Age management. School of Professor Sotnikova
L.S. Sotnikova, Professor of the Department of Obstetrics and Gynecology of Siberian State Medical University, dr med Sciences
Currently in Russia there is a catastrophic situation with women's health. Every 9th woman in the Russian Federation develops breast cancer, 30% of them under the age of 45. In the structure of oncological morbidity in women, breast cancer occupies 20%, which is 3 times more than the total share of the entire oncological pathology reproductive system. Mammary cancer - main reason female mortality today. Mastopathy is currently unequivocally considered as a precancerous condition, which affects 60% of women, and 80% also have gynecological pathology.
Considering the huge social significance of this problem, for the first time in Russia, in Tomsk, with the support of the Administration of the President of the Russian Federation and the National Corporation Rosnano, a scientific and practical program "Women's Health" was created, within which, through the joint efforts of leading scientific institutions countries (Siberian State medical University, Research Institute of Pharmacology SB RAMS, Research Institute mental health SB RAMS) and the Department of Health of the Administration of the Tomsk Region in short term should be developed effective methods early diagnosis and prevention of underlying conditions for breast cancer. The scientific and practical program "Women's Health" consists of two blocks: diagnostic and therapeutic. The project leader is Professor of the Department of Obstetrics and Gynecology of Siberian State Medical University, Doctor of Medical Sciences. Sotnikova Larisa Stepanovna.
The purpose of the diagnostic part of the program is to identify patients with precancerous condition, i.e. with mastopathy. Kit diagnostic measures designed in such a way that the woman receives full information about the state of her health in general, this allows her to choose an individual treatment and health program and recommendations for her. The woman is comprehensively examined by specialists: mammologist, gynecologist, oncologist, endocrinologist and neuropsychiatrist. Using modern hardware, tools and laboratory methods research, doctors receive complete information about the state of her psychoneurological, hormonal and immune status, as well as ultrasound characteristics of the pelvic organs, mammary gland and thyroid gland. Thus, together with the reproductive system, the condition of all organs and systems that affect women’s health is assessed.
The purpose of the treatment part of the program is to draw up therapeutic recommendations specifically and individually for each examined woman. In 2009, together with specialists from the regional healthcare, clinical researches biologically active additives from medicinal herbs of Altai, developed and produced by Biolit LLC, with the aim of their possible use in complex treatment mastopathy and a number of gynecological diseases. Previously proposed therapeutic regimens for practical health care using drugs plant origin did not have evidence base and were not always effective. The program "Women's Health" provides for monitoring the effectiveness of diagnostic and therapeutic measures. In Tomsk, reception under the “Women’s Health” program is carried out at the base antenatal clinic maternity hospital named after. Semashko and in the Medical and Diagnostic Center of the Siberian State Medical University, and in the near future, admission will begin in the city of Strezhevoy.
Currently, herbal preparations are in high demand abroad and in Russia. However, the laws of world pharmacology require manufacturers of dietary supplements to fully comply with GMP standards. It is noteworthy that Academician of the Russian Academy of Natural Sciences, Dr. Chem.. Sci. Valentina Nikolaevna Burkova, as the head of Biolit LLC, always does her best to ensure that the company's products meet international standards. Herbal remedies developed and produced by Biolit LLC were studied as part of the scientific and practical program "Women's Health" and proved to be highly effective.
Now herbal remedies can be selected according to indications individually for each woman after the comprehensive survey, which greatly increases the effectiveness of therapy and reduces the risk of developing breast cancer.
The scientific and practical program "Women's Health" offers several positions for the complex therapy of mastopathy and the prevention of breast cancer. Toxidont-May (May burdock root extract) has antiproliferative and hepatoprotective effects. Venorm restores iodine balance (it contains kelp), has a vegetative-normalizing effect. Polikavin due to bioflavonoids reduces the level of hyperestrogenemia and reduces the processes of estrogen-dependent proliferation. Mamavit gel is intended for local application, made on the basis of May burdock root extract, has a resolving and cytostatic effect.
In the complex therapy of gynecological diseases, one can note Reishi-kan, which, due to its normalizing effect on the nervous, immune and hormonal system can be used by women with mammological and gynecological pathologies. Galega-Nova has proven itself in the complex treatment of polycystic ovary syndrome (PCOS) by reducing insulin resistance female body. Achillane can be used in complex therapy, that is, together with antibiotics, when inflammatory diseases pelvic organs. Polikavin increases efficiency hormonal treatment uterine fibroids. The combined administration of nettle extract orally and phonophoresis with 1% Eplir solution to the area of the uterine appendages has great prospects for use in a contingent of women suffering from ovarian cysts. The regimen for taking the dietary supplement "Esobel" with cinquefoil extract together with phonophoresis with a 3% solution of esobel on the area of the uterine appendages and the use of the dietary supplement "Venorm" gave good results in therapy painful menstruation. In the complex therapy of endometriosis, a course of Toxidont-Maya can be recommended to reduce the degree of proliferative processes in ectopic foci. Due to the influence of Populin on psycho-emotional regulation processes discovered by scientists for the first time menstrual cycle, it can be used for oligomenorrhea (rare and scanty menstruation). To date, the joint cooperation of the manufacturer of biologically active additives Biolit LLC with scientific and practical medicine Tomsk is very fruitful. Every woman can choose a highly effective complex therapy regimen gynecological pathology using the products of Biolit LLC.
Indeed, BIOLIT is on guard women's health!
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Download for iPhone, Androidgirls! advise in Tomsk good gynecologist who can get pregnant, my friend hasn’t been able to for a long time (((
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Comments
Did she even go to the doctor?
Sotnikova Larisa Stepanovna.
- @fea383 at rd 4?
Nosov V.V.
