Background: To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia (EH) either a levonorgestrel impregnated intrauterine system (LNG-IUS; MIRENA®) or two regimens of oral dydrogesterone (DGS) after primary histological response. Currently, the incidence of EH is indistinctly reported to be around 200,000 new EH cases per year in Western countries. Methods: Patients were at their choice assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral DGS administered for 10 days per cycle for 6 months; or 10 mg of oral DGS administered daily for 6 months. The women were followed for 6 months after ending therapy. [Figure2] Women aged 25-55 years with low or medium risk endometrial hyperplasia met the inclusion criteria, and 35 completed the therapy. Results: Histological relapse was observed in 55/ (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In our study involved 25-55 (mean 42.2±1.61) aged 35 women. Among them had reproductive aged 31.43% (n= 11) premenopausal women 42.86 % (n= 15) postmenopausal women 25.71% (n= 9). Their mean body mass index had 28.8±1.15 kg/m², and normal weight 34.29% (n=12), overweight 34.29% (n=12), obese 17.14% (n=6), extremely obese 14.29 % (n=5). [Figure3] Types of obesity had normal 37.14% (n=13), android 25.71% (n=9), gynecoid 37.14% (n=13). Mean parity had 1.8±0.19 to nulliparous 14.29% (n=5), primiparous 60% (n=21), multiparous 25.71% (n=9). Smoke 17.14% (n=6). Non combined disease had 65.7% (n=23), diabetes mellitus 17.14% (n=6), PCOS 14.29% (n=5), cardiovascular disease had 2.86% (n=1). [Table1] Mean endometrial thickness of TVUS had ( 16.0±0.91mm). Smoke (p=0.0391), types of obesity (p=0.0436) and myoma of the uterus (p=0.0187) seen affected the endometrial thickness. LNG-IUD group had after treatment’s menstrual period 11.11% heavy 80ml (n=1), 88.89% light 5ml (n=8). DGS (5-25 day) group had after treatment’s menstrual period 9.09% heavy =80ml (n=1), 90.91% light5ml (n=10), DGS (16-25 day) group after treatment menstrual period 40% heavy 80ml (n=6), 46.67% normal 5-80ml (n=7), 13.33% light 5ml (n=2) байв. Therefore between the three treatment groups had no differences. But treatment’s before and after result had statistics probability differences (P= 0.4064). [Figure4] Conclusions Finally, given the long natural history of menorrhagia, study outcomes need to be assessed over a period that is longer than 2 years. In conclusion, our study showed that both the LNG-IUD, oral progestin treatment reduced the adverse effect of menorrhagia on women’s lives over the course of two years. LNG-IUD was the more effective first choice, as assessed impact of bleeding on the women’s quality of life.

Introduction: The clinical skills training at medical schools provides the opportunity for future medical doctors to deal with the client with proper care, diagnosis of the disease, first aid, treatment, nursing, treatment, counseling to address the complexity of the problem solving and the ethical attitude of the doctor. To achieve this objective, it is necessary to assess the level of knowledge, skills and attitudes students have acquired. Goal: To analyze assignment of basic clinical skills assessment and to identify the level of кknowledge and skills students who have graduated second year medical program at “Ach” Medical University during 2016- 2017 academic year. Materials and Methods: The study was used as a descriptive model to measure the reliability of the assignment, the difficulty factor of tasks, and the Hoffsten’s scores based on the tasks and performance of each station and compared with the indicators. Results: Based on Hoffsten’s study on the success rate of examiners at the 5 stations, the Hoffsten’s score level of clinical examination was 68 percent, the physical examination station was 64 percent, the station’s diagnostic level was 71 percent, the laboratory was 70 percent and the nursing station was 70 percent. Conclusion At each clinical trial, the differential diagnosis of each individual clinical trial, clinical interview, nursing station and visual diagnostic station (DF> 95), at the laboratory and at the physical examination station, assess the student with a higher grade of difficulty factor (DF> 80) to the Hoffsten’s score of the basic clinical skills exam is set to be 70 percent.

