Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.

Aim and objective of the study. Aim of the study is to study artery disease of lower extremities by dopplerograph method. - To study dopplerograph symptom of artery disease of lower extremities. - To study dependence of age, sex and which vessel is at risk Material and Methods. We involved 61 cases which were done dopplerograph analyse because of artery disease of lower extremities at the centre of BestEMA from 2006 to January 2008 dopplerograph analyse was done by using Angiodin apparatus and by standard method divided them into 6 groups by 10 ages and studied by male and female. Results and Discussion. From 100 cases which the disease revealed in 37 artery blockade, in 27 artery stenosis in 36 hemodynamic changes revealed. In order to put differential diagnose of artery blockade and artery stenosis we defined LPI in all persons. In the period of artery blockade and artery stenosis of lower extremities form of artery stream is changed LPI is decreased below 1 depending on disease. These symptoms were common. By our study 40.9% of people with artery disease of lower extremities smoked more than 20 years and 27.3% had hyperglycemia more than 10 years. Result of our study suits to the study of A.G. Evdoximov (1999), V.G. Leluk (2003), Volmar (1996). Conclusion: 1. In 75.4% of people who were done dopplerograph analyse artery disease of lower extremities, artery blockade of lower extremities revealed in 45 stenosis in 37 and hemodynamic change in 42. 2. In the period of artery blockade and artery stenosis of lower extremities from of artery stream changes and decreases below LPI, These symptoms mostly revealed. 3. Artery blockade and artery stenosis are mostly occur in the hip and on males.

Disease of venous of the lower limb has been studied since the period of ancient Hippocrat, Glan and Avitsen and it occurred among the people not a few. Among the disease of venous of the lower limb, disease of venous dilatation occurs mostly (Savliev., B.S, 1999, Morosov, V, Savranski 2000). By recent study about 20% of population where industry developed highly, are affected by disease of venous. It occurs mostly among the people aged 25-55. In medical practice of our country since 1996, diagnosing method of dopplerography has been introduced and began to diagnose venous disease of lower limb in the recent years numbers of people involved in analyze because of acute and chronic insuffi ciency increased year by year. In up-todate phlebolog practice method of ultra sound diagnosing which is harmless to vascular and doesnt hurt is widely used and new methods have been introduced. Aim and Objectives. In order to realize aim of studying and diagnosing venous disease of the lower limb by the method of dopplerography, well solve the following objectives; -to study form and location of venous of the lower limb, to study dependence of age and sex of venous disease of the lower limb, to study symptom of dopplerography in the process of venous disease of the lower limb. Material and Methods. The study was done on the base of 120 patients material that was done dopplerography in the centre Best Ema of private structure in 2007-2008. We used dopplerographic apparatus such as: sonomed 325 and Angiodin. Conclusion 1. Venous disease of the lower limb revealed in 85% of people involved in the analyse. 2. 88.3% of people with venous disease of the lower limb were women aged 31-60. 3. In dopplerography in 37% - symptom of change of venous stream form and the breath is not coordinated, symptom of stream negative in the deep leg vascular after the test -89.4%., in superfi cial venous -10.6%.

