

00:59:06

opening of the milk ducts at all; we also

00:59:15

see this lost duct; see, it’s

00:59:17

so white. a droplet yes in the arial what is it this is of

00:59:19

course not milk

00:59:23

flowing out of the Montgomery gland it’s just

00:59:25

one of the ducts of which enters the

00:59:27

nipple and for some reason in the arial why this

00:59:32

could be such a rudimentary

00:59:34

vestigial sign because the nipple

00:59:37

is, well, a later structure and

00:59:41

in more primitive mammals

00:59:43

there is no ska, but there is in a personal field, that is, the

00:59:46

ducts open immediately on

00:59:48

and the baby licks it and receives milk

00:59:52

immediately, it has aged all this is not combined into a

00:59:54

convenient tube for a cocktail, which

00:59:59

is the nipple, and thus it is for us

01:00:04

under the millet of the century feeding such

01:00:08

hello others glands

01:00:18

rent there are montgomery glands in

01:00:23

practice

01:00:25

the work of these glands with the brains by the way they are

01:00:29

considered to be such a house of iron we don’t see

01:00:31

when we don’t see the secret of this montgomery gland

01:00:34

you can only kind of take it on faith

01:00:37

that it exists and it works but if you’re

01:00:40

curious you can look at the

01:00:42

Montgomery iron, try to squeeze out a drop of it sticking out of it, you

01:00:46

will see this transparent tracing paper

01:00:49

if you take it on the fabric, it is slightly

01:00:51

yellowish, that secret is the Montgomery iron,

01:00:53

it is a very cool thing because it

01:00:56

softens, it makes the skin elastic, it

01:01:00

protects the nipple and areola from infection mothers

01:01:04

and partly the child’s mouth, that is, a

01:01:08

recommendation to wash the breasts,

01:01:10

preferably with soap, before feeding,

01:01:12

it is harmful and not good because we

01:01:14

again secrete the glands into the selection world and

01:01:16

deprive both the child and the mother of protection, what

01:01:23

else is not there, there are also sebaceous glands

01:01:25

and even completely such are the hairs and yes,

01:01:31

in real life there is a hair follicle and when a

01:01:36

question comes from my mother, why do I have

01:01:38

some kind of abscess, check or pimple, is something

01:01:40

inflamed, we are in no hurry, says something

01:01:42

with the fields of the Montgomery gland, of course

01:01:45

you are not an old diagnosis span

01:01:47

we send you to the doctor, but it could be

01:01:52

completely different than

01:01:55

these mongomery glands themselves, the quantitative

01:01:58

spread can be from four to 28, that

01:02:00

is, not everyone has the same number, but it

01:02:02

happens, but it’s different and there are a lot of mothers of

01:02:05

which we actually see four,

01:02:10

so perhaps for this reason I have all the presentations,

01:02:14

perhaps they are even longer in volume

01:02:17

than they usually tell us in the initial

01:02:21

courses, thanks to those who listen to us

01:02:24

recordings

01:02:25

clopper

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