Background. Cerebral palsy (CP), which is the most commonly encountered neuromuscular disorder of childhood, causes permanent physical deficits and sometimes intellectual deficits. Despite advances in the diagnosis and treatment of CP, the incidence of that disorder has not declined; it parallels the increased survival rates of premature infants. The children with CP may not have trunk control because they have spasticity and weakness in their trunk control. Goal. This study aimed to investigate the efficiency of functional electrical stimulation (FES) application on the abdomen-posterior back muscles in children with Cerebral palsy (CP). Materials and Methods. However 40 children with spastic CP, being treated in physical therapy, were selected by the way of random-sampling in the study, some of children were excluded by exclusion criteria and then 30 children have completed the study. The participants were randomly divided into two groups FES (n=15) and control groups (n=15). The control group received physical therapy 3 days a week in 45 minute for 6 weeks. The children in the FES group received physical therapy in addition to function electrical stimulation. FES was applied 5 days a week for 6 weeks to abdomen-posterior back muscles in 30 minute-long sessions. To evaluate the score of gross motor function measurement (GMFM) and to evaluate the trunk asymmetry in sitting, radiographic measurements were used. Result. The comparisons of the measurements of the two groups before and after the treatment showed that the GMFM standing score were statistical significantly (p<0.001) increased, and Cobb angles were decreased both groups, but the decrease in the control group was not statistically significant (p=0.128), and FES group was statistically significant (p=0.033). The comparison between groups GMFM standing score increased higher in the FES group than in the control group. Cobb angles after the treatment were statistically significant higher in the FES group than in the control group. Conclusion: To improve gross motor developing for children with CP, FES applied on abdomenposterior back muscles along with physical therapy is more effective than physical therapy alone.

BACKGROUND The role of epacl, an exchange protein activated by cAMP. in melanoma migration is largely unknown. Heparan sulfate (HS), a major ECM, and syndecan2, a HS-binding protein on the cell surface, play important roles in regulating such migration. Synde- can2, when activated, translocates to lipid-rich plasma microdomains, known as lipid rafts. We thus examined the role of epacl in HS production and syndecan2 transloca¬tion in melanoma migration. METHODS SK-MF.L-2, a human melanoma cell line, and migration assays with Boyden cham¬bers were employed. RESULTS Activation of Epacl adenoviral Epacl overexprcssiotl or HpMeOPT, at) Epac-specif- ic cAMP analog, significantly increased cell migration in a time- and dose-dependent manner. Epacl also increased HS production by 2-fold, and the removal of HS abol¬ished Epacl-induced migration. Epacl also increased expression of N-deacetylase/N- sulfotransferase-1 (NDST-1), a key synthetic enzyme for HS. Sucrose gradient frac¬tionation showed that Epacl increased syndecan2 translocation to rafts. In addition, disruption of rafts with lipid depletion abolished Epacl-induced migration. SUMMARY Epacl increased migration in malignant melanoma through HS production and syn- decan2 translocation to rafts.

Objectives: We aim to determine rehabilitation physicians’ attitudes toward and awareness of evidence-based medicine (EBM), level of knowledge and its usage, and barriers to implement it. Design: Cross-sectional survey from a questionnaire distributed in 2010. Setting: The rehabilitation physicians that participated in nation-wide rehabilitation congress in Mongolia. Participants: 58 rehabilitation physicians who responded to a questionnaire (77.3% response rate). Main outcome measures: Rehabilitation physicians’ attitudes toward EBM, level of knowledge and understanding of related technical terms of EBM, clinical use of EBM, level of awareness of and access to EBM literature and databases, and barriers to implementing EBM. Results: Most of the respondents had a positive attitude toward EBM; 91.4% agreed that the use of evidence in practice was necessary; 87.9% agreed that EBM improved patient care; 94.7% were interested in improving the skills necessary to implement EBM. Respondents had a low level knowledge of EBM. Only 39% of the respondents had been trained in EBM, and reported a low level of awareness of some of the technical terms. The practice of evidence-based medicine by a rehabilitation physician was insufficient. Most respondents obtained information of evidence that was necessary for practice from a textbook. Higher than half of the respondents stated they read fewer than 2 articles in a typical month. The primary barrier to implementing EBM was lack of research skills. Conclusion: The respondents had a positive attitude towards EBM and were interested in improving the skills necessary to implement EBM. In the future, the importance of EBM and medical statistics in undergraduate education is suggested. In addition, measures for EBM skill improvement among rehabilitation physicians is of urgent necessity.