Introduction: Cardiovascular diseases are one of the leading causes of mortality and morbidity in Mongolia during last 10 years. Accordingly, increasing number of the procedures cardiac open heart surgeries in Mongolia.The aim is to evaluate of the scientific literature related toestimation of expenditure for open heart surgeries.Method: The literature search strategies were developed to identify published studies. The following literature databases were searched and collected individually: MEDLINE PubMed, Google and abstract books in Mongolian libraries.Result: Analyzed the 28 published literatures which made in estimation of expenditures for open heart surgery. The most of the study were generally focused on the expenses of diagnosis and treatments of open heart surgery. Literature showed that for patients not covered by health insurance, valve replacement surgery typically costs from about $80,000 -$200,000 or more with an average, according to an American Heart Association report, of $164,238, not including the doctor fee. A surgeon fee can add $5,000 or more to the final bill. For example, Dartmouth-Hitchcock Medical Center in New Hampshire charges about $86,500, including doctor fee, after a 30% uninsured discount. St. Mary’s Hospital in Wisconsin charges an average of $107,000, but costs can reach $200,000 or more. AndBaptist Memorial Health Care charges about $75,000 -$140,000, not including doctor fee, but cost can go up to more than $200,000 with major complications. In Russia, total 700,000 people take surgery on annual average each year and on which they spend 10 902 500 000$ annually, it has been stated on Bokeriya.L found that 464 637.840 ruble annually on cardiac surgery coronary angioplasty surgery, 792 237 ruble on coronary heart disease surgery and 9 522 ruble on congenital heart defect repairment surgery. Up to per 15 years old children, 24 288 ruble spend on average. Bokeria et all reported that, expenses of medicine through ABC/VEN analysis, 47 types of medicines of A group(13.1% of total medicines) takes 79.62% of total expenses, 71 types of medicines of B group(19.8% of total medicines) takes 15.36% of total expenses, 242 types of medicines of C group(67.1% of total medicines) takes 5.02% of total expenses. Out of this report, N group’s portion of A group medicines takes 0.79% by VENanalysis. Approximate, all inclusive cost for open heart bypass surgery (CABG ) vary between USD 5500 - USD 7800, depending on the facility & city you chose to get the procedure done in India. D.Tsegeenjav and D.Bat-Undral reported the expenses on open heart surgery in Mongolia, as a result showed that health insurance spend 56 422 656 ₮ (appx 39,100,093$) for 156 numbers of procedures. But real cost expenditure was 440 300 000.00₮. It means health insurance spent 12.6% of total expenditure for procedures. Also health insurance expenditure for CABG and one valve replacement per patient were same as 643 272.00₮, but real expenditures for CABG was 2 000 000.00₮, and for one valve replacement surgery per patient was 5 000 000.00 ₮.Conclution: The scientific literatures showed that many studies related in estimation of expenditure for open heart surgery made in international countries such as Russia, USA, UK and India et all. But we didn’t found the study for estimation of expenditures for open heart surgery by using ABC/VEN analysis in Mongolia.References:1. Health indicators of Mongolia 2002-2012. Report of the state implementing agency.2. Цэгээнжав д, Бат-ундрал д. зүрхний нээлттэй мэс заслûн эмчилгээний зардлûн асуудалд, “авьяслаг шастинчууд 2013” эрдэм шинжилгээний хурлûн эмхэтгэл, х3-4Бокерия л. а.самородская и. в.ßрустовский и др., Oпыт применения авс- и ven-анализа в сердечно- сосудистой хирургии фгбу. Бюллетень нЦссх им. а.н. Бакулева рамн, 2012, ¹1, стр http://lekarius. ru/external/paper/26143. The European health report 2009: health and health system. WHO Library Cataloguing in Publication Data.4. Shear A, Scuffham P, Mollon P. The cost of coronary artery disease in the UK. Br. J. Cardiol. 2004. Vol. 11. P 218-223.5. Htt://health.costhelper.com/valve-replacement.html Heart valve replacement costKey words : Open heart surgery, expenditure

Background: According to the International Labor Organization (ILO), 2.78 million workers are injured and killed each year as a result of occupational diseases, while 374 million are injured. Furthermore, work-related injuries cost the global economy 4% of its GDP. Construction workers are more likely than other workers to die and twice as likely to be injured. Construction accidents are frequently caused by a lack of knowledge and training, negligence, and inadequate safety equipment. Workers account for 70% of the factors influencing accidents, 49% of workplace problems, 56% of equipment shortages, 27% of material conditions, and 84% of risk management. Between 2009 and 2017, 3321 industrial accidents and acute poisoning cases were reported in Mongolia. 509 people died as a result of industrial accidents, 761 people became disabled as a result of injuries, and 2051 people temporarily lost their ability to work. As a result, determining the distribution, causes, and factors of accidents is reasonable. Purpose: To detect the prevalence and influencing factors of accidents in the construction industry in the last 5 years. Material and Method: Secondary data was collected using a quantitative research method based on a single-moment model of observational research from the "General Directorate of Professional Supervision" quantitative data on industrial accidents and acute poisoning by sampling 10 groups and 59 indicators of accident cases in the construction industry. Result: The prevalence of accidents in the construction industry was calculated for 1000 workers in Ulaanbaatar's 21 provinces and 9 districts using the ARC GS program. For the calculation of influencing factors and injury causes at www.graphpad.com, P values less than 0.05 was considered significant.
Between 2017 and 2021, 134 accidents and injuries were reported in Mongolia's construction industry. All accidents were male in 123 cases (92%), and female in 11 cases (8%).
Accidents and injuries in the construction industry are distributed. In Mongolia, Ulaanbaatar had 66 cases, Umnugovi had 10, Orkhon had 10, and Khovd province had 12, all of which had more accidents than other provinces. Calculating the distribution per 1000 workers, Sukhbaatar has 20, Dornogovi has 15, Umnugovi has 12, and Khovd has 10.9.
The most important factors influencing construction accidents are the workplace environment and human factors. In terms of accident causes, falling, tripping, or slipping caused 55 or 41% of all accidents, falling objects caused 24 or 18%, being trapped by objects caused 19 or 14%, and 20 or 15% were remaining causes of injuries. In the last 5 years, 47 or 35.07% of all accidents were caused by workplace environment, 45 or 33.5% by human factors, 23 or 17.1% by management system, and 19 or 14.1% by technical and technological factors. Conclusions
1. In the last five years, the prevalence of accidents among construction workers is 16.3 per 1000. The prevalence is 42.9% (66) highest in Ulaanbaatar City, 20.1% (27) in Khan-Uul district, and 8.9% (12) in Khovd province. The prevalence per 1000 workers is 20 in Sukhbaatar, 15.7 in Dornogovi, 12 in Umnugovi, and 10.9 in Khovd, with a high prevalence of 1.07 in Ulaanbaatar.
2. Human factors, such as falling from a height due to noncompliance with safety rules, limited space in the workplace and environment, and falling into pits, wells, ditches, and excavated pits, are the leading causes of injuries and accidents. Closed fractures and head injuries are the most common.