In MC Bion Sainakova Marina Yuryevna, here is a 👍 doctor
- @rfkbirf no, in 4th row there is a regular Gynecologist. and this is a professor with an international reputation and vast experience. she has her own private clinic. google it.
- @fea383 thanks
At the Center for Prenatal Health in Siberian - Alisher Shavkatovich!
- @rfkbirf I also heard about Sotnikova, they say she’s a brilliant doctor! Let him try to contact her!
Eve and Adam - Nosov V.V. And in general, how will God give a child!
- @rfkbirf, in general, you need to be referred to a reproductive specialist!
By the way good doctor G, we also need a psychologist) it’s not always a matter of physiology)
Tikhonovskaya Olga Anatolyevna, receives first private clinic, simply the smartest doctor! she is also a professor at the department of Siberian State Medical University (she teaches with us and works in gynecology) + about 30 years of experience. He'll get to the bottom of everything, in in a good way!) By the way, all my patients I know got pregnant))
Petrova and Spirina, Women's Health Center
Go to Elena Viktorovna El Akad, she receives at the Central Clinical Hospital on Krasnoarmeiskaya 92/1. She's a truly amazing doctor. I can write more about her in PM and why I like her so much
I also know about Tikhonovskaya, a friend couldn’t get pregnant for 10 years, so many doctors, money, time and nerves were spent, she had already lost all hope, but she helped, at 35 she gave birth to a daughter ☺️
- @evlampiya06 write)) I’ll be glad
Yana Borodina is admitted to the Voykova Center for Medicine, she is a reproductive specialist. All pregnant women leave her
Tsukanova Irina Aleksandrovna, Center for cm. From personal experience I recommend.👍🏻
Saynakova Marina Yurievna!!!
In bion! I saw her both before and now!! very cool!!
El-Akad Elena Viktorovna, Siberian Medical Center!
Spirina Yulia Valerievna, Women's Health Center! personal experience. After 3 years of suffering, I came to her. and after 4 months she became pregnant, and after 2 years she returned for a second
Right to Spirina! She is a doctor from God, she gets infertile people pregnant, such energy!
The invention relates to medicine, namely to psychiatry and gynecology, and can be used in the treatment of endometriosis in women with anxiety and depressive disorders. To do this, 1 month after laparoscopy, against the background of drug hormonal treatment for 6 months, phenotropil is additionally prescribed at a dose of 100 mg/day for 90 days. The administration of phenotropil in the specified dose and mode of administration allows reducing anxiety and depressive symptoms and has a positive effect on the functional state of the immune and autonomic systems. nervous system. 4 tables
The present invention relates to medicine, namely to psychiatry, gynecology, and can be used in the treatment of endometriosis in women with anxiety and depressive disorders.
The relevance of increasing the effectiveness of treatment for endometriosis is due, first of all, to the leading position of this pathology in terms of prevalence and severity in women. reproductive age, negatively affecting the mental and physical condition, quality of life. Almost all women with endometriosis have been diagnosed with affective disorders, immune disorders And autonomic dysfunctions.
A two-stage method of treating endometriosis is known, including surgical removal of endometrioid heterotopias followed by treatment with an antigonadotropic drug (danazol) for 6 months. This method is the closest to the claimed one and was chosen as a prototype.
Traditional surgical and medicinal hormonal treatment of endometriosis, including drugs: gonadotropin releasing hormone agonists, antigonadotropic drugs, progesterone analogues, synthetic gestagens, combined monophasic estrogen-gestagen drugs, does not provide adequate correction of psychoneuroimmune disorders (anxiety-depressive symptoms and disorders of immune reactivity, dysfunction autonomic nervous system, reduced adaptive reserves of the body), accompanying endometriosis in women. In this regard, it is relevant to search for new methods and expand the arsenal medicines, increasing the effectiveness of treatment of endometriosis in women with anxiety and depressive disorders, the main manifestations of which are psychoneuroimmune disorders.
The objective of the invention is to increase the effectiveness of treatment and improve the quality of life of women suffering from endometriosis with anxiety and depressive disorders.
This problem is solved by additionally prescribing phenotropil at a dose of 100 mg/day for 90 days, 1 month after laparoscopy, against the background of medicinal hormonal treatment for 6 months.
What is new is the prescription of phenotropil at a dose of 100 mg/day for 90 days, 1 month after laparoscopy.
The clinical picture of endometriosis is accompanied by mental disorders, the features of which are determined by the complex and variable ratio of severity pathological process, on the one hand, and the nature of the state of the body and, above all, the central and autonomic nervous system, as well as immune system, with another. The development of endometriosis is facilitated, among other things, by immune imbalance. According to the immunological concept, the following immunopathological processes are formed in endometriosis: induction of autoimmune reactions against endometrial tissue and development secondary immunodeficiency. Main clinical manifestations endometriosis are a pronounced syndrome pelvic pain and anovulatory infertility, which aggravate the insufficiency of adaptive reactions resulting from neuroendocrine disorders, previous extragenital and gynecological diseases.
Thus, this disease is one of the central medical and social problems, requiring optimization of treatment with mandatory clinical and dynamic assessment of their consequences. IN clinical picture in women with gynecological diseases asthenic, anxiety-depressive symptoms, pronounced autonomic disorders, as well as behavioral changes are detected that aggravate the course of the pathology of the reproductive system, leading to a deterioration in the woman’s quality of life and the prognosis of the disease. It is well known that the nervous, immune and endocrine system are components common system adaptation.
In the claimed totality, new features showed new properties of phenotropil, which do not clearly follow from the state of the art in this field and are not obvious to a specialist. In the scientific, medical and patent literature, no indications were found for the use of phenotropil in the treatment of endometriosis in women of reproductive age with anxiety and depressive disorders.
The invention can be used in clinical practice in order to increase the effectiveness of treatment of endometriosis (ICD-10 - N80) in women.
