Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).

Background: Reconstruction of mandibular and maxillary defects resulting from malignant tumors has remained a complex challenge in recent years. Defects caused by tumors—as well as trauma, inflammatory diseases, and congenital anomalies—lead to impaired essential functions such as mastication, swallowing, and speech. Prior to the 1950s, reconstruction of maxillofacial hard tissue was not commonly performed. Instead, metal plates were used to reestablish bony continuity, and surrounding tissues were utilized to close soft tissue defects, without effectively restoring function. With modern advances in three-dimensional (3D) virtual planning, it is now possible to accurately plan free bone flaps for reconstructing jaw defects. During surgery, manually bending reconstruction plates to fit donor bone precisely is often not feasible. Preoperative 3D planning allows for precise fabrication of surgical guides and fixation plates, improving accuracy and significantly reducing operative time. Additionally, incorporating dental implant planning into the reconstruction process facilitates restoration of both structural and functional outcomes. Aim: To evaluate the outcomes of mandibular defect reconstruction using scapular free flaps in Mongolia and explore potential approaches to optimize the technique. Materials and Methods: This was a case study series. Data from reconstructive surgeries performed at the National Cancer Center of Mongolia, Central Dental Hospital, and the Mongolia-Japan Hospital were collected. Variables included patient age and sex, etiology of the mandibular defect, size of the scapular bone segment, operative time, ischemia time of the free flap, number of vascular anastomoses performed, and pedicle length. For 3D planning, CT scans of the patient's head and lower limb (slice thickness <1 cm) were used to generate 3D models via the 3D Slicer software. Cutting guides for the mandible and scapula (ASIGA), as well as the reconstruction models (AMS), were printed using a 3D printer. Results: A total of 400 free flap reconstructions were performed during the study period. Of these, 29 cases involved reconstruction of mandibular defects using scapular free flaps. The mean age of patients was 40.0 ± 18.3 years, with 52% (15 patients) being female. The etiologies of the defects included malignant tumors (13 cases, 45%), benign tumors (6 cases, 21%), and pre-existing defects (10 cases, 34%). In one case, tumor resection and mandibular reconstruction were performed using 3D planning. The total operative time was 9 hours and 30 minutes, and the ischemia time was 2 hours and 40 minutes. Conclusion Between 2012 and 2025, a total of 29 mandibular reconstructions using scapular free flaps were performed in Mongolia. Traditional reconstruction methods were associated with prolonged ischemia time. The use of 3D surgical planning has shown potential in significantly reducing ischemia time and improving surgical outcomes.