Introduction: The curriculum development is important issue, especially sudent’s evaluations for the implementation of the curriculum. Accordingly this time we conducted this survey to determine the level of satisfaction of students, which is a key factor in implementation of curriculum at the “Ach” Medical University. Goal: To determine student’s satisfaction level in the curriculum implementation of “Ach” Medical University Materials and Methods: Study was conducted descriptive study design using quantitative research methodology. The Likert scale (1-5) used for the assessment of satisfaction score. Total 1105 students were included in the study. Study questionnaire included 2 groups with 17questionnaires. Results: Students’ satisfaction level is 3.22 point on average and students gave lowest points 2.77 on the quality of classroom, school environment, training equipment and books and course materials. Conclusions The average satisfaction score was 3.22 above the average but the some factors including classroom capacity, study environment, training equipment and books and course materials, textbooks were below average.

Introduction: One of the quality assurance measurements for medical schools is the achievement of students who have graduated in the assessment of the knowledge, skills and attitudes they are trained in. Goal: To analyze assignment of theoretical and practical exam and to identify the level of кknowledge students who have graduate at “Ach” Medical University during 2015-2016 academic year. Materials and Methods: The study was conducted on a cross sectional and descriptive study through the based on the task of analyzing the 261 graduate students theoretical and practical exam performance of the bachelor degree in Medicine, Dentistry, Traditional Medicine and Nursing of Ach Medical University of Mongolia /AMU/ and was assessed and to identify a reliability coefficient, difficulty factor, discrimination index, Hoffsten’s score. Results: The reliabiliy coefficient of graduate exam meets requirement when it’s 0.94-0.96. According to the analysis of the 300 test of the each classroom of graduates was 70 percent (n=202) with weak dicrimination index, difficallty factor was more than 50 percent too easy, The Hoffsten’s score to which exam was passed of Medical graduates is 70 percent, traditional medicine is 87 percent, dentistry is 79 percent, the nursing is a Hoffsten’s score was 80 percent. Conclusions The reliability coefficient the theoretical exam of the graduates’ knowledge is convenient for all occupations, and whole field examines the weak difficulty index (DI≤0) for all field examinations. The Hoffsten’s score is 70% above the medical field. Graduate assignments can not discriminate graduates’ knowledge and skills levels and the difficulty factor graduate examination was very easy.

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.

Introduction: Researchers have found that people living in polluted areas have a lower ability to resist skin bacteria and increase the number of skin microflora. Decreased immune function increases the risk of sore throat, influenza, respiratory infections, pneumonia and gastrointestinal diseases. One of the main indicators of the human immune system is the normal microflora. Goal: To study the relationship between normal human microflora and specific immunity. Material and Methods: This study was conducted within the framework of the project “Effects of non-specific immune factors on injectable infectious disease immune system”. The survey sampled 10 households from Dornod aimag, 8th khoroo of Chingeltei district, Ulaanbaatar city, and 3rd khoroo of Baganuur district. A total of 176 people aged 6 months to 50 years were involved. A total of 528 swab samples and 31 blood samples were collected from the throat, tonsils, skin and mucous membranes to study the relationship between normal human microflora and specific immunity.
The research methodology was discussed at the meeting of the Academic Council of the Ministry of Social Welfare and the Medical Ethics Review Committee under the Ministry of Health (January 5, 2018, Resolution 646) and the research was approved. Results: The total number of normal microorganisms in the skin and mucous membranes of the study participants changed, and the number of hemolytic strains and fungi increased. 58%-67% of the participants had normal and long-term immunity against diphtheria and tetanus, while 5% -14% were not. This result was as high as in urban and rural areas. Conclusion This result was as high as in urban and rural areas. As the age group increases, the level of the body’s specific immunity decreases, the structure of the normal microflora changes, and the number of fungi and hemolytic bacteria increases. Furthermore, it is necessary to study specific and nonspecific immunity in detail in relation to environmental pollution indicators.