BACKGROUND: Acute myocardial infarction is leading cause of global morbidity and mortality and major health care burden in worldwide. Previous studies demonstrated that restoration of myocardial tissue perfusion after primary PCI is significant factor of improved outcome. In Mongolia, studying long term effects of primary PCI in patients with AMI and its’ association with coronary blood flow, tissue Doppler imaging, left ventricular global strain pattern in speckle-tracking echocardiography and risk factors are essential in theoretical and clinical practice. AIMS: To determine long term effects of primary PCI in patients with AMI and its’ association with left ventricular strain pattern in speckle-tracking echocardiography, risk factors and patient prognosis. METHODS: We used prospective cohort study design. We were selected 414 patients with AMI who treated by primary PCI between 2015 and 2016 at the State Third Central Hospital. Echocardiographic examination was conducted on Philips iE33 xMATRIX ultrasound machine. The PCI was performed according to the MNS:6379-2013 standard. RESULTS: Mean age was 60±13 and majority of them were male 84% (n=347). Complete coronary perfusion (TIMI-3) was achieved in patients 88% (n=367) after primary PCI. There was weak, negative correlation between coronary TIMI flow grade and left ventricular global longitudinal strain (r=-0.183, CI 95% -0.289 to-0.066, p<0.001). In patients with incomplete coronary perfusion (TIMI<3), mortality rate was significantly higher during 24 months follow-up. After primary PCI, 24 months mortality was 9.9% (n=39). Cut-off value of left ventricular global longitudinal strain which predict long term (within 24 month follow-up) mortality was -12.93% (sensitivity 74.4%, specificity 74.3%). Mortality during 24 months follow-up was significantly different between left ventricular global longitudinal strain groups (log-rank test p<0.001) and mortality was higher in left ventricular global longitudinal strain ≥ -12.93% group. CONCLUSION: Coronary no-reflow phenomenon is associated with long term mortality in patients with AMI. In patients with AMI who treated by PCI, long term mortality is predictable with left ventricular global longitudinal (≥-12.93%, p<0.001) strain.

Aim and objective of studyTo study possibility of detecting Arteria carotis communis disease by dopplerosonography.Objectives:- To study dopplerography symptom which reveals in the period of Arteria carotis communis disease?- To study dependence of age, sex and artery pressure.Materials and Methods. Study was done on 100 patients who were analysed by dopplerosonograph at the centre of cerebrovessel diagnose BestEMA in 2006-2007. Study was done by using Angiodin ultrasonic dopplerosonograph apparatus and by standard method.Results: On 33 patients who were involved in the study functional defi ciency of Arteria carotis communis was revealed. Functional deficiency of carotis artery of one side was revealed on 12 patients, functional defi ciency of carotis artery of 2 sides on 21 patients, on 7 people had defi ciency of carotis artery hemodynamic over 30% and on 12 more than 50%. 84, 8% of people with functional defi ciency of general artery of carotis have hypertension at some extent. For age there were 19 males-32-77 aged and 14 females. There is Tendency of increasing defi ciency of Arteria carotis communis of 2 sides when the people become older. By dopplerosonograph analyse, when defi ciency of Arteria carotis communis increases speed of blood stream decreases, survey changes, becoming without window, sound /noise/ of stream changes and peripheral resistance increases. Such symptoms are mostly revealed.Conclusion:1. By dopplerosonograph analyse on 33% defi ciency because of Arteria carotis communis sclerosis was revealed.2. 90% of functional defi ciency of Arteria carotis communis occurs on people who are more than 40 years old.3. In the period of general artery scleroses of carotis speed of artery stream decreases survey and noise are changed, peripheral resistance increases. These symptoms are revealed.4. 84.8% of people, on whom carotis artery defi ciency was revealed, hypertension increases at some extent.