The method is carried out as follows.
For women suffering from endometriosis with anxiety and depressive disorders, treatment including surgical (laparoscopy with maximum excision of endometriotic implants and restoration reproductive function) and medicinal hormonal treatment (antigonadotropic drugs) for 6 months, 1 month after laparoscopy against the background of medicinal hormonal treatment, phenotropil is additionally prescribed at a dose of 100 mg/day for 90 days.
Clinical example
Patient K., 35 years old (case history No. 1545/832) was admitted to gynecological department MLU "Regional clinical Hospital» Tomsk on March 4, 2009 with complaints of heavy uterine bleeding within 10 days, pain during menstruation, dyspareunia, lack of pregnancy with regular sexual activity for 2 years, depressed mood, constant feeling anxiety, a feeling of difficulty breathing, a feeling of lack of air, rapid breathing when excited or in a stuffy room, paroxysmal, diffuse, constricting headaches, fatigue, sleep disturbances were noted in the form of presomnia insomnia and superficial, shallow sleep and lack of feeling of rest upon awakening.
From the anamnesis: she suffers from menstrual irregularities for 2 years after a medical abortion. The disease is permanent. Menarche from age 13. IN Last year menstrual flow were observed irregularly, with an interval of 14 to 21 days, lasting from 10 to 18 days, abundant in quantity, with clots, painful, especially on the first day of the menstrual cycle. Since that time, a decreased mood, a constant feeling of anxiety, a feeling of difficulty breathing, a feeling of lack of air, rapid breathing when excited or in a stuffy room, paroxysmal, diffuse, constricting headaches, fatigue, sleep disturbances were noted in the form of presomnia insomnia and superficial, shallow sleep and lack of feeling of rest when waking up. Objectively: condition medium degree gravity. Height: 162 cm, weight: 54 kg. Asthenic physique. Skin pale pink, dry mucous membranes. During a physical examination of the pathology of the cardiovascular, respiratory, urinary systems, gastrointestinal tract not detected.
Mental condition. Fully oriented. Looks a little older than his age. The background mood is reduced. Hypomimic. The voice is quiet, slightly modulated. The facial expression is pained. Complains of low mood, a constant feeling of anxiety, a feeling of difficulty breathing, a feeling of lack of air, rapid breathing when excited or in a stuffy room, paroxysmal, diffuse, constricting headaches, fatigue, sleep disturbance noted in the form of presomnia insomnia and superficial, shallow sleep and lack of feeling of rest upon awakening. Notes an increase in these symptoms in the last 2 months. Autonomic disorders are detected in the form of slight tremor of the hands, coldness of the extremities, and sweating. Memory for current events and events from the past is preserved. Expresses passive suicidal thoughts. The conversation quickly becomes exhausted. Fixed on the state of her health. Mental status qualified as anxiety-depressive syndrome.
Results of psychometric assessment of severity mental disorders using diagnostic scales:
Spielberg-Khanin scale: reactive anxiety - 38 points, personal anxiety - 42 points;
Hamilton Anxiety Scale (HAS): mental anxiety - 15 points, somatic anxiety - 11 points, neurovegetative anxiety - 4 points;
Hamilton Depression Scale (HADS) - 14 points;
questionnaire to identify signs of autonomic changes - 32 points.
Neurologist's conclusion: Autonomic dystonia syndrome.
Laboratory results:
Complete blood count: red blood cell count - 3.42×10 12 /l, reticulocyte count - 8; hemoglobin content - 122 g/l; color index - 0.9; weak hypochromia of erythrocytes;
Immune status - CD3+ - 53% (0.99·10 9 /l), CD4+ - 35% (0.56·10 9 /l), CD8+ - 18% (0.33·10 9 /l), immunoregulatory index (CD4+/CD8+) - 1.7, CD72+ - 10% (0.19 10 9 /l), CD16+ - 6% (0.11 10 9 /l), CD25+ - 15% (0.28 10 9 /l), CD95+ - 18% (0.33·10 9 /l). Conclusion: decrease in the relative and absolute content of T-lymphocytes identified as CD3+-positive cells; CD4+ cells exhibiting helper activity; cytotoxic T lymphocytes, carrying CD8 surface molecules; NK cells and the general population of B lymphocytes, which perform the functions of antigen-presenting cells and precursors of cells that secrete antibodies of the humoral immune system.
ECG - heart rate - 86 per minute, deviation electrical axis left;
Ultrasound of the pelvic organs: Conclusion: Suspicion of internal genital endometriosis (adenomyosis). Impaired transformation of the endometrium;
A study of heart rate variability demonstrated a decrease in current functional state(TR indicator = 1283.5 ± 102.9 ms 2 /Hz), excessive activation of the sympathetic-adrenal system (LF/HF ratio = 2.11 ± 0.16) and decreased activity (tone) parasympathetic system regulation (NR component = 352.2 ± 41.9 ms 2 /Hz). These changes demonstrate autonomic disorders.
Conducted in a hospital setting: hysteroscopy and laparoscopy.
During hysteroscopy, endometrioid tracts and rough relief of the walls in the form of ridges and crypts were identified. The degree of prevalence of endometriosis, according to the classification of V.G. Breusenko (1997), corresponded to stage 2 of the process. During laparoscopy, retrocervical endometriosis was diagnosed, and electrocoagulation of identified foci of external genital endometriosis was performed.
After a comprehensive examination, a diagnosis was made: External (retrocervical) and internal (adenomyosis) genital endometriosis. Menometrorrhagia. Alnodysmenorrhea. Dyspareunia. Secondary infertility.
Appointed therapeutic measures: antigonadotropic drug danazol at a dose of 800 mg/day for 6 months as the second stage of treatment of endometriosis in outpatient setting. Objective criteria for evaluation clinical effectiveness The use of danazol as a treatment for endometriosis resulted in the onset of pharmacological amenorrhea in the patient.
