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.

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. Low back pain is a frequently encountered symptom. Although 70-80% of the entirepopulation have low back pain complaints in their lives, only 2-4% of them require surgical intervention.’Department of Neurosurgery, Shastin 3rd Central Hospital about 200 patients who undergo back surgery,while 90% of patients who have prolapsed lumbar disc surgery from 2010 to 2012. There are variousstudies indicating that exercise improves pain and disability in chronic low back pain and in those whohave had surgery. The main objectives of the postoperative rehabilitation programmes are to accelerateand maximize function recovery as much as possible, and to prevent further injury by restricting theprogression of degenerative changes. We evaluated the effectiveness of rehabilitation treatments thatare used in our department which is the first time in our country.Goal. To evaluate the effectiveness of rehabilitation after lumbar discectomy.Materials and Method. We examined 83 patients were included the Shastin central hospital, Departmentof neurosurgery and rehabilitation after lumbar discectomy at a single level and operated in the periodfrom May 15, 2013 to September 15, 2014. All patients were evaluated at the beginning and at theend of treatment by Oswestry Disability Index which is a specific functional questionnaire for back pain.Pretreatment values are one month after surgery and posttreatment values three months after surgery.All patients received the intensity specific exercise and back school education programme 3 days aweek for eight weeks.Results. All patients pain intensity are reduced after treatment evaluated by VAS (p<0.000). Functionalability had significantly increased after treatment which is evaluated by Oswestry Disability Index in allpatients (p<0.000). 46 from all patients had minimal disability before treatment and this number wasincreased in to 79 after treatment. The number of moderate and severe disabled patients ability wasincreased after treatment.Conclusion: Back school education and specific exercise programme should be one of the parts oftreatment after lumbar discectomy. After treatment was increased functional ability and early painrelief.

Introduction: Astragalus is the largest member of the Fabaceae family of about 3,000 species on all continents except Australia, and the Astragalus mongholicus Bunge and the Astragalus membranaceus (Fisch.) Bge are studied and widely used. Astragalus contains polysaccharides, saponins, flavonoids, amino acids and trace elements, so it has a variety of pharmacological effects and is active in supporting the immune system and protecting the liver, heart and kidneys. Objectives: A joint research team of the “Tsombo Pharm” Co., LTD and the Drug research Institute is conducting an experiment to produce an injectable solution from Astragalus mongholicus Bunge. The aim is to expand these previous studies to determine the main parameters of the “Монгол хунчир” injection drug technology. Methods: The quality of the injection was assessed by the following parameters. These include: appearance, color of the injection solution, mechanical mixture sensing method, solution filling volume method, solution environment potentiometry method, solution clarity comparison method, insoluble particle size microscopy method, heavy metal mixture atomic absorption spectroscopy method and calicosine-7-o-β-d-glycoside content was determined by HPLC. Results: According to the results of the study, the injectable drug was weak yellow, clear, free of mechanical impurities and heavy metal content, filling 2 ± 0.001 ml, pH 6.5, insoluble particle size greater than 10 μm, 3 particles per 1 ml, small particles larger than 25 μm were present in 1 ml. Calicosin-7-o-β-d-glycosides were identified in the “Монгол хунчир” injection as having the same standard and sample peak times, with the standard substance being detected at 9.003 minutes and the sample solution at 9.016 minutes (Picture 1, 2). In addition, the injection sample contained 0.0477 ± 0.0021 mg / g of calicosin-7-o-β-d-glycoside, and 0.0451-0.0551 mg / g was considered appropriate for further standardization. Conclusions The “Монгол хунчир” injection meets the general requirements for injection in accordance with the Mongolian National Pharmacopeia 2011. This shows that the technological parameters developed by our research team are appropriate.