Background. Nowadays more attention is paid to the study of blood supply of the brain in during headache with various causes. Blood supply of the branch is supplied by 2 pairs of carotis and vertebral artery and 2/3 of it in the carotis and 1/3 of it by the vertebral artery. (Farekas et al., 1963) disease with various causes of the vertebral artery in the external part of the cranium or abnormal system have been studied from ancient un the external part of the cranium, lengthening, aplasia and hypoplasia, change of neck vertebra disk affect to dynamic change of back artery blood supply. By scholar maisel fold of vertebral artery is 40%. Stenoses-18%, hypoplasia-10% vertebral artery through c 3-c5 vertebra occurred 12-20%., abnormal system of vertebral artery and location occur more than carotis artery and it has more dependence on external part of the cranium. Study of disease of vertebral artery in the external part of the cranium by the method of angiography hasnt been done in our country. Aim of research work: We aimed at diagnosing disease of vertebral artery in the external part by the method of angiography and studying its form, case, age and sex dependence. Conclusion: 1. Change of vertebral artery revealed 62.3% 2. Fold of vertebral artery in the 6th level 42% in v2, 3 level -9% revealed. 3. Vertebral artery is congenitally narrow (aplasia, hypoplasia)12%., through v3-5, vertebra-13%. 4. 58% of the people with vertebral artery disease occupy females.

Background. In the process of infarction, important mechanism of blood supply deficiency is collateral blood supply. There are a lot of various collaterals which are able to supply in the period of necessity of human brain. Collateral which forms in the level of villas circle (ring) in the cranium is the most important front and back artery cord of brain form villas circle (ligament) as a result of these arteries possibility of forming collateral blood supply in the period of blood insufficiency in vertebral and carotis and between magisterial artery of 2 sides of brain opens. It is rare when the system of villas circle (ring) is complete (full), artery cord is narrow (hypoplasia, aplasia) or none, villas circle(ring) loses its complete and it becomes open on the front and at the back part. By the researchers study hypoplasia of artery cord occurs in 20-40% because it branches off from other artery. By Yu.M. Nixitins study vertebral artery of the brain branches off the form the artery into carotis and it open at back part-was 25%, study of system of villas circle (ring) by angiography hasnt been done. Aim. We aimed at the diagnosing villas circle system by angiographic method and studying its incompleteness, form cause, age and sex dependence. Materials and Methods. We studied material of 595 patients who were done angiography of the brain because of acute and chronic deficiency of blood supply of the brain in 2007-2008 at the third clinical hospital by P.N.Shastin in the cabinet of angiography came from clinic, district and Achtan Elit hospital. We clarified magisterial arteries and villas circles in the cranium by the standard method in 2 sides used polydiagnostic 2 digital subtraction equipment of Philips form of Japan. We evaluated artery system, location, form and size and studied age and sex dependence.75% of verographer solution not more than 80-100ml was injected into the artery. Conclusion: 1. Incompleteness of circle revealed in 31.7 % 2. Open case of villas circle in the front part was in 41.5 % 3. Open case of villas circle at the back revealed in 58.4% 4. Studying villas circle, evaluating collateral blood supply is necessary to blood supply deficiency in particular to define blood deficiency insult.

Background. Disease of vertebralis and insufficiency of blood supply occur not a few, it decreases lab our ability much, complaints such as: headache, to feel giddy, to blur eyes, fatigue heartache, neck becomes stiff and unbalance reveal. By some researches study 25-30% of blood supply insufficiency of cranium occupies artery disease 65% of vertebral artery insufficiency occupies disease of external part of cranium we have introduced duplex sonography method by using medison Pico-ACE apparatus since 2006 and it gave possibility of revealing artery disease of external cranium. The most causes of artery disease occupy congenital and acquired deficiency such as: aplasia, hypoplasia and vertebra skin. Revealing and diagnosing these disease early is the confronted problem of society and health and it attracts attention of doctors and specialists of angioneurological branch. Aim of research work: We aimed at the study of diagnosing disease of artery of vertebral of external part of cranium by the method of duplex-sonography and studying dependence of type, size, form, case, age and sex. Materials and Methods. We did the study on 100 people who was done duplexsonographic diagnose because of blood supply insufficiency of cranium in the centre of diagnose of private structure Best Ema. We did analyse of DSG by using MedisonPicoACE apparatus by the stand and method, divided them into 6 groups in 10 age and studied type, size, location speed of stream, age and sex. Conclusion: 1. By duplex-sonography, in 18% hypoplasia of vertebral artery revealed, in 88.8% of it hemo-dynastic change revealed. 2. In 24% of patients involved in the study artery fold revealed, in 62.5 hemo-dynastic change revealed. 3. The main method of analyze which reveals location, size and dynamic and diagnosis vertebral artery of external part of cranium is DSG.