1 month after endoscopic surgery (laparoscopy) during treatment with danazol, phenotropil was prescribed at a dose of 100 mg/day for 90 days. The effectiveness of phenotropil was assessed by reducing the severity of symptoms. As a result of the treatment, the patient's anxiety-depressive symptoms and autonomic disorders were reduced. These changes were recorded using diagnostic scales:
Spielberg-Khanin scale: reactive anxiety - 19 points, personal anxiety - 29 points;
Hamilton Anxiety Scale (HAS): mental anxiety - 7 points, somatic anxiety - 6 points, neurovegetative anxiety - 1 point;
Hamilton Depression Scale (HADS) - 6 points;
questionnaire to identify signs of autonomic changes - 16 points.
Clinical improvement was accompanied by normalization of indicators immune status: CD3+ - 72% (1.80·10 9 /l), CD4+ - 43% (1.08·10 9 /l), CD8+ - 29% (0.72·10 9 /l), immunoregulatory index (CD4+ /CD8+) - 1.48; CD72+ - 8% (0.20·10 9 /l), CD16+ - 12% (0.30·10 9 /l), CD25+ - 17% (0.43·10 9 /l), CD95+ - 7% ( 0.17 10 9 /l).
The results of the study of heart rate variability after treatment registered an increase in the total power of the spectrum (TP indicator = 2837 ms 2 /Hz), power of slow waves (LF component = 1023 ms 2 /Hz) and fast periods(HF component = 1468 ms 2 /Hz), normalization of the balance of the sympathetic and parasympathetic parts of the autonomic nervous system (LF/HF ratio = 0.69).
After finishing this course treatment, the patient did not require re-prescription of an antigonadotropic drug (danazol) for 6 months.
Thus, phenotropil had positive influence on anxiety-depressive symptoms, the state of the immune system (specific and nonspecific immunity, pro-apoptotic readiness of lymphocytes) and the autonomic nervous system with a shorter duration reuse medicinal hormonal treatment for 6 months.
The analysis of the effectiveness of the course of treatment and the control group included 46 patients. The distribution of patients into groups was as follows:
Group 1 - 25 patients who received 100 mg/day of phenotropil for 90 days;
Group 2 - 21 patients who did not receive phenotropil.
In addition to the drug phenotropil, patients of all groups received basic treatment:
Stage 1 - endoscopic surgical intervention(laparoscopy) with maximum excision of endometrioid implants and restoration of reproductive function;
Stage 2 - antigonadotropic drugs (danazol 800 mg/day) postoperative period to prevent relapse for 6 months.
These patients underwent repeated clinical-psychopathological, immunological and functional examination.
Analysis of the dynamics of indicators of the severity of psychopathological symptoms using clinical-psychopathological research and psychometric assessment of the severity of mental disorders using diagnostic scales (Spielberg-Hanin scale, Hamilton Anxiety and Depression Scales (HADS and HAS) showed an almost complete reduction of anxiety-depressive disorders in the group of patients , receiving phenotropil with high level significance (p<0,001) по всем исследуемым параметрам по сравнению с группой сравнения (табл.1).
When assessing the state of the autonomic nervous system in accordance with the recommendations of the Center for Pathology of the Autonomic Nervous System (Vein A.M., 1998), studying the structure and severity of autonomic disorders using a questionnaire proposed by the Center for Autonomic Pathology (Vein A.M., 1991): “Questionnaire to identify signs of autonomic changes " and "Research schemes for identifying signs of autonomic disorders", a statistically significant decrease in the manifestations of autonomic disorders was revealed, compared with the group of patients who did not receive the drug (Table 1).
These changes were confirmed by the results of a study of the modulating influence of the autonomic and central nervous systems, a number of humoral and reflex effects on the heart rhythm at rest and when performing experimental clinical tests based on spectral and temporal analysis of heart rate variability using the computer program "Poly-Spectrum-Rhythm" "according to "International Standards" in accordance with the recommendations of the European Society of Cardiology and the North American Society for Electrical Stimulation and Electrophysiology (1996) on the "VNS-Micro" device (Neurosoft, Ivanovo).
The study of the spectral parameters of heart rate variability after treatment with phenotropil registered a significant increase in the total power of the spectrum, the power of the waves of the slow and fast periods, the normalization of the balance of the sympathetic and parasympathetic divisions of the autonomic nervous system compared with the results of this study of the control group (Table 2). The results of the study of the Ewing test battery after the treatment with Phenotropil moved within the normal range (according to Ewing D.J.), in contrast to the group that did not take the drug (Table 3).
The conducted immunological study revealed a significant increase, compared with similar indicators in patients who did not receive the drug, in the absolute number of subpopulations of peripheral blood lymphocytes carrying the following markers of cell differentiation: CD3+, CD4+, CD8+, CD72+, CD16+, CD25+; the relative and absolute content of cells carrying the CD95+ receptor on their surface decreased statistically significantly (Table 4). The results obtained demonstrate the immunomodulatory (increasing specific and non-specific immunity, reducing the proapoptotic readiness of lymphocytes) effect of Phenotropil.
In patients treated with phenotropil, there was a decrease in the rate of progression of endometriosis, in this group, re-administration of hormonal drugs was required in 32% of cases, which is statistically significantly less (p<0,01), чем в группе сравнения (72%).
Thus, the use of phenotropil led to an increase in the effectiveness of the treatment of endometriosis in women with anxiety and depressive disorders due to the reduction of anxiety and depressive symptoms, a positive effect on the functional state of the immune system (increased specific and nonspecific immunity, decreased proapoptotic readiness of lymphocytes) and the autonomic nervous system when reducing the duration of the use of repeated drug hormonal treatment within 6 months. In this regard, Phenotropil at a dose of 100 mg/day can be recommended for use in the complex pharmacological pathogenetic treatment of endometriosis in women of reproductive age with anxiety and depressive disorders, which improves the effectiveness of treatment and their quality of life.
