Background This study is a multi-centre, open-label, randomised controlled trial that will compare the impact of selective internal radiation therapy (SIRT) using SIR-Spheres® yttrium-90 microspheres versus sorafenib on overall survival in patients with locally advanced hepatocellular carcinoma (HCC). A definitive RCT comparing the 2 most promising therapies in locally-advanced HCC will impact on outcomes in a large number of patients and change clinical practice. This will also pave the way for future trials in combined modality therapies in HCC. Methods The study is structured so that patients with locally advanced HCC, who satisfy the study eligibility criteria, will be randomised to receive either: Treatment Arm A: Oral Sorafenib therapy at a dose of 400 mg b.i.d until disease progression, no further response, complete regression or unacceptable toxicity or Treatment Arm B: A single administration of SIR-Spheres into the liver targeted at HCC in the liver by the trans-arterial route. Results Twenty patients treated with 90Y-RE and nineteen patients received Sorafenib at our institution from 14 March 2011, and 30 June 2016 were included. Data from 39 consecutive patients were analyzed. The majority of patients were Child Pugh class B(90%), Barcelona Clinic liver Cancer(BCLC) stage C(58.5%) and Okuda class I (89.5%). Approximately 71% patients diagnosed in IIIa stage and 70% of patients had HBV infection. In the analysis for best response, three of 20 patients in the SIRT group (15%) achieved a partial response 7 of 19 patients (46%) had stable disease, whereas in Sorafenib group, two of 19 patients in the SIRT group (12%) achieved a partial response 9 of 19 patients (39%) had stable disease. Conclusion This study shows the potential efficacy of SIR-Spheres and sorafenib. In summary, selective internal radiation therapy (SIRT) using SIR-Spheres is a promising treatment for well selected patients with unresectable HCC. Sorafenib is effective for the patients with locally advanced HCC without portal vein thrombosis (PVT).

BACKGROUND:Our previous study has shown that the prevalence and structure of the neurohereditary diseaseswere different by provinces and some form of these diseases as “indigenous” in some isolatedpopulation. There are some scientific results of our researches–genetics about consanguineous,which is more potential factor of community is some area of Mongolia. All these circumstance isgiving to carry out this study.MATERIALS AND METHODS:We used descriptive epidemiological method for revealing hereditary neurological diseases in thepopulation of 6 provinces (aimags) of Mongolia: Dornogobi (Easth-gobi), Sukhbaatar, Gobisumber,Central aimag, Bulgan, and Darkhan-Uul. Total population of these provinces is 363072. Thenumber of population in 6 provinces was fluctuated in the range from 15.000 (Govisumber) to 88.875(Darkhan-Uul). Prevalence was accounted for 100.000 populations.RESULTS:The prevalence of neurohereditary diseases makes up 17.08 cases per 100.000 populations amongthese 6 provinces. 79% of these are hereditary neuromuscular diseases i.e 49 patients from 29families. Myotonic dystrophia and genetic neuropathies Charcot-Marie-Tooth have comparativehigh prevalence over test forms of disease.The high rate neurohereditary diseases was established in the population of Bulgan (35.80•10-5),Sukhbaatar (31.17•10-5), and Dornogobi (21.33•10-5) provinces. Their prevalence’s prevailed in the7-10 times over rates Darkhan-Uul, 3-5 times over rates of Gobisumber aimags.No neuromuscular forms of neurohereditary diseases i.e spastic paraplegia (11.3%) andspinocerebeller ataxia (9.68%) accounts for 21% among all forms of neurohereditary diseases.The prevalence of neuromuscular diseases in the population of these six provinces is two times highthen the average rate of the population of Russia (1980 years). First reason is may be associatedwith high predisposition of based on consanguineous through reproductive way in some of theseprovinces of Mongolia.

Background: Our previous study has shown that the prevalence and structure of the neurohereditary diseases were different by provinces and some form of these diseases as “indigenous” in some isolated population. There are some scientific results of our researches–genetics about consanguineous, which is more potential factor of community is some area of Mongolia. All these circumstance is giving to carry out this study.Materials and Methods: We used descriptive epidemiological method for revealing hereditary neurological diseases in the population of 6 provinces (aimags) of Mongolia: Dornogobi (Easthgobi), Sukhbaatar, Gobisumber, Central aimag, Bulgan, and Darkhan-Uul. Total population of these provinces is 363072. The number of population in 6 provinces was fluctuated in the range from 15.000 (Govisumber) to 88.875 (Darkhan-Uul). Prevalence was accounted for 100.000 populations.Results: The prevalence of neurohereditary diseases makes up 17.08 cases per 100.000 populations among these 6 provinces. 79% of these are hereditary neuromuscular diseases i.e. 49 patients from 29 families. Miltonic dystrophia and genetic neuropathies Charcot-Marie-Tooth have comparative high prevalence over test forms of disease.The high rate neurohereditary diseases was established in the population of Bulgan (35.80•10-5), Sukhbaatar (31.17•10-5), and Dornogobi (21.33•10-5) provinces. Their prevalence’s prevailed in the 7-10 times over rates Darkhan-Uul, 3-5 times over rates of Gobisumber aimags. No neuromuscular forms of neurohereditary diseases i.e spastic paraplegia (11.3%) and spinocerebeller ataxia (9.68%) accounts for 21% among all forms of neurohereditary diseases. The prevalence of neuromuscular diseases in the population of these six provinces is two times high then the average rate of the population of Russia (1980 years). First reason is may be associated with high predisposition of based on consanguineous through reproductive way in some of these provinces of Mongolia.

BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.

Background: Stroke is one of the leading causes of mortality and disability worldwide. Understanding sex differences in risk factors, clinical characteristics and death after stroke might provide valuable evidence for prevention and management of stroke. Aim: We aimed to describe sex differences in risk factors, clinical characteristics and death after intracerebral hemorrhage (ICH) and ischemic stroke (IS) using hospital-based registry in 6 districts of Ulaanbaatar, Mongolia. Materials and methods: We used hospital-based stroke registry in Ulaanbaatar Mongolia. From 2019 to 2020, total of 974 patients with acute ICH and 1612 patients with acute IS were enrolled in this study. The severity of stroke was measured by National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Risk factors for stroke were defined as patient’s history and their medical record. Death after stroke was registered at 28 days and 90 days by follow-up study. A comparison of categorical and continuous variables was analyzed using chi-squared test, Student’s t-test and Mann Whitney U test. Univariable and multivariable logistic regression analyses were also performed. Results: The mean age of ICH patients was 58.41±11.56. There was significant difference in age (59 vs 57, p=0.009) between women and men. Men with ICH were more likely to drink alcohol (35.4% vs 5.2%, p=0.000) and to smoke (37.0% vs 8.4%, p=0.000) and to have arterial hypertension (72.7% vs 58.6%, p=0.000). However, there were no significant differences in other risk factors including atrial fibrillation, diabetes mellitus, prior stroke and other cardiac diseases. There were no sex differences in clinical characteristics including systole and diastole blood pressure, NIHSS scores and GCS. In our study, case fatality rate was 23.8% at 28 days and 1.9% at 90 days after ICH. By multivariable regression analyses, there were no significant association between sex and death at 28 days and at 90 days (OR:0.74; 95% CI:0.52-1.06, OR: 0.80; 95% CI:0.29-2.21).
The mean age of IS patients was 61.07±12.88. The women were older (63 vs 59, p=0.000) than men. Men with IS also were more likely to be current smokers (37.6% vs 9.0%, p=0.000), current drinkers (33.2% vs 3.4%, p=0.000) and to have arterial hypertension (74.7% vs 65.9%, p=0.000). There were no significant differences in other risk factors. For IS patients, there also was no sex difference in clinical characteristics. Case fatality rate was 13.3% at 28 days and 1.1% at 90 days after IS. By multivariable regression analyses, there were no significant association between sex and death at 28 days and at 90 days (OR:0.90; 95%CI: 0.64-1.26, OR:5.16; 95%CI: 0.99-23.9). Conclusion Our study showed sex differences in some vascular factors of both stroke subtypes which emphasized that we need to implement stroke prevention targeting sex-specific risk factors. While clinical characteristics and early mortality of intracerebral hemorrhage and ischemic stroke were not differed by gender.

Background: Globally the incidence of stroke is not decreasing, and the deaths and disabilities caused by stroke is increasing every year, especially in low and low-middle income countries.
Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance.
Having reliable data on stroke morbidity and mortality, as well as periodic identification of long-term trends will be important information for proper prevention planning in the population, monitoring the disease and further improving the quality of health care. Material and Method: A prospective cohort study has been conducted in adult citizens (972409 in 2019, 925367 in 2020) of 6 districts of Ulaanbaatar from the 1st of January, 2019 to 31st of December, 2020. All first-ever and recurrent stroke cases were included using special software, developed for stroke registry, based on the WHO STEPS approach from participating radiology departments of state hospitals, district hospitals, and some private hospitals. Information of stroke death was obtained from forensic institute and state registration office of the capital city.
The trends of stroke incidence and mortality was compared to data between 1998-1999 and 2019- 2020 in UB. Results: The age-standardized crude incidence rate per 100.000 person-years of stroke were 209.0/100.000 (n=1934) in 2019 and 194.0/100.000 (n=1821) in 2020 among adults of UB city. The above results were compared to 1998-1999 studies and the incidence rate declined by 94.0/100.000 in 2019-2020, whereas mortality rate increased by 10.0/100.000 in women aged 16-34. Stroke mortality was 11.6% in 1998 and 26.5% in 1999, while in our study it was 33.87% in 2019 and 29.71% in 2020. Although the incidence of stroke rates has decreased in 1998-1999, the mortality rate has not decreased significantly. Conclusion Morbidity and mortality rates among the population of Ulaanbaatar citizen remain highest in the world, compared to 20 years ago with overall morbidity declining but mortality has not decreased.
In recent years, the Government of Mongolia has been focused on reducing non-communicable diseases, but the primary and secondary prevention and control of stroke in the general population, as well as the acquisition of knowledge attitudes, practices and access to health care still need to be improved.

