Background: Ovarian cancer (OC) ranks first in mortality among gynecological malignancies, and according to the 2024 WHO report, 90–95% of ovarian tumors are diagnosed as high-grade malignant forms. Early identification of ovarian cancer risk factors is of great importance in improving diagnostic and treatment management. Aim: To investigate risk factors influencing malignant and benign ovarian tumors in women. Materials and Methods: The study was conducted using a prospective observational design between 2025 and 2026, based at the Departments of Gynecological Surgery of the National Cancer Center (NCC) and the Mongolian Japanese Teaching Hospital (MJTH). A total of 93 women aged 26–78 years diagnosed with ovarian masses (72% benign, 28% malignant) were enrolled, and data were collected using a 116-item questionnaire. Statistical analysis was performed using binary logistic regression in SPSS 25.0. Results: The mean age of the malignant group (53.45±12.97) was statistically significantly higher than that of the benign group (38.95±12.81) (p<0.0001). Lower educational level (p=0.046) and higher smoking rates (p=0.034) were observed in the malignant group. Regarding symptoms, abdominal distension (p=0.005), urinary difficulty (p=0.016), and weight loss (p=0.002) were predominantly present in the malignant group. Multivariate logistic regression analysis showed that weight loss increased the risk of malignant ovarian tumor by 7.0-fold (OR=7.0; 95% CI: 1.74–28.14; p=0.006), urinary difficulty by 4.05-fold (OR=4.05; 95% CI: 1.23–13.37; p=0.022), and abdominal distension by 3.52-fold (OR=3.52; 95% CI: 1.43–8.67; p=0.006). Additionally, menstrual irregularity, postmenopausal status, and family history of ovarian cancer were statistically significantly associated with malignancy. Conclusion Malignant ovarian tumors predominantly occur in postmenopausal women, with risk increasing with age. Weight loss, urinary difficulty, and abdominal distension are the key clinical symptoms for differentiating malignant tumors, and menstrual irregularity, menopausal status, and family history showed statistically significant associations with malignancy. The use of the HE4 biomarker and the ROMA algorithm is recommended for early detection of ovarian cancer in future practice.

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality worldwide and develops through the accumulation of genetic alterations involving multiple genes. In Mongolia, the substantial burden of CRC, limited treatment options, and scarcity of studies investigating its molecular genetic characteristics highlight the need to improve molecular diagnostics and expand personalized treatment options. Aim: To identify genetic variants in tumor tissues from patients with CRC and compare them with variants detected in matched adjacent normal tissues. Materials and Methods: This cross-sectional study was conducted between August 2023 and May 2024 in collaboration with the National Cancer Center of Mongolia, the Mongolian Institute of Human Genetics, and Happy Veritas Hospital. Eleven patients who underwent surgical treatment for CRC at the Department of General Surgery were enrolled. Paired tumor and adjacent normal tissue samples were collected from each patient and analyzed. Targeted next-generation sequencing (NGS) was performed using the MGISEQ-200 platform, covering 2,881 targeted positions across 53 cancer-associated genes. Sequencing data were processed through a bioinformatics pipeline involving quality control, alignment to the reference genome, variant calling, and filtering. BWA-MEM, GATK Mutect2, and Variant Effect Predictor (VEP) were used to identify and annotate genetic variants. Variants were comparatively evaluated according to their occurrence in tumor and adjacent normal tissues, potential functional consequences, and clinical significance. Results: A total of 60 genetic variant observations were identified across 11 paired CRC and adjacent normal tissue samples, including 56 single-nucleotide variants (SNVs; 93.3%) and four insertions or deletions (INDELs; 6.7%). Of these, 36 observations (60.0%) were recorded in tumor tissues and 24 (40.0%) in adjacent normal tissues. Eleven amino acid-altering variants were identified in tumor tissues. Variants in PDGFRA (90.9%), TP53 (54.5%), APC (36.4%), PTEN (27.3%), KIT (18.2%), and KRAS (9.1%) were detected in tumor tissues. The frequencies of variants in PDGFRA, TP53, and PTEN were higher in tumor tissues than in adjacent normal tissues, although the differences were not statistically significant (p > 0.05; FDR ≥ 0.75). Variants detected in APC, KRAS, TP53, PTEN, and MLH1 were associated with molecular pathways involved in colorectal carcinogenesis, including Wnt/β-catenin, MAPK, p53, PI3K–AKT–mTOR, and DNA mismatch repair pathways. The KRAS p.Gly13Asp (G13D) variant was identified as a clinically relevant alteration for evaluating response to anti-EGFR targeted therapy. Conclusion Variants in PDGFRA, TP53, and PTEN were more frequently observed in CRC tissues than in adjacent normal tissues; however, the differences were not statistically significant. Variants in KRAS, KIT, and CDKN2A were detected exclusively in tumor tissues. The KRAS p.Gly13Asp variant may have clinical relevance in evaluating the selection of anti-EGFR targeted therapy.