Bibliography
1. Nasyrova R.F., Sotnikova L.S., Novitsky V.V. et al. The state of autonomic regulation in endometriosis in women of reproductive age with anxiety and depressive disorders // Bulletin of Siberian Medicine. - 2009. - Volume 8, No. 3. - P.58-63.
2. Chandra P.S., Ranjan S. Psychosomatic obstetrics and gynecology - a neglected field? //Curr. Opin. Psychiatry. - 2007. - V.33 (1). - P.11-16.
3. Lorrencatto C., Petta C.A., Navaro M.J. et al. Depression in women with endometriosis with and without chronic pelvic pain // Acta Obstet. Gynecol. Scand. - 2006. V.85. - P.88-92.
4. Gynecology: national guide / ed. V.I. Kulakova, I.B. Manukhina, G.M. Savelyeva. - M.: GOETAR-Media, 2007. - P.792-800.
5. Ishchenko A.I., Kudrina E.A. Endometriosis: modern aspects. - M.: MIA, 2008. - 173 p.
6. Manukhin I.B., Tumilovich L.G., Gevorkyan M.A. Clinical lectures on gynecological endocrinology. - M.: GOETAR-Media, 2006. - 357 p.
7. Siedentopf F., Tariverdian N., Rucke M., Kentenich H., Arck P.C. Immune Status, Psychosocial Distress and Reduced Quality of Life in Infertile Patients with Endometriosis // American Journal of Reproductive Immunology. - 2008. - V.60. - P.449-461.
8. Nasyrova R.F., Kupriyanova I.E., Sotnikova L.S. Anxiety and depressive disorders in women with pathologies of the reproductive system // Siberian Bulletin of Psychiatry and Narcology. - 2009. - No. 4 (55). - P.44-46.
9. Aleksandrovsky Yu.A., Chekhonin V.P. Clinical immunology of borderline mental disorders. - Moscow, “GEOTAR-Media”, 2005. - 250 p.
| Table 1 | ||
| Current state according to the scales: Spielberg’s situational and personal anxiety, Hamilton’s anxiety and depression in patients at the 2nd visit | ||
| Index | Comparison group | |
| Scale for identifying signs of vegetative changes, points | 9.23±1.87 | 28.02±3.86 |
| p 1<0,001 | p 1<0,05 | |
| p2<0,001 | ||
| Hamilton Depression Scale, points | 6.21±1.78 | 12.96±3.04 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,001 | ||
| Spielberger-Hanin Situational and Personal Anxiety Scale | ||
| Situational anxiety, points | 18.34±3.46 | 38.15±4.91 |
| p 1<0,001 | p 1<0,01 | |
| p 2<0,001 | ||
| Personal anxiety, points | 29.71±4.02 | 45.34±5.46 |
| p 1<0,001 | p 1 >0.05 | |
| p 2<0,001 | ||
| Hamilton Anxiety Scale | ||
| Mental anxiety, points | 6.42±1.09 | 13.97±2.89 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,001 | ||
| Somatic anxiety, points | 7.02±1.31 | 14.62±2.73 |
| p 1<0,001 | p 1 >0.05 | |
| p 2<0,001 | ||
| Neurovegetative anxiety, points | 1.02±0.35 | 3.07±0.81 |
| p 1<0,001 | p 1 >0.05 | |
| p 2<0,001 | ||
| Note: here and further in tables 2, 3, 4, 5 | ||
| p 1 - reliability of differences in indicators compared with similar parameters in patients of this group at the 1st visit; | ||
| p 2 - reliability of differences in indicators compared with similar parameters in patients at the 2nd visit who did not take phenotropil. |
| table 2 | ||
| Background spectral indicators of heart rate variability in patients at visit 2 | ||
| Index | A group of subjects who took phenotropil at a dose of 100 mg/day | Comparison group |
| Total spectrum power (TP), ms 2 /Hz | 2978.90±221.38 | 1469.72±182.46 |
| p 1<0,05 | p 1 >0.05 | |
| p 2<0,001 | ||
| Power of very slow period waves (VLF component), ms 2 /Hz | 335.46±69.43 | 601.32±89.12 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,05 | ||
| Power of slow period waves (LF component), ms 2 /Hz | 1364.75±129.78 | 597.98±123.08 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,001 | ||
| Power of fast period waves (HF component), ms 2 /Hz | 1697.21±123.95 | 418.92±67.45 |
| p 1<0,001 | p 1<0,01 | |
| p 2<0,001 | ||
| Indicator of the balance of the sympathetic and parasympathetic divisions of the ANS (LF/HF) | 0.64±0.09 | 1.61±0.14 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,01 |
| Table 3 | ||
| Indicators of vegetative (cardiovascular) tests in patients at visit 2 | ||
| Index | A group of subjects who took phenotropil at a dose of 100 mg/day | Comparison group |
| Deep breathing test coefficient (K breath.) | 1.61±0.12 | 1.19±0.09 |
| p 1<0,001 | p 1 >0.05 | |
| p 2<0,05 | ||
| Ratio 30:50 in active orthostatic test (K 30:50) | 1.42±0.21 | 1.19±0.08 |
| p 1<0,001 | p 1 >0.05 | |
| p 2<0,05 | ||
| Valsava sample coefficient (K Vals.) | 1.73±0.23 | 1.25±0.11 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,01 | ||
| Change in blood pressure systole. with an active orthostatic test (decrease) | 10.09±1.65 | 17.12±2.32 |
| p 1<0,001 | p 1<0,05 | |
| p 2<0,01 | ||
| Change in diastole blood pressure. during a test with isometric load (increase) | 15.87±1.91 | 13.02±1.52 |
| p 1<0,001 | p 1<0,01 | |
| p 2<0,05 |
| Table 4 | |||