Background: Stroke is a leading cause of death and disability, especially in low-income and middle-income countries and it impacts a tremendous medical, emotional and fiscal burden on society. Due to advances in Western healthcare, the prevalence of stroke since 1970 has decreased by 42%, whereas it has more than doubled in low-income to middle-income countries.
Stroke is a heterogeneous, multifactorial disease regulated by modifiable and nonmodifiable risk factors. Approximately 80% of stroke events could be prevented by making simple lifestyle modifications. In fact, nationwide characterization of well-known stroke factors in all social backgrounds is essential, however; populations can differ significantly not only in their socio-behavioral, legal, and geographical conditions, but also from other, historically understudied. Therefore, it is crucial to determine characterization of risk factors for ischemic stroke among Mongolian population. Objective: To determine etiology and risk factors for ischemic stroke among Mongolian population Material and methods: Our study was conducted by case-control study design. Cases were patients with acute first stroke; controls were matched with cases, recruited in a 1.2:1 ratio, for age and sex. The case series study was conducted in Stroke center of Third State Central hospital from January 2017 to December 2017. Structured questionnaires were administered and physical examinations were done in the same manner in cases and controls. Self-reported history of hypertension and diabetes mellitus or blood pressure of 140/90 mm Hg and blood sugar 6.4 mmol/L or higher was used to hypertension and diabetes mellitus, respectively. Smoking status was defined as never, former, or current smoker. Alcohol use was categorized into never or former, low intake, moderate intake, and high or episodic heavy intake. Atrial fibrillation was based on previous history, review of baseline electrocardiograph results (for cases and controls). Odds ratios (OR) and logistic regression were calculated, with 95% confidence intervals. Results: In total, 173 patients with ischemic stroke and 146 controls were included. The patients’ age ranged from 17 to 92, the mean age was 61.2. Ischemic stroke more frequent in man than women by 27.4%. Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2.40, 95% CI 1.48-3.88), diabetes mellitus (OR 3.08, 95% CI 1.44-6.57), hyperlipidemia (OR 5.09, 95% CI 2.64-9.82) atrial fibrillation (OR 8.70, 95% CI 2.01-37.64 ), current smoking (OR 2.07, 95% CI 1.26-3.40), alcohol consumption (OR 4.75, 95% CI 2.58-8.73) were all significantly associated with ischemic stroke. The mean age was lower in patients with stroke of other determined etiology. The frequency of hypertension was higher in patients with lacunar infarct than other subtypes. Smoking was high frequent in patients with large artery atherosclerosis. Conclusion 6 potentially modifiable risk factors were collectively associated with ischemic stroke and were different among ischemic stroke subtypes. The odds ratios of these risk factors are higher than other countries’ study.

Background: Stroke is still one of the leading causes of morbidity and mortality worldwide. Registry-based data of stroke are scarce in low and middle-income countries such as Mongolia. We aimed to investigate the incidence and mortality of stroke in adult population of UB Mongolia by stroke registration method. Material and Method: Covering 611265 (≥15 years old) adult citizens of three districts of Ulaanbaatar, a population-based prospective study was done from the first, January of 2019 to 31st, December of 2019. All first-ever and recurrent stroke cases were included using special software, developed for stroke registry, based on the WHO STEPS approach from participating radiology departments of state hospitals, district hospitals, and family clinics. Information of stroke death was obtained from forensic institute and state registration office of the capital city. Results : In a 1-year study period, 1068 (women 39.1%) stroke cases were registered in people with 60.16±13.66 years old. Stroke incidence rate was 169.81/100000 including first-ever and recurrent events. Stroke incidence rate was higher in men and people with 80 and above years old. The ratio between IS and ICH was 1.14:1.0. Stroke mortality was 27.1% and mortality rate was 45.94/100000. The highest rate mortality was in ICH subtype, male population and older people. Conclusion We identified relatively high incidence and mortality rate of stroke in ICH indicating an urgent need for improvement of arterial hypertension control, health education and primary prevention mainly among men.