Background: Recent international studies have demonstrated that vaginal microbiota dysbiosis is associated with persistent human papillomavirus (HPV) infection, cervical precancerous lesions, and cervical cancer. In healthy women, Lactobacillus spp. dominate the vaginal microbiota and produce lactic acid and other bioactive compounds, thereby maintaining an acidic vaginal pH and protecting against colonization by pathogenic microorganisms. A reduction in Lactobacillus spp. and overgrowth of pathogenic bacteria, resulting in dysbiosis, has been associated with HPV persistence as well as the progression and recurrence of cervical precancerous lesions. However, no study has compared the prevalence of Lactobacillus spp. and aerobic bacteria, or their associations, among Mongolian women diagnosed with cervical precancerous lesions or cervical cancer. Therefore, this study was conducted to address this gap. Aim: To compare and characterize the composition of selected vaginal microorganisms in women diagnosed with cervical precancerous lesions and cervical cancer. Materials and Methods: This hospital-based, cross-sectional study was conducted from May to October 2026 at the Department of Gynecologic Oncology, National Cancer Center of Mongolia. A total of 275 women with histologically confirmed cervical precancerous lesions or cervical cancer were voluntarily enrolled after providing written informed consent. Prior to initiation, ethical approval was obtained from the Research Ethics Committee of the Mongolian National University of Medical Sciences at its meeting held on April 22, 2026 (Minutes No. 2026/04-28). General information, medical history, and behavioral factors were collected using a structured questionnaire. Three vaginal swabs were collected from the posterior vaginal fornix. Vaginal discharge was examined, and Lactobacillus spp. and aerobic bacteria were cultured. The associations between these microbiological findings and diagnostic groups were compared across five diagnostic categories. Results: Of the 275 women enrolled, the diagnostic distribution was as follows: CIN I, 41 (14.9%); CIN II, 73 (26.5%); CIN III, 80 (29.1%); cervical carcinoma in situ (CIS), 45 (16.4%); and cervical cancer (CC), 36 (13.1%). Vaginal pH was significantly and positively correlated with the cocci count (ρ=0.346, p < 0.001), white blood cell count (ρ=0.283, p < 0.001), and AV score (ρ=0.277, p < 0.001). In contrast, the Lactobacillus count was significantly and negatively correlated with vaginal pH (ρ=−0.238, p < 0.001). When the AV score was compared across diagnostic groups, it was 2.8±1.3 in stage IIB cervical cancer and 3.67±2.3 in stage III cervical cancer (p=0.008). Lactobacillus spp. were isolated from 119 participants (43.3%), while aerobic bacteria were isolated from 103 participants (37.5%). The most frequently identified aerobic bacteria were Escherichia coli (32; 11.6%), Enterococcus faecalis (17; 6.2%), Streptococcus agalactiae (11; 4.0%), and viridans group streptococci (9; 3.3%). However, the detection rates of Lactobacillus spp. and aerobic bacteria did not differ significantly across diagnostic groups (p=0.634 and p=0.221, respectively). Conclusions Among women with cervical precancerous lesions and cervical cancer, an increase in vaginal pH was significantly positively associated with cocci count, white blood cell count, and AV score. The higher AV scores observed in the cervical cancer group suggest that aerobic vaginitis may be associated with the progression of cervical precancerous lesions. Although the prevalence of Lactobacillus spp. and aerobic microorganisms did not differ significantly across diagnostic groups, the CC group showed a trend toward increased prevalence of aerobic microorganisms and decreased prevalence of Lactobacillus spp.

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.