Introduction: Calycosin-7-O-β-D-glucoside is a glycosyloxyisoflavone that is calycosin substituted by a beta-D-glucopyranosyl residue at position at 7 via a glycosidic linkage. calycosin-7-O-β-D-glucoside, a calycosin derivative compound derived from Astragali Radix, has protective effect against ischemia/ reperfusion injury as well as bacterial endotoxin-induced vascular cell injury. A joint research team of the “Tsombo Pharm” Co., LTD and the Drug research Institute is conducting an experiment to produce a solution of “Astragalus mongholicus” injection prepared by Astragalus mongholicus bunge. Goal : The aim of this study was to develop the validation method of Calycosin-7-O-β-D-glucoside in “Astragalus mongholicus” injection. Material and Methods: As a test sample “Astragalus mongholicus” injection was produced by “Tsombo pharma” Co., LTD. The starndard Calycosin-7-O-β-D-glucoside was supplied from Xilong Scientific Co., Ltd. The reagent were high-performance liquid chromatography (HPLC) grade acetonitrile, formic acid, methanol and purified water. Shimadzu HPLC (CMB-20 A, UV detector Shimadzu SPD-20A was used as the analytical instrument and the analysis conditions were as follows Table 1. Results: The calibration curves for Calycosin-7-O-β-D-glucoside were made by plotting the peak area versus the concentration for each analyte using regression analysis. Each calibration curve was obtained using six levels of concentrations in the range 12.5-100µg/ml. The linear correlation coefficient (R2) for all calibration curves was higher than 0.9981 for all analytes. The limit of detection and limit of quantitation for Calycosin-7-O-β-D-glucoside were in 10.37 µg/ml and 31.45 µg/ml. Accuracy and precision were assessed by analyzing five sets of samples, independently prepared at low (50%) middle (100%) and high (150%) concentrations. The RSD values of both repeatability and intermediate precision were below 0.68% and 0.618% the accuracy remaining between 95.55 to 101.71%. The resulting accuracy data were satisfactory for the quantitative analysis of Calycosin-7-O-β-D-glucoside in “Astragalus mongholicus” injection. Conclusions Finally, this method can be employed conveniently, reliably and successfully for the estimation of Calycosin-7-O-β-D-glucoside for routine quality contral and stability studies in “Astragalus mongholicus” injection.

Introduction: Carthamus tinctorius L. widely accepted as Safflower or false saffron, belongs to the Compositae or Asteraceae family. Hydroxysafflor yellow A is the main active chemical compound present in florets of Carthamus tinctorius L. A joint research team of the “Tsombo Pharm” Co., LTD and the Drug research Institute is conducting an experiment to produce a solution of “Carthamus tinctorius” injection prepared by Carthamus tinctorius L. Goal : The aim of this study was to develop the validation method of hydroxysafflor yellow A in “Carthamus tinctorius” injection. Material and Methods : As a test sample “Carthamus tinctorius” injection was produced by “Tsombo pharma” Co., LTD. The standard Hydroxysafflor yellow A was supplied from Sigma-Aldrich Co., Ltd. The reagent were high-performance liquid chromatography grade acetonitrile, phosphoric acid, methanol and purified water.
Shimadzu HPLC (CMB-20 A, UV detector Shimadzu SPD-20A was used as the analytical instrument and the analysis conditions were as follows Table 1. Results: A Shimpack С18 column was used with methanol:acetonitrile:0.7% phosphoric acid as the mobile phase under the condition of gradient elution. The hydroxysafflor yellow A were analyzed by using a timed wavelength measure according to their maximum absorption wavelength. Accuracy and precision were assessed by analyzing five sets of samples, independently prepared at low (50%) middle (100%) and high (150%) concentrations. The intraday and interday precisions of the investigated compound were less than 1.59 % and the average recoveries ranged from 81.9% to 101.5%.
There were good linear correlations between the concentrations of the hydroxysafflor yellow A and its chromatographic peak areas (R2 = 0.998), the proposed method was successfully applied to determine the hydroxysafflor yellow A in “Carthamus tinctorius” injection. Conclusions The results indicated that the proposed method is simple, stable, and accurate and could be readily utilized as a quality control method for manufacturing process of “Carthamus tinctorius” injection.

