To study the correlation within psychological and social suffering in palliative care cancer patientsWe provide study within 100 palliative care patients with cancer stage 3-4. Depression was evaluated by San Diego hospice screening method with 3 questions. Anxiety was assessed by Spielberg -Hanin anxiety scale. Spiritual pain was assessed by San Diego hospice questionnaire, which includes main 4 factors of spiritual suffering, like cooperation, meaning of life, hope, forgiveness. Results of study was statistically evaluated by SPSS20 program.19% of patients had depression, 40% had anxiety, 46% patients had insomnia. 18% of patients with depression had spiritual suffering. 33% of patients with anxiety had spiritual pain. 31% of patients with insomnia had spiritual pain. Depression and spiritual suffering had mild correlation (R-0.318), anxiety and spiritual suffering had mild correlation (R-0.330), insomnia and spiritual suffering had very strong correlation (R-0.84). Psychological suffering of palliative care cancer patients increased with spiritual suffering and correlated with spiritual suffering. Especially insomnia had very strong correlation with spiritual suffering (R-0.84).

Background: Infertility is defined as the inability of couples to conceive despite engaging in regular, unprotected sexual intercourse for over a year. Assisted reproductive technology (ART), particularly in vitro fertilization (IVF), has emerged as the most widely utilized solution for infertility. The cause of infertility, a woman's ovarian reserve, response, egg and sperm quality, the number and quality of embryos, and various other factors influence the outcome of IVF. Despite significant advancements in ART, predicting IVF outcomes remains challenging, especially when tailoring treatment strategies to individual patient factors. Aim: To investigate the clinical indicators, ovarian reserve markers, and stimulation outcomes influencing the success of IVF treatment in Mongolian women. Materials and Methods: A prospective study was conducted at the Unimed International Hospital IVF Center between October 2023 and August 2024. Clinical and demographic factors, ovarian reserve markers (FSH, AMH, AFC), and ovarian stimulation outcomes were analyzed in 242 women aged 25-44 years undergoing IVF. Logistic regression analysis was performed to identify risk factors and predictors of clinical pregnancy, with a statistical significance threshold set at p<0.05. Results: Among 208 women who underwent embryo transfer, the clinical pregnancy rate was 36.5%, and biochemical pregnancy was observed in 38.4%. Age was a significant predictor, with older age groups (35-39 years: OR=7.11, p=0.004; 40-44 years: OR=12.65, p=0.004) associated with reduced IVF success. Ovarian reserve markers, including AMH (OR=2.49, p<0.001) and AFC (OR=1.56, p<0.001), were significantly correlated with pregnancy outcomes, whereas FSH was not significant (p=0.518). Higher numbers of pre-ovulatory follicles (POF) (OR=1.03, p=0.040) and high-grade embryos (OR=1.26, p=0.045) increased the likelihood of clinical pregnancy. No significant associations were observed between total gonadotrophin dosage, ovarian sensitivity index, and fertilization rate with pregnancy outcomes. Conclusion Age and ovarian reserve markers (AMH, AFC) are critical predictors of IVF success, while pre-ovulatory follicle counts and number of high-grade embryos significantly enhance pregnancy likelihood. These findings emphasize the importance of personalized ART protocols tailored to ovarian reserve and age-related factors to optimize IVF outcomes.

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.