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: Nucleic acid sequencing is a multi-step process taken place in medical research or diagnostic laboratories. Since the emerge of second generation sequencing technology generally referred as next generation sequencing (NGS), the mass parallel reads covering human genome or transcriptome is achieved by cost cut down over thousand folds. Though the technology made tremendous push forward to various applications, its data analysis time and effort still takes worrisome time and human effort, bringing the emerge of next-step demand: targeted mass sequencing of only desired part from human genome or transcriptome with lower material cost and labor. By targeted sequencing, both run cost and data analysis process can be further cut down, and the read results are more reliable on changes such as determining varied number of repeats, heterozygote alleles, deletions, chromosomal scale abnormality and more. Objective: In this study, we explored the utilization of biotinylated RNA baits on captured sequencing of cancer marker genes functional regions. Method: Targeted NGS was achieved by capturing desired genomic regions using preparatory nucleic acid probes. RNA bait capturing of desired genomic regions has shown to have high specificity and quality.
The study was carried out with informed consent obtained from patients, with the approval №53 in 2018.03.15 by Medical Ethics committee, Ministry of Health, Mongolia. Result: By preparing library of biotinylated RNA baits with 75000 unique sequences, we achieved mass parallel sequencing of human 410 cancer-marker-genes’ exons and UTRs with average read depth ~760, and covered thousands of SNPs on 5 genomic DNA samples. Tissue samples derived from breast cancer and ovary cancer had SNP and deletion on 7 marker genes (BRCA1, BRCA2, ATM, BRIP1, PTEN, TP53, RAD51C) not registered in database. Conclusion Experiments showed RNA baits with up to 117 nucleotide length, produced from ssDNA oligonucleotide stock, can be utilized to capture desired regions of human genome, and bring the cost of captured mass sequencing to 1500 USD, with 93.14-93.33% of Q30 read quality.

Introduction: Hysterectomy is second mostfrequent gynecological operation. Historicallythe uterus has been removed by either theabdominal or vaginal route. The vaginaloperation is preferable when there are nocontraindications because of lower morbidityand quicker recovery. Since it was first reportedby Reich et al in 1989 laparoscopically assistedvaginal hysterectomy (LAVH) has gainedwidespread acceptance. To compare totallaparoscopic hysterectomy (TLH), laparoscopicassistedvaginal hysterectomy(LAVH), vaginalhysterectomy (VH) and total abdominalhysterectomy(TAH).Materials and methods: A prospective,randomized study was performed atGynecologic Surgery Department of NationalCancer Center of Mongolia between March2013 and January 2014. A total of 120 womenindicated to undergo hysterectomy for cervixcancer stage 0-1, uterine myoma, uterinecancer were randomly assigned to fourdifferent groups (30 VH, 30 LAVH,30 TLH and30 TAH). Operating time, blood loss, rate ofcomplications, consumption of analgesics andlength of hospital stay were measured in eachgroup.Results: In our research the groups weresignificantly different for mean intraoperativeblood loss were TLH:119+/-54.7mL, LAVH:127.5+/-52.7 mL, VH; 145+/-57.8 mL andTAH: 210+/-77.4mL (P=.007) and operativetime were TLH 115+/-16.6 minutes LAVH:112.5 +/-18.5 minutes; VH: 51.6 +/-16.9minutes;TAH:69+/-18.2 (P = .001). Theaverage weight of uterine were from 95.1+/-27.6mg (range 58-140) in the VH group ,to 181.2+/-97 (range 76-400g) in the LAVHgroup through to 122.3+/-64 for the TAHgroup. Postoperative pain on day 0 and thetotal abdominal group were 5.5+/-0.7 days ofanalgesic request it was higher than other threegroups (TLH: 3.0+/-0.8days, LAVH: 3.08+/-0.7days, VH: 3.0+/-0.86 days P<.001). LAVHwas associated with a reduced hospital stay(TLH: 3.3+/- 0.7, LAVH: 3.3 +/- 0.6 days;VH: 3.7 +/- 0.6 days;TAH:6.5+/-0.7 P <.001). Total Laparoscopic hysterectomy hadlongest operating time (115+/- 16.6min), a lowcomplication rate, lack of severe post-operativecomplications. Vaginal hysterectomy had theshortest operating time (51.6+/-16.9min).However, there were technical problems withsalpingo-oophorectomy from the vaginalapproach and this group had a significantlyhigher rate of febrile complications (20%)compared to LAVH (2.3%) and TAH (16%).Conclusion: Even though operative timefor VH is less than TLH, there is a technical problem known as salpingo-oophorectomy.TLH and LAVH have number of advantagesincluding less interaoperative blood lose, lesspostoperative analgesic requirement, andshorter duration of postoperative hospitalstays.