Background: The incidence of gastric cancer has been declining worldwide in recent years; on the contrary, it has increased in the last decade in Mongolia. In Mongolia, over 80% of gastric cancer cases are diagnosed in the late stage. We performed a gastroduodenoscopy for screening and histological evaluation to diagnose gastric cancer. These methods are an effective diagnostic modality for gastric diseases; however, invasive and cause discomfort, making it an undesirable procedure for patients. Aims: To determine serum PGs and H.pylori IgG in atrophic gastritis and gastric cancer patients and evaluate the risk by ABC(D) classification. Materials and Methods: We selected 40 atrophic gastritis and 36 newly diagnosed gastric cancer patients from National Cancer Center of Mongolia, before surgery and other therapies. Besides, we enrolled population-based 38 healthy controls. Subjects of three groups were matched by age (±1) and sex. Written informed consents were obtained from all subjects. The fasting blood samples were collected and tested PGI, PGII, and H.Pylori IgG levels by enzyme-linked immunosorbent assay. Also, PGI to PGII ratio (PGI/II ratio) was calculated. We classified subjects into four groups based on ABC(D) classification. All statistical analyses were performed by SPSS (version 26.0, Chicago, IL, USA) software. Results: Median age of the subjects was 62, 52.6% (n=60) were male. Proportions of family history of gastric cancer and previous history of gastric disease were significantly higher in the gastric cancer group compared with atrophic gastritis and healthy control groups (p<0.05, p<0.05). H.pylori was positive in 67 (58.8%) subjects according to H.pylori IgG assay and there was no difference between study groups. The serum PGI level and was significantly decreased in gastric cancer and atrophic gastritis groups as compared to the healthy control (p<0.05, p<0.05). The PGI/II ratio was significantly lower in the gastric cancer group compared with the healthy control (p<0.01). The optimal cut off value of PGI was ≤35.25 ng/ml (AUC 64.3, 95% CI 51.3-77.2, p<0.05) for gastric cancer and PGI was ≤75.07 ng/ml (AUC 65.2, 95% CI 53.0-77.3, p<0.05) for atrophic gastritis. Also, the optimal cut off value of PGI/II ratio was ≤5.27 (AUC 71.6, 95% CI 69.6-82.8, p<0.01) for gastric cancer and PGI/II ratio was ≤6.25 (AUC 62.7, 95% CI 50.1-75.3, p<0.05) for atrophic gastritis. According to classification of atrophic gastritis patients and healthy control, group D had higher proportion of atrophic gastritis cases than group A, B and C (OR 5.04, 95% CI 1.13-22.50, p<0.05). According to classification of gastric cancer patients and healthy control, groups C had higher proportion of gastric cancer cases than group A, B and D (OR 6.19, 95% CI 1.04-36.78, p<0.05). Conclusion Our findings suggest that PGs level and H.pylori IgG may predict development of gastric cancer and could identifying individuals at high risk of gastric cancer and precancerous lesions who may need endoscopy.

Background and Aims: Hepatocellular carcinoma (HCC) is a common cause of cancer related death in Mongolia. Early diagnosis is the very important management to increase successful treatment and survival rate. Glypican-3 (GPC3) protein is highly expressed in hepatocellular carcinoma (HCC) tissue and in serum of HCC patients. Recent studies have been conducted and suggested as a diagnostic biomarker for detecting HCC in the early stage. Therefore, we investigated the diagnostic value of the serum GPC3 level and compared it to the alpha-fetoprotein (AFP) level as a diagnostic biomarker of HCC. Methods: We enrolled a total of 90 participants and divided into 3 groups with HCC (30), with liver cirrhosis (LC/30) and healthy (30) as the control group (30). GPC3 and AFP serum (sGPC-3, sAFP) levels were measured using commercially available enzyme-linked immunosorbent assay kits. The diagnostic accuracy was analyzed using the receiver operating characteristics (ROC) curve and estimated sensitivity and specificity of each biomarker. Results: sGPC3 was significantly elevated in the HCC group as compared to liver cirrhosis and healthy subjects (658±138.2 pg/ml, 378±25.5 pg/ml, 356.3±29 pg/ml) respectively. sGPC-3 sensitivity was 96.6% and specificity was 100%. The area under the ROC curve (AUC) for GPC3 was 0.999 (0.996- 1.0).
In comparison, the mean of AFP was significantly higher in HCC (16.9±11.7 ng/ml) than in LC (6.7±7.6 ng/ml) and in healthy subject (3.3±2.1 ng/ml) and AFP sensitivity was 43,3 %, specificity was 95 % with an AUC of 0.808 (0.696- 0.921).
The combination of GPC-3 with AFP achieved the highest sensitivity (97.1%) and specificity (97%). Conclusion Serum GPC3 has a higher sensitivity than AFP for the early diagnosis of HCC. Combination of two markers showed greatest diagnostic accuracy.