BACKGROUNDThe role of epacl, an exchange protein activated by cAMP. in melanoma migration is largely unknown. Heparan sulfate (HS), a major ECM, and syndecan2, a HS-binding protein on the cell surface, play important roles in regulating such migration. Synde- can2, when activated, translocates to lipid-rich plasma microdomains, known as lipid rafts. We thus examined the role of epacl in HS production and syndecan2 transloca¬tion in melanoma migration. METHODSSK-MF.L-2, a human melanoma cell line, and migration assays with Boyden cham¬bers were employed.RESULTSActivation of Epacl adenoviral Epacl overexprcssiotl or HpMeOPT, at) Epac-specif- ic cAMP analog, significantly increased cell migration in a time- and dose-dependent manner. Epacl also increased HS production by 2-fold, and the removal of HS abol¬ished Epacl-induced migration. Epacl also increased expression of N-deacetylase/N- sulfotransferase-1 (NDST-1), a key synthetic enzyme for HS. Sucrose gradient frac¬tionation showed that Epacl increased syndecan2 translocation to rafts. In addition, disruption of rafts with lipid depletion abolished Epacl-induced migration.SUMMARYEpacl increased migration in malignant melanoma through HS production and syn- decan2 translocation to rafts.

Regardless the possession of any graduation and qualifications anywhere in order to train the doctors and medical professionals with the capabilities to work in any places there are the needs of the knowledgeable mentors to teach their knowledge, abilities and trends to the students in national, regional and international levels. This survey was started to determine the needs of the skills development of the mentors of the Mongolian National University of Medical Sciences under the mission to make it as one of the best 100 medical universities in the Asia-Pacific region and in order to create the favorable environment to accelerate the development of the university and creating a team consists from qualified mentors and researchers by improving the trainings, researches and clinical favorable environment including the quality improvement of the activities.The total of 333 mentors from the 5 structures and 3 branches of the Mongolian National University of Medical Sciences were surveyed to be developed by the University of Michigan including the use of the widely used questionnaires in the universities consisting from 7 groups and 81 questions to determine the needs of the mentors.The working range of the best medical mentors including their needs of the skills was studied. The 55.7% (50.4-61.0%) of the mentors included in the survey were told that the facilitation of the learning needed, 82.4% (78.3-86.5%) as the role models needed, 79.9% (75.6-84.2%) as the provision of the information is needed, 76.3% (71.7-80.9%) as 82.8% (78.8-86.9%) as the planning needed and 81.0% (76.8-85.2%) as the assessment of the training is needed.There is a need to develop the skills related to the 6 frameworks as the learning facilitation for the mentors, role model providers, information providers, resource developers, planners and assessors.

Background:After the transition from socialism to a market economy in 1990, human brucellosis re-emerged in Mongolia. The aim of our study was to estimate a representative seroprevalence of Brucella spp. and to determine risk factors for brucellosis seropositivity among rural people. Methods:A cross-sectional study with multistage random selection was conducted in eight provinces of Mongolia. Study participants were interviewed using a questionnaire to obtain their brucellosis history, current symptoms and likely risk factors. Blood samples were drawn to determine brucellosis seroprevalence.Results:A total of 2856 randomly selected rural people aged four to 90 years were enrolled in the study. The seroprevalence of Brucella spp. was 11.1% (95% confidence interval [CI]: 10.0–12.1), ranging between 2.3% and 22.6% in the eight provinces; 39.2% ( n = 609) of nomadic camps had at least one seropositive participant. Risk factors associated with brucellosis seropositivity were being older than 45 years (adjusted odds ratio [AOR] = 6.9, 95% CI = 5.1–8.7) and being a veterinarian (AOR = 2.8, 95% CI = 1.5–5.0). Conclusion:Our study confirms that human brucellosis seroprevalence among rural people in Mongolia is high. Human brucellosis can be effectively controlled if high-coverage livestock mass vaccination is implemented with a coverage survey after the vaccinations to ensure completeness. This mass vaccination should be accompanied by public awareness and educational programmes.

Purpose. Differences in language and literacy impede our understanding of the impact of disability around the world. Since function is primarily action, the computer-animated Language Independent Functional Evaluation (L.I.F.E.) might bypass the use of written or verbal scales. This study validates L.I.F.E. in a developing world population. Methods. Families were randomly chosen from the city centre, suburban ‘ger’ districts and countryside of Arvaikheer, Mongolia. The L.I.F.E. and cross-translated Mongolian Barthel Index were administered in random order. Demographics including subjective observation of disability were gathered. L.I.F.E. scores were converted to Barthel equivalents. Results. One hundred sixty eight persons completed the test. Persons with observed disability had lower L.I.F.E. scores (64.55 vs. 94.53, p<0.001). L.I.F.E. and Barthel scores related well. (Spearman’s rho=0.757, p<0.001; for persons with observed disability Pearson r=0.820, p<0.001). Individual functions all had high interclass correlations (40.75), except bowel and bladder, which had moderate correlations. Qualitative inquiry found the L.I.F.E. was preferred over the Barthel. Conclusions. Using L.I.F.E., function can be measured without language or literacy. L.I.F.E. expands our ability to measure and compare the prevalence of disability and the impact of rehabilitation across regions perhaps leading to more rational allocation of resources.