Neonatal mortality is declining in our FIRST MATERNAL HOSPITAL last few years but the number of preterm babies are increasing. Globally, the main causes of neonatal deaths are preterm birth complications (35 per cent), intrapartum-related complications (complications during labor and delivery) (24 per cent), and sepsis (15 per cent). Together, these three causes account for almost three quarters of all neonatal deaths.We have analyzed 51 medical records who have died in neonatal intensive care unit of Urgoo maternal hospital. 23 questionnaries were analyzed.Premature infant deaths basis of the mother’s birth disorders and mother abnormality. Furthermore, abruption placenta 25.1%, caesarian section 57.1%, hypertonus–21.4%.Prevention of fetal lung under development treatment did not affect 67.8% mortality. Chronic hypoxia is 46.4%, not a day mortality 25.4%, treating was 1–3 days mortality rate is 57.1% is the ability to live shows children die. Compared treated for complications premature infant mortality is 14.2%, causes premature infant mortality is ischemia of brain.Based on the study of maternal hospital mortality in the treatment of premature infants most important thing is CPAP machine it is premature to reduce infant mortality 30.7per cent. Is necessary to use with respiratory distress syndrome infant most important thing is surfactant treatment.

BACKGROUND: Hysterectomy is second most frequent gynecological operation. Historically the uterushas been removed by either the abdominal or vaginal route. The vaginal operation is preferablewhen there are no contraindications because of lower morbidity and quicker recovery. Since it wasfirst reported by Reich et al in 1989 laparoscopically assisted vaginal hysterectomy (LAVH) hasgained widespread acceptance.OBJECTIVES: To compare the outcome measures which including operating time, blood loss, rateof complications, consumption of analgesics, and length of hospital stay of total laparoscopichysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy(LAVH), vaginal hysterectomy(VH) and total abdominal hysterectomy(TAH).METHODS: A prospective, randomized study was performed at Gynecologic Surgery Department ofNational Cancer Center of Mongolia between March 2013 and January 2014. A total of 110 womenindicated to undergo hysterectomy for cervix cancer stage 0-1, uterine myoma, and uterine cancerwere randomly assigned to four different groups (30 VH, 30 LAVH, 20 TLH and 30 TAH).RESULTS: In our research the groups were significantly different for mean intraoperative blood losswere TLH: 119+/-54.7mL, LAVH: 127.5+/-52.7 mL, VH; 145+/-57.8 mL and TAH: 210+/-77.4mL(P=.007) and operative time were TLH 115+/-16.6 minutes LAVH: 112.5 +/-18.5 minutes; VH:51.6 +/-16.9 minutes; TAH: 69+/-18.2 (P = .001). The average weight of uterine were from 95.1+/-27.6mg (range 58-140) in the VH group, to 181.2+/-97 (range 76-400g) in the LAVH group throughto 122.3+/-64 for the TAH group. Postoperative pain on day 0 and the total abdominal group were5.5+/-0.7 days of analgesic request it was higher than other three groups (TLH: 3.0+/-0.8days,LAVH: 3.08+/-0.7days, VH: 3.0+/-0.86days P <.001). LAVH was associated with a reduced hospitalstay (TLH: 3.3+/- 0.7, LAVH: 3.3 +/- 0.6 days; VH: 3.7 +/- 0.6 days;TAH:6.5+/-0.7 P < .001). TotalLaparoscopic hysterectomy had longest operating time (115+/- 16.6min), a low complication rate,lack of severe post-operative complications. Vaginal hysterectomy had the shortest operatingtime (51.6+/-16.9min). However, there were technical problems with salpingo-oophorectomy fromthe vaginal approach and this group had a significantly higher rate of febrile complications (20%)compared to LAVH (2.3%) and TAH (16%).CONCLUSION: However TLH, LAVH and VH seem to be operative time, blood loss and hospitalstay, VH were technical problem salpingo-oopheretomy. TLH and the LAVH has advantages overthe TAH in that in the former there is less intraoperative blood loss, less postoperative analgesicrequirement, and a shorter duration of postoperative hospital stays.