| Population and subpopulation composition of peripheral blood lymphocytes in patients at visit 2 | |||
| Markers of cell differentiation | A group of subjects who took phenotropil at a dose of 100 mg/day | Comparison group | |
| CD3+ | % | 74.92±6.23 | 61.95±7.64 |
| p 1<0,001 | p 1 >0.05 | ||
| p 2<0,001 | |||
| ·10 9 /l | 1.72±0.15 | 1.24±0.26 | |
| p 1<0,001 | p 1 >0.05 | ||
| p2<0,01 | |||
| CD4+ | % | 46.82±3.94 | 39.07±5.28 |
| p 1<0,001 | p 1<0,001 | ||
| p 2<0,01 | |||
| ·10 9 /l | 1.23±0.09 | 0.69±0.08 | |
| p 1<0,001 | p 1 >0.05 | ||
| p 2<0,001 | |||
| CD8+ | % | 30.23±2.78 | 23.06±3.94 |
| p 1<0,001 | p 1 >0.05 | ||
| p 2<0,001 | |||
| ·10 9 /l | 0.70±0.11 | 0.45±0.06 | |
| p 1<0,001 | p 1<0,001 | ||
| p 2<0,001 | |||
| Immunoregulatory index (CD4+/CD8+) | 1.62±0.24 | 1.97±0.38 | |
| p 1<0,001 | p 1 >0.05 | ||
| p 2 >0.05 | |||
| CD72+ | % | 8.01±1.03 | 5.99±0.89 |
| p 1<0,05 | p 1 >0.05 | ||
| p 2<0,05 | |||
| ·10 9 /l | 0.17±0.11 | 0.10±0.01 | |
| p 1<0,001 | p 1 >0.05 | ||
| p 2<0,001 | |||
| CD16+ | % | 7.96±1.43 | 4.93±0.81 |
| p 1<0,001 | p 1<0,01 | ||
| p 2<0,001 | |||
| ·10 9 /l | 0.20±0.02 | 0.08±0.01 | |
| p 1<0,001 | p 1 >0.05 | ||
| p 2<0,001 | |||
| CD25+ | % | 15.87±1.97 | 10.02±1.46 |
| p 1<0,05 | p 1 >0.05 | ||
| p2<0,001 | |||
| ·10 9 /l | 0.29±0.08 | 0.17±0.03 | |
| p 1<0,001 | p 1 >0.05 | ||
| p2<0,001 | |||
| CD95+ | % | 4.1±0.64 | 9.21±0.83 |
| p 1<0,001 | p 1<0,001 | ||
| p2<0,001 | |||
| ·10 9 /l | 0.12±0.09 | 0.19±0.08 | |
| p 1<0,001 | p 1<0,001 | ||
| p2<0,001 |
CLAIM
A method of treating endometriosis in women with anxiety and depressive disorders, including laparoscopic surgery and hormonal drug treatment for 6 months, characterized in that 1 month after laparoscopy phenotropil is additionally prescribed at a dose of 100 mg/day for 90 days.
Sotnikova Larisa Stepanovna
Doctor of Medical Sciences, Professor of Siberian State Medical University (Tomsk), President of the Russian NGO “Union of Independent Experts”,doctor of the highest category - obstetrician-gynecologist, endocrinologist, mammologist, reproductive specialist, pediatric gynecologist,clinical pharmacologist, director of the Scientific and Clinical Center for Hormonal Health “Vozrozhdenie”
COMPARELY RECENTLY, THE CONCEPT OF ANTI-AGE APPEARED IN MODERN MEDICINE AND ACQUIRED INTERDISCIPLINARY SIGNIFICANCE. AGE MANAGEMENT IS A TASK IN WHICH DOCTORS OF DIFFERENT SPECIALIZATIONS TAKE PART. IN ADDITION, IT HAS NOT ONLY MEDICAL, BUT ALSO SOCIAL SIGNIFICANCE, AS IT PURSUES THE GOAL OF INCREASING THE QUALITY OF LIFE. THE SOLUTION OF THIS MEDICAL PROBLEM IS ALSO BECAUSE OF PARTICULAR RELEVANCE BECAUSE THE NUMBER OF WOMEN IN THE OLDER AGE GROUP IS INCREASING EVERY YEAR ALL OVER THE WORLD AND IN RUSSIA IN PARTICULAR.
FACTOR OF SOCIAL LIFE
From the point of view of anti-aging, increasing the retirement age does not seem like a necessary evil; rather, it is a positive change that leads to an increase in social life expectancy. It has long been proven that people who are active and in demand professionally live better and longer lives. Unfortunately, according to the Federal State Statistics Service, on average our compatriots live 5 years less than people in other developed countries. However, over the past few years in the history of our country, an increase in average life expectancy has been recorded for the first time, and today it is 71 years.
Aging is an inevitable biological destructive process that leads to a gradual decrease in the adaptive capabilities of the body. It is inevitably accompanied by the development of age-related pathology.
Old age is a naturally occurring period of age-related development, the final stage of ontogenesis. Old age can be chronological, physiological (biological), psychological and social. Social old age, or more precisely social age, determines a person’s demand in society, which ultimatelyhas a significant impact on his health and longevity.
MOLECULAR GENETIC NATURE OF AGING
Today, the so-called concept of “successful aging” is gaining increasing popularity in the world. This concept includes not only longevity, but also quality of life. With successful aging, a person’s chronological age should correspond to or even be slightly higher than their physiological, psychological and social age. Unfortunately, many elderly people in our country are significantly ahead physiologically of their own chronological age and have several combined age-associated diseases. The pathogenesis of diseases in this group is based on insulin resistance, that is, a violation of the metabolic response to endogenous or exogenous insulin. The most effective and etiopathogenetically substantiated method of combating insulin resistance is to reduce the amount of adipose tissue, usually through nutritional correction.
