Background: Type I hypersensitivity, commonly known as an allergic reaction, is characterised by an IgE-mediated immune response triggered when foreign proteins enter the body. During allergic reactions, cytokines such as IL-4, IL-5, IL-9, and IL-13, secreted by T-helper 2 (Th2) cells, play a crucial role in activating immune effector cells like eosinophils and mast cells, which contribute significantly to airway inflammation and obstruction. Conversely, interferon-gamma (IFN-γ), produced by Th1 cells, suppresses Th2-mediated responses and plays an essential role in regulating allergic inflammation. Therefore, determining the balance of cytokines produced by Th1 and Th2 cells is crucial for understanding the mechanisms underlying allergic responses. Aim: We aimed to induce an allergic response in experimental animals using ovalbumin and to determine the levels of IL-4 and IFN-γ cytokines using an in-house enzyme-linked immunosorbent assay (ELISA). Materials and Methods: A total of 20 female C57BL/6 mice aged 6–8 weeks were selected for the experiment and randomly divided into two groups: control and experimental groups. The concentrations of IL-4 and IFN-γ cytokines in mouse serum were determined using an in-house enzyme-linked immunosorbent assay (ELISA). Result: Compared to the control group, the levels of IL-4 and IFN-γ cytokines in the serum of allergic model-induced C57BL/6 mice were determined to be 513.7 pg/mL and 193.2 pg/mL, respectively. A statistically significant difference was observed in IL-4 cytokine levels between the two groups (p < 0.001). Conclusion In the allergic model group, serum levels of IL-4 cytokine were elevated, while IFN-γ cytokine levels were decreased, suggesting a predominant Th2-type immune response.

Background: Midwives provide essential maternal, neonatal, reproductive and sexual health care and save lives. In our country, in 2017, the job description of midwives was revised and approved by the Minister of Health in accordance with the core competencies established by the International Federation of Midwives by Order A/216. Therefore, it is necessary to study the extent to which midwives are performing the duties included in the revised job description. Aim: To assess of the professional role and performance of midwives in Mongolia five years after the updated midwifery job description was declared. Materials and Methods: There were 1119 midwives working at all levels of the facilities national wide, and 589 respondents were analyzed. Data were collected using a questionnaire, which was developed with input from an obstetrics and midwifery care advisory group, and was distributed online through Google Forms. We developed a questionnaire on the daily professional roles and performances of midwifery services and skills that were part of the job description of midwives in Mongolia. The questionnaire consisted of three parts and were scored based on a Likert scale. This study was approved by the research ethics committee of the School of Nursing (protocol №22/07-b), Mongolian National University of Medical Sciences (MNUMS), and Ministry of Health. Result: 62.3% of the participants had a bachelor’s degree, 34.3% had a professional degree, 93.5% worked as midwives at all levels of health care, 73.4% worked according to their job description, but 21.9% were unable to work according to their main duties; 56% considered that they faced some difficulties in performing their duties at work. Within the scope of maternity care services mentioned in the job description, 71.4% of them often provide monitoring and counseling to normal, low-risk pregnant women according to guidelines (mean 3.07± 0.96); childbirth and postpartum care are occasionally (mean 2.70±1.10) or not regularly provided; and the average ratings of reproductive health, family planning services, and emergency obstetric care interventions are 2.32±1.120 and 2.40±0.040, respectively. According to self-assessment of professional skills, the average score for the ability to provide care during pregnancy was 3.10±0.038, which is sufficient; the ability to provide care during childbirth and postpartum was 2.83±0.037, which is above average; and the ability to provide emergency obstetric care and reproductive health and family planning care was 2.77±0.84 and 2.57±0.890, which is moderate, respectively. Conclusion The education and professional level of midwives working at all levels of the health sector has improved. While midwives frequently provide the pregnancy care outlined in their job descriptions, they only occasionally perform duties related to childbirth, postpartum and reproductive health, family planning, and obstetric emergency care. According to their self-assessments, midwives demonstrate sufficient competence in teamwork and pregnancy care; above-average competence in childbirth and postpartum care; and moderate competence in obstetric emergency care, reproductive health, and family planning services.There is a need to improve the involvement of midwives in certain professional activities.