BACKGROUND: Toll like receptors (TLRs) are a class of proteins that key role in the innate immune system. TLR7 is expressed on monocytes, macrophages and dendritic cells, T cell, B cell and eosinophiles. TLR7, originally identified as recognizing imidaquinoline, loxibrine, broprimine and ssRNA, ssRNA viruses such as vesicular stomatitis virus, influenza A virus and human immunodefiency virus. It is known that virus ssRNA affects signaling molecule of IFN-y. Objective: To determine gene and protein activation of IFN-y signal transduction by TLR7 ligand in the endothelial cells. MATERIAL: In study we used mouse aortic linear endothelial cell which is cultured (END-D) in 5% heat- inactivated fetal calf serum (FCS), medium (DMEM) containing antibiotic mix(penicillin G, streptomycin, amphotericin B) at 37°C (5% CO2). Endothelial cells treated with synthetic IFN-γ and imiquimodligands, then the NO (nitric oxide) concentration in the supernatant is determined by Griess reagent. Endothelial cells are cultured in 6 well cell culture plate and in each well 2*104cells are expected to be grown for 24 hours of culture. Then, the cells are treated with synthetic IFN-γ and имиквимод ligand for 6 hours and the NO signaling gene activation iNOS mRNA expression which is induced by IFN-γ is determined by RT-qPCR. Endothelial cells are cultured in 12 well cell culture plate and in each well 2*104 cells are expected to be grown for 18 hours of culture. Then, the cells are treated with synthetic IFN-γ and imiquimodligands for 24 hours and the NO signaling protein iNOS expression which is induced by IFN-γ is determined by western blotting. The experiment was conducted as representation mean of at least three test results. The difference between statistical probabilities is determined by the “Students” t test. The p<0.01 value is assumed to be statistically different. RESULTS: TLR7 ligand imiquimodaugmented interferon gamma induced nitric oxide production TLR7 ligand imiquimodincreased interferon gamma induced iNOS mRNA gene expression. TLR7 ilgand imiquimodup-regulated interferon gamma induced iNOS protein expression. CONCLUSIONS: TLR7 ligand imiquimod augments IFN-γ signaling in the endothelial cells. This synergistic effect has revealed in the levels of gene and protein expression.

Introduction: When human body encounters external pathogens primary/innate immunity cells are activated by recognizing them and secondary/adaptive immunity is activated consecutively. In our previous study, we revealed that there is a synergistic action between TLR9 and IFN-γ signaling in the endothelial cells. Purpose: To determine the role of negative and positive regulator proteins on the IFN-γ/TLR9 signaling pathway. Methods: In this study, murine endothelial cell (END-D) culture was used. END-D cells pre-treated with TLR9 ligand CpG DNA and then stimulated with IFN-γ. The negative (SHP-2, SOCS1, PIAS1) and positive (p38) regulator protein expression was detected by Western blotting. Results and Conclusion Treatment by TLR9 ligand CpG DNA and IFN-γ increased positive regulator p38 phosphorylation in 0.5 hour. CpG DNA inhibited IFN-γ negative regulator PIAS1 protein expression in 6 hour and SOCS1 and SHP-2 expression could not affect in 4 hour.