Research of function of vitamin D on immune system has been studying since the study revealed that vitamin D receptor is expressed on the surface of the immune cells. 1,2-dihydroxyvitamin D3 [1,25(OH)2D], physiologically active form, can be generated through hydroxylation of 25-hydroxyvitamin D3 [25(OH)D], inactive form of vitamin D, in a liver, connecting with specific VDR make biological action. Vitamin D make different biological actions depends on connecting with different immunological cells. Some studies indicated that Vitamin D plays pivotal role in antibacterial innate immune responses through regulating reaction of the main cells as macrophages and dendritic cells. Moreover, calcitriol, the active form of vitamin D, is connected with VDRE, modulates the innate immune response through directly inducing expression of catelicithin and β-defensin as antimicrobial peptides, reducing secretion of IL-1b, IL-6, TNF-a, RANKL, COX-2 as proinflammatory cytokines and increasing production of IL-10, an anti-inflammatory cytokine. Vitamin D plays in proliferation and differentiation of T and B cells and regulates the activities of over 500 genes. Vitamin D differently impacts on per se stages of T cells’ proliferation. Vitamin D indirectly mitigates the differentiation from immature B cells to plasma B cells while it directly impacts on regulation of overloaded production of antibodies in plasma B cells. In conclusion, vitamin D modulates the innate- and adaptive immune response through regulation on activation of APCells, proliferation and differentiation of immune cells, secretion of some antibacterial peptides.

Introduction: Air pollution has become one of the major problems in socio-economic and health issues in Mongolia. Among the various hazards of particulate matter (PM) pollutants, microorganisms in PM2.5 and PM10 are thought to be responsible for various allergies and for the spread of respiratory diseases. Recent studies have shown that PM2.5 particles can cause chronic heart failure, heart arrhythmias, and strokes, as well as lung damage, cirrhosis, inflammation, cancer, cardiovascular disease, and metabolic disorders. Furthermore, some studies have concluded that PM2.5 particles in the environment are a risk factor for gastrointestinal, liver, colon, and lung cancer as well as it affects the growth and metastasis of various cancer cells caused by other factors. In our country, the health effects of air pollution and the relationship between the pathogenesis of cancer research are scarce. Therefore, the study of the effects of PM2.5 particles on cancer cell proliferation, migration (metastasis) can provide a significant role for cancer treatment, diagnosis, and prevention. Purpose: Determining the effects of PM2.5 particles on cancer cell proliferation, migration (metastasis) in in-vitro Material and Methods: A human liver cancer cell line (HepG2), human gastric cancer cell line (AGS) were obtained from the central scientific research laboratory in the Institute of medical sciences. HepG2, AGS cells were seeded at a concentration of 1*105 cells/mL in a culture flask and cultured in RPMI-1640 medium supplemented with 10% FBS, 1% antibiotic mix (penicillin, streptomycin) in a humidified atmosphere of 5% CO2 at 37 °C. The cytotoxic effect of PM 2.5 in AGS, HepG2 cells were evaluated by MTT, CCK8 assays. AGS, HepG2 cells were incubated in 96 well plates for 24h then treated with different concentrations (0, 5, 10, 25, 50 and 100 μg ) of Bayankhoshuu, Buhiin urguu, and Zaisan samples for 24h, respectively. Results: Concentrations of 10, 25, and 50 μg/ml of samples collected from the Bukhiin urguu and Zaisan in March increased HepG2 cell growth, while doses of 25, 50 μg/ml of samples collected from Bayankhoshuu in March and December increased HepG2 cell growth. Therefore, concentrations of 25 and 50 μg/ml of samples collected from Bayankhoshuu in March increased AGS cell growth, while concentrations of 25, 100 and μg/ml of samples collected in December increased AGS cell growth. However, no cytotoxic effect was observed in the sample collected from Zaisan in March, whereas the PM2.5 sample enhanced AGS cell growth in dose dependent manner in December.(p <0.05) Conclusion High levels of heavy metals were detected in samples collected in December from Bayankhoshuu, Bukhiin urguu and Zaisan of Ulaanbaatar. Concentration of 25 μg/ml of samples collected from the Bukhiin urguu and Zaisan in March increased HepG2 cell growth. Concentrations of 25 μg/ml of PM2.5 collected from three regions around Ulaanbaatar increased HepG2 and AGS cell migration.