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: Otitis media is an inflammatory disease involving the mucous membrane of the middle ear, including the auditory tube, tympanic cavity, mastoid antrum, and air cells¹. Multiple factors contribute to the development of OM, one of which is adenoid hypertrophy5. However, to date, no study has been conducted in Mongolia to assess the relationship between the degree of adenoid hypertrophy and OM. Aim: To analyze cases of children who underwent adenotonsillectomy. Materials and Methods: The study was conducted using a cross-sectional observational research design. Clinical data from a total of n=215 cases of children who were diagnosed with adenoid and palatine tonsil hypertrophy and underwent surgical treatment at Gurvan Gal Hospital between October 2023 and October 2024 were analyzed. Statistical processing was performed using STATA 14.2, with statistical significance considered at p < 0.05. Results: Clinical data from 215 children were analyzed to evaluate the relationship between the degree of adenoid hypertrophy (AH) and otitis media. The children ranged in age from 2 to 17 years, with a mean age of 7.23 ± 3.4 years. Among them, 128 (59.53%) were male (7.09 ± 3.29 years) and 87 (40.46%) were female (7.45 ± 3.58 years). A statistically significant moderate negative correlation was found between age group and the degree of adenoid hypertrophy (rho = -0.3485, p < 0.001). A significant seasonal variation in otitis media was observed (p = 0.0001). A statistically significant correlation was found between the degree of adenoid hypertrophy and otitis media (p < 0.001). However, no significant correlation was observed between the degree of palatine tonsil hypertrophy and otitis media (p = 0.8762). Conclusion The incidence of adenoid hypertrophy is highest among children aged 6 to 9 years, and there is a moderate negative correlation between age and the degree of adenoid hypertrophy. The occurrence of otitis media varies by season, with the highest number of cases reported during the winter months. As the grade of adenoid hypertrophy increases, the number of otitis media cases also rises.

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.

Introduction: When human body encounters external pathogens primary/innate immunity cells are activated by recognizing them and secondary/adaptive immunity is activated consecutively. Immune cell surface receptors, called Toll-like receptors (TLRs) recognize and bind pathogens. 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 regulatory proteins on the IFN-γ/TLR9 synergistic signaling pathway Materials and Methods: This study was held in the Core Laboratory, Science Technology Center, Mongolian National University of Medical Sciences (MNUMS). In this study, murine endothelial cell (END-D) culture was used. The negative and positive regulator protein expression was detected by Western blotting. Result: Result of immunoblotting assay indicated that CpG DNA enhanced IFN-γ positive regulator protein p38 phosphorylation in the endothelial cells. Treatment by TLR9 ligand CpG DNA and IFN-γ increased p38 activation in 0.5 hour and 1 hour. CpG DNA inhibited IFN-γ negative regulator SOCS1 protein expression in 4 hr and 8 hr. Therefore, TLR9 ligand CpG DNA increased IFN-γ signal transduction in the endothelial cell line. Conclusion TLR9 ligand CpG DNA has decreased IFN-γ negative regulator protein SOCS1 expression. CpG DNA has increased IFN-γ positive regulator protein p38 phosphorylation.

Introduction: Toll like receptors (TLRs) are a class of proteins that key role in the innate immune system. The SOCS1 and SHP2 proteins are negative-feed loop inhibitors of signaling of JAK/STAT and TLRs pathways. Purpose: To determine negative regulator protein activation which is activated through TLR7 ligand/IFN-γ signal transduction in endothelial cells. Methods: We used mouse aortic linear endothelial cell (END-D); protein expressio was detected by western blotting Results: We analyzed a time dependent stimulation effects of negative regulator proteins stimulated by TLR7 ligand/IFN-γ in endothelial cell cultures. Imiquimod of 10 μg/ml treatment of 1 hr was followed by 100 ng/ml IFN-γ stimulation for 1-8hr to analysis of negative regulator SOCS1 and SHP2 protein expression.
In untreated cells, there was low activations of negative regulator SOCS1 and SHP2 proteins. IFN-γ stimulation alone had increased SOCS1 and SHP2 protein expressions, also imiquimod treatment highly elevated SOCS1 and SHP2 expressions. However imiquimod and IFN-γ doubled treatment have decreased activation of negative regulator SOCS1 and SHP2 proteins. These findings suggest SOCS1 and SHP2 proteins are inhibitors in the TLR7 ligand/IFN-γ signaling. Conclusion Negative regulators, SOCS1 and SHP2 strongly suppressed activations of TLR7 ligand/IFN-γ signaling

Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.