In many modern theories of aging, a special place is given to the possibility of changing human genetic programs, which can prolong not only life, but also youth. Numerous experiments on animals in this area have shown that changing genetic programs makes it possible to increase their life expectancy severalfold. However, genetic modification technologies have not yet been applied to humans. But geneticists (Zakharov I.A., author of the book “Ethical aspects of the latest achievements of experimental
geneticists") admit that even now there is no need to directly influence the human genome; it can be influenced by changing lifestyle and, in particular, by making a lifestyle correction, that is, not triggering the activation of genes responsible for the development of a particular pathology . For example, if a person is genetically predisposed to diabetes, it is necessary to minimize risk factors through diet, and the likelihood of gene activation will be significantly reduced.
REGULATION OF BODY SUPPORT SYSTEMS
The aging process in the human body is triggered by an organ located in the brain, the weight of which does not exceed 10 grams - the hypothalamus. It is this organ that is the center of regulation of the body’s five main life support systems: the central nervous system, the autonomic nervous system, the hormonal, immune and blood coagulation systems.
Normal functioning of the hypothalamus supports the body's adaptive capacity. A marker of lost adaptive capabilities is the appearance of dyslipidemia and hypercholesterolemia. Therefore, for all older patients it is necessary to determine the lipid spectrum of the blood. Its decoding will provide information about the quantitative and qualitative composition of fatty acids. A sufficient amount of high-density lipoproteins (over 0.9 mmol/l) characterizes normal synthesis
hormones. An excess of low-density lipoprotein levels (normally the level should be less than 4.9 mmol/l) indicates a high risk of developing age-related diseases and cardiovascular risks.
Academician I.M. spoke about neurohumoral regulation. Sechenov. However, modern scientists argue that it is not the central nervous system, but the autonomic nervous system that plays a special role in maintaining homeostasis. It is she who controls the so-called soma - all cells of the body with the exception of reproductive ones. Control is carried out through the hormonal, immune and hemostatic systems. Disruption of the autonomic nervous system provokes psychosomatization, which is typical for most older patients.
ANTI-AGING AS A SYSTEM
As a rule, the method of providing medical care in most clinics in Russia is structured in such a way that the patient is prescribed treatment in response to a subjective complaint or the objective presence of a symptom.
On the contrary, anti-aging is based on a systematic approach to the human body. All cells of the body are characterized by the phenomenon of aging. It is associated with genetics, the synthesis of certain proteins, and the content of certain enzymes. A special role is assigned to mitochondria, which produce adenosantriphosphoric acid (ATP) - the energy potential of the cell. Mitochondria are inherited through the maternal line and their life cycle is 12 years.
The largest number of mitochondria are found in germ cells. Defective mitochondria do not give rise to pregnancy, and in older age they can become one of the reasons for the development and progression of age-associated diseases.
Clinical manifestations of mitochondrial deficiency are not always considered as symptoms, and patients, as a rule, overlook such manifestations as fatigue, fatigue from communication, and decreased vitality.
A doctor who practices anti-aging will definitely pay attention to these points when collecting anamnesis, since one of the most important points in the age management system is the elimination of mitochondrial deficiency. The method used in the system includes 5 points:
- elimination of insulin resistance,
- relief of cell hypoxia,
- elimination of hormone deficiency,
- microbiota correction,
- work with bioenergy (biophysics).
Anti-aging is not just a way of life, it is a change in worldview. The doctor must remember that the success of this system is possible only if the patient makes a conscious decision to remain healthy and wants to prolong a socially active life without disease. A number of patients susceptible to psychosomatization are not able to make such a decision: it is beneficial for them to remain sick, since pathology gives them the opportunity to avoid responsibility for their behavior, as well as the opportunity to manipulate
close people.
By making the decision to “age gracefully,” the patient makes a commitment to himself, and the doctor helps him achieve his goals.
In anti-aging, the “Health Quartet” concept, authored by Professor S. Yu. Kalinchenko (Moscow), is actively used - complex metabolic therapy.
But before prescribing hormonal therapy, it is necessary to get rid of insulin resistance. Until success is achieved in this regard, menopausal hormone therapy technologies will not only be ineffective, but will also have side effects. It is precisely because MHT was prescribed against the background of insulin resistance that many doctors developed hormonophobia. Insulin is the only hormone to which it is possible to eliminate cell resistance without using medications. Through insulin growth factor, it becomes a powerful anabolic hormone.
Detailed information about the new scientific insulin-lowering method in the book “Insulin and Health” is given by Dr. Yu. A. Babkin (Israel). He claims that every meal triggers the release of insulin into the blood, which provokes cells to proliferate. The body's protective reaction to excess insulin is the development of resistance to it. At the same time, the cells become immune to sex hormones. This is why MHT does not bring the desired effect.
In addition, anti-aging involves controlling carbohydrate metabolism. In 2015, American endocrinologist and well-known specialist in the treatment of obesity, Professor George Bray, publicly admitted that he was mistaken when speaking about metabolically neutral obesity. In fact, obesity is always associated with a problem in carbohydrate metabolism.
Monitoring technologies are now used in Europe, Israel, and South Korea. The method allows you to monitor changes in carbohydrate metabolism in real time using a cell phone. In Russia there is no such technical capability yet, but a test similar to the tolerance test has been developed and registered in Tomsk
to glucose, but more informative. It allows you to assess the dynamics of carbohydrate metabolism over 3 months.
The effectiveness of the anti-aging system will enhance the elimination of sleep disorders and the reduction of psychosomatization. Neurovegetative testing - monitoring the state of the autonomic nervous system - allows you to determine the level of psychosomatization. It is possible to normalize unbalanced autonomic regulation with the help of a drug thatcontaining Cimicifuga racemosa (climadinone) extract, which is a very powerful vegetative corrector due to its serotonergic effect.