Purpose: Due to the shortage in the healthcare workforce, insufficient qualifications, a lack of infrastructure and limited resources in Mongolia, it is not always possible for healthcare workers in rural areas who wish to attend continuous training and retraining courses to do so. However, in order to provide high-quality care, the demand for distance learning and the upgrading of knowledge and practice of many medical topics (especially related to morbidity and mortality) are necessary for the rural population. This study aimed to assess the needs of e-learning medical education, of graduates in Mongolia. Methods: A cross-sectional research design was implemented. We collected data from 1,221 healthcare professionals (nursing professionals, physicians, midwives, and feldshers) who were randomly selected from 69 government hospitals in Mongolia. Data were collected using self-assessment questionnaires which captured the needs assessment in a survey for online continuous medical education in Mongolia. Data were analyzed using descriptive statistics and Kruskal-Wallis statistical test. Results: Ninety percent of the respondents reported that they plan on attending online continuous medical education with the most preferred specialty area being emergency medicine. Results using the Kruskal-Wallis statistical technique suggested the preferred specialty area, educational content, appropriate time schedule, available devices, and tools were statistically significant and were different between the nursing professionals, physicians, midwives, and feldshers (p<0.05). Conclusion Findings provide important evidence for the implementation of measures and strategies which can assist healthcare professionals in low and middle-income areas/countries to constructively address their need for enhanced knowledge and practice through distance learning.

Abstract Bloodletting is a medical tradition that probably began in prehistoric times. Its rationale was based on the belief that removing blood eliminated “impure blood”. From antiquity until the beginning of the 20th century, bloodletting was considered a panacea, and it was the most common and versatile form of medical treatment. Not only was it believed to cure the sick, but also to promote vigor in the healthy. Some of the antient books of traditional medicine noted that the bloodletting tools is very importance when opening a vessel in order to bleed. Traditional medical bloodletting tools are one of the oldest archeological findings, and researchers have found many types of bloodletting tools in our country dated back thousands of years. Therefore, research on bloodletting tools an important component of bloodletting therapy, is of theoretical and practical importance. The location, indications, and tools of bloodletting therapy and bloodletting vessels are described in detail in the “Subsequent Tantra” of “Four Medical Tantras”, and its commentaries: Dar mo sman rams pa blo bzang chos grags “Dka’ phreng mun sel sgron”, Sde srid sangs rgyas rgya mtsho “Be edurya sngon po” and Luvsanchoinpil “Gces btus snying nor” so on. The first Mongolian surgical work is directly related to the historical tradition of bloodletting therapy. It is now known that the stone needles, which was discovered in the 3000th millennium BCE, may have originated from the Mongolia used to use in medicine as bloodletting tools. In the seventeenth and nineteenth centuries, Mongolian medical bloodletting tools were passed down through India and Tibet medical books, and later the science of surgery and bloodletting therapy became more sophisticated and comprehensive knowledge. At the same time, it is clear that there is every reason to say that it has been enriched by the medical knowledge of the neighboring countries and improved by their own experience.

Background: In worldwide, 16.9 million cases of stroke were reported in 2010. It has increased by 68% since 1990. In 2016, there were 5.5 million deaths attributable to cerebrovascular disease worldwide (2.7 million deaths from ischemic stroke and 2.8 million deaths from hemorrhagic stroke). Furthermore, dysphagia is one of the most common complication and occurs 35-78% of patients with stroke. Specifically, dysphagia occurs in 51-100% of the brain stem stroke patients. Moreover, it could be the independent factor to predict mortality. In other words, it directly impacts the quality of life and decreases social activity.
Incidence of cardiovascular disease and stroke have been increasing related to instability of economy, urbanization, bad lifestyle and stress. As a result of that, dysphagia has increased as well and is becoming one of the pressing issue of health care. It results malnutrition and prolonged the hospital stays. Unfortunately, its diagnosis and treatment are still not clearly defined yet.
Many researchers have investigated patients’ treatment outcome using a single treatment. In other word, researchers have studied the comparison of the separate results of electric stimulation and traditional swallowing therapies. In this study, we studied the results of combination therapy of traditional swallowing and muscle stimulation, and we aimed to identify the benefits of the combined therapeutic approach and to propose the effective, non-invasive methods for patients. Objective: We aimed to study treatment outcome and quality of life among stroke patients with dysphagia. Material and Methods: The study was conducted on a hospital-based, cross-sectional method. Study participants were obtained from Affiliated Hospital of Inner Mongolian University for the Nationalities between July 2018 and March 2019. All patients were divided into the three treatment groups. 150 dysphagic patients were evaluated by Swallowing Related Quality of Life (SWL-QOL) Scale before and after the treatment. Results: In total, 150 participants (mean age=59.70±9.55 years) aged between 34-77 were obtained in this study. There were no statistically significant differences between the three groups in age (p=0.609).The data showed statistically significant positive treatment effect for all three groups (p=0.0001).The SWAL-QOL score was 39.25±3.50 in A group, 39.10±3.54 in B group, 42.12±4.55 in C group after the treatment. The SWAL-QOL score shows statistically significant difference, after the treatment (p=0.0001). Conclusions Rehabilitation treatment combined with neuromuscular electrical simulation appears better outcome than nerve or muscular stimulation combined with rehabilitation among stroke patients with dysphagia.