Insulin resistance leads to the growth of brown (visceral) fat. It is very toxic, as it produces a lot of interleukins and cytokines, which provoke the development of age-associated diseases, chronic inflammation and cell hypoxia. However, the growth of visceral fat is the body's protective response to a sustained increase in insulin levels. The values of functional hyperinsulinism can reach 200-300 µU/ml. Normally, the value should not exceed 20 µU/ml.
However, the anti-aging system allows you to eliminate these problems. Moreover, thanks to modern technologies, type II diabetes mellitus is completely cured.
MENOPAUSE FROM AN ANTI-AGING PERSPECTIVE
The menopausal period is characterized only by a certain decrease in the level of sex hormones, during which menstruation and ovulation are impossible, but not by their complete disappearance. However, insulin resistance, and therefore resistance to sex hormones, can also provoke early menopause, which is now becoming more and more common. Also, insulin resistance simultaneously creates a state of increased levels of prolactin, which is responsible for the health of the mammary glands. Retromammary fiber of the mammary glands is similar in composition to brown visceral fat. That is why today a clear connection has been proven between obesity - insulin resistance - hyperprolactinemia - mastopathy - breast cancer. For effective prevention of breast cancer, which is the leader in cancer morbidity and mortality, reducing insulin resistance and using Vitex Agnus Castus extract preparations (mastodinone, cyclodinone) to normalize prolactin levels are of great importance.
In addition to nutritional correction, anti-aging also includes physical activity. Muscle tissue is capable of regeneration at any age. It produces testosterone, which is necessary to combat insulin resistance, as well as powerful cytokines that act as a counterbalance to insulin growth factor. The anti-aging program also includes the fight against obesity.
To obtain a physiologically stable result, the most effective is the combined use of sibutramine and metformin (reduxinmet). The first component allows you to adjust your appetite, and the second component relieves insulin resistance. This year, the Ministry of Health of the Russian Federation officially registered the use of metformin for impaired glucose tolerance; previously the drug was prescribed only for the treatment of diabetes. Now reduxinmet is the only proven drug, the use of which is recommended for the treatment of obesity, even against the background of type II diabetes and dyslipidemia. But therapy to eliminate visceral obesity will be effective only if eating behavior is corrected and physical activity is available. It should also be noted that the use of reduxinmet helps the patient not only evaluate
the degree of your “food addiction”, but also to find new ways of getting energy for the full functioning of mitochondria. The following factors will help eliminate mitochondrial deficiency: spiritual growth, development, contemplation of beauty, love, communication with the opposite sex, family, nature, socialization, positive emotions.
IMPORTANCE OF DEHYDROEPIANDROSTERONE (DHA)
In older patients, secondary aldosteronism often develops with characteristic pastosity and swelling, combined with the formation of hypogonadism.
DGA allows you to avoid such manifestations. This hormone is synthesized in the body: 80% in the adrenal glands, 20% in the brain. Any stress that ends in success raises DHA levels. The catalyst for the natural production of DHA is not only physical, but also brain activity - learning foreign languages, problem solving, creativity.
In synthetic foreign dietary supplements, DHA performs its functions only during the period of their direct use. But any synthetic drug has a natural analogue. In Russia, such analogues are pantobiol 1 and pantobiol 2 (biolite, Tomsk), which are produced from the horns of the Altai deer. The use of both potentiates the synthesis of its own DHA. Moreover, the effect persists for another 3 months after the end of taking the drugs.
Anti-aging involves minimizing the drug load against the background of a normalized carbohydrate metabolism, leaving only the necessary drugs for MHT, the "gold standard" of menopausal hormone therapy and the correction of hypogonadism at any age is the drug femoston. It is the only drug that eliminates dyslipidemia by lowering levels of total cholesterol and low density lipoproteins and increasing high density lipoproteins (precursors of its own steroid hormones). Molecular biologists believe that when working with mitochondrial deficiency and stopping insulin resistance, it will be enough to use a preparation of sex hormones in a homeopathic dose. This is exactly the drug that was recently registered in Russia, and it is Femoston-mini.
In the age management system, a special role is assigned to cellular technologies (plasmolifting, placentotherapy). It is in the blood that cytokines circulate, the use of which makes it possible to obtain the necessary growth factors and activate the immunological links in the regulation of aging. Activation of platelets in the bloodstream produces the effect of cell regeneration, including stem cells. This is also facilitated by dynamic loads, massages, kinesiotherapy (S.M. Bubnovsky method).
Plasmolifting in gynecology is actively used in atrophic, inflammatory and involutive processes and in aesthetic medicine. Good results are shown by the use of the placenta extract drug melsmon, which in Japan and South Korea is used free of charge at the expense of medical insurance for the prevention of age-related conditions and diseases.
START WITH GYNECOLOGY AND ENDOCRINOLOGY
An anti-aging program for women should be started by eliminating gynecological and endocrine problems. Strengthening the pelvic floor muscles with the help of modern technologies allows you to achieve a positive effect. Plasmolifting and thread lifting of the perineum can eliminate urinary incontinence, progression of genital prolapse and atrophic manifestations. An undoubted advantage is the possibility of using these and other technologies in the early stages.
To summarize, we can say that anti-aging is programming the body to change its way of thinking and focus on healing. It is important to note that the age management system should be acceptable to the whole family, and the gynecologist should work in tandem with an andrologist. Under this condition, the married couple will receive the desired effect.
We must remember that the proposed modern advances in medicine and pharmacology in the anti-aging system constitute only a 10% guarantee of success. The remaining 90% is the decision of the patient himself to take a firm course towards health and longevity.