Background: Globally, approximately 322,000 new cases of brain and central nervous system (CNS) tumors were reported in 2022, accounting for 1.6% of all newly diagnosed cancers. Primary brain tumors represent 85–90% of all CNS tumors, and survival varies substantially by tumor type and stage. Malignant brain tumors have a 5-year survival rate of approximately 35.7%, while meningioma, the most common benign brain tumor, has a 5-year survival rate of 88.2%. Furthermore, survival outcomes are substantially poorer in low- and middle-income countries (LMICs). For example, the median survival of patients with glioblastoma (GBM) is 12–15 months in high-income countries but only 6–9 months in LMICs. In Mongolia, 93 new cases of brain and CNS tumors were reported in 2024. Although the incidence is lower than that of other common cancers, the mortality rate remains high (80.4%). Because brain tissue biopsy is invasive and repeated sampling is often impractical, in Mongolia, brain and CNS tumors continue to be associated with high mortality, underscoring the need for minimally invasive biomarkers for early diagnosis and disease monitoring MicroRNAs (miRNAs) are small non-coding RNAs (18–22 nucleotides) that regulate gene expression at the post-transcriptional level and remain stable in body fluids, making them promising biomarkers. Among them, miR-21 is a well-characterized oncogenic miRNA that is overexpressed in glioma and glioblastoma. However, evidence regarding its clinical utility in LMICs, particularly in Mongolia, remains limited. Aim: To evaluate plasma miRNA-21 expression in patients with primary brain tumors and evaluate its diagnostic performance. Materials and Methods: This study enrolled 120 participants, including patients with primary brain tumors, patients with other neurological disorders (non-tumor), and healthy controls. Peripheral blood samples were collected, and plasma miRNA-21 expression was quantified using quantitative real-time polymerase chain reaction. Relative expression was calculated using the 2^-ΔΔCt method. Descriptive statistics and one-way analysis of variance (ANOVA) were performed to evaluate differences among groups. Receiver operating characteristic curve analysis was performed to assess diagnostic performance, with statistical significance set at p < 0.05. Result: Plasma miRNA-21 expression was significantly higher in patients with primary brain tumors than in healthy individuals, showing a 3.81-fold increase (p<0.001), and was 1.53-fold higher than in patients with neurological disorders (p<0.001). miRNA-21 expression was significantly elevated in patients with glioma, meningioma, and adenoma compared with both healthy individuals and patients with neurological disorders (p<0.001). Similarly, miRNA-21 expression was significantly higher in both glial and non-glial tumors than in the healthy and neurological disorder groups (p<0.001) and showed an increasing trend according to tumor stage/grade (p<0.001). ROC curve analysis demonstrated that miRNA-21 had a sensitivity of 92.3% and a specificity of 80.5% for distinguishing patients with primary brain tumors from the comparison groups. Conclusion Plasma miRNA-21 has the potential to distinguish patients with primary brain tumors from healthy individuals and patients with neurological disorders and may serve as a minimally invasive diagnostic biomarker for primary brain tumors.

Background: Multiple sclerosis (MS) is an autoimmune inflammatory neurodegenerative disease of the central nervous system and a major cause of disability in young adults. MRI is essential for diagnosis and monitoring, while early evaluation of structural brain changes is important. Aim: To evaluate brain volumetric changes using automated MRI analysis in patients with MS. Materials and Methods: This case–control study included 50 MS case patients and 50 controls patients examined between 2020–2023 at the Third State Hospital. T1-MPRAGE images were analyzed using volBrain automated segmentation software. Result: The mean age of MS patients was 45.5±11.8 years. Compared with healthy controls, the MS group showed significantly lower total grey matter volume (p=0.002), cortical grey matter volume (p<0.001), subcortical grey matter volume (p=0.006), and cerebral volume (p=0.02). Significant volume reductions were also observed in the temporal (p=0.006) and occipital (p<0.001) lobes. Deep grey matter structures, including the thalamus (p=0.001), caudate nucleus (p=0.009), putamen (p=0.008), and nucleus accumbens (p<0.001), also showed significantly reduced volumes. Disease duration was negatively correlated with total grey matter volume (r=−0.30, p=0.02), thalamic volume (r=−0.28, p=0.04), and occipital lobe volume (r=−0.43, p=0.002). Disease duration was also significantly associated with spinal cord involvement (p=0.01) and grey matter volume (p=0.04). The number of relapses was negatively correlated with total brain volume (r=−0.28, p=0.046). Conclusion Patients with MS demonstrated decreased grey matter volume, particularly within deep grey matter structures, along with increased abnormal white matter volume, suggesting the coexistence of neurodegeneration and demyelination in MS. Brain volume loss in MS appeared to occur independently of aging. Automated quantitative MRI analysis may provide important diagnostic value in detecting structural brain changes associated with MS.

Background: One of the major mechanisms underlying myocardial injury during ischemia and hypoxia is oxidative stress. Under hypoxic conditions, excessive production of reactive oxygen species (ROS) disrupts the cellular antioxidant defense system, enhances lipid peroxidation, and ultimately leads to apoptosis and cellular damage. Superoxide dismutase (SOD) is a key intracellular antioxidant enzyme that neutralizes oxidative stress, whereas malondialdehyde (MDA), an end product of lipid peroxidation, reflects the extent of membrane damage. Therefore, investigating antioxidant compounds in hypoxia-induced cardiomyocyte injury is of significant importance. Pinocembrin, a bioactive compound derived from Dalbergia odorifera T.Chen, exhibits multiple pharmacological activities, including antioxidant and anti-apoptotic effects. Aim: To evaluate the effects of pinocembrin on oxidative stress in hypoxia-induced H9C2 cardiomyocytes. Materials and Methods: H9C2 cardiomyocytes were divided into five groups: a control group, a model group, and three pinocembrin-treated groups (low, medium, and high doses). Except for the control group, cells were cultured under hypoxic conditions (5% CO2, 1% O2, 37 °C) in glucose- and serum-free DMEM to establish a hypoxia-induced injury model. Cells were then treated with pinocembrin for 4 hours. Oxidative stress levels were assessed by measuring ROS accumulation, SOD activity, and MDA content. Result: Compared with the control group, the model group showed a significant increase in ROS production, a decrease in SOD activity, and a marked elevation in MDA levels, indicating severe oxidative stress under hypoxic conditions. In contrast, the pinocembrin-treated groups exhibited attenuation of hypoxia-induced oxidative stress. Specifically, ROS accumulation decreased, SOD activity was restored, and MDA levels were significantly reduced. These findings suggest that pinocembrin exerts protective effects by enhancing the cellular antioxidant defense system and inhibiting lipid peroxidation. Conclusion Pinocembrin reduces oxidative stress and protects against cellular injury in hypoxia-induced H9C2 cardiomyocytes. These results indicate that pinocembrin may serve as a potential therapeutic agent for ischemiaand hypoxia-related cardiac disorders and provide a valuable foundation for further research.

Background: Adhesion small bowel obstruction (ASBO) is a common complication following abdominal surgery and can significantly impair postoperative recovery. This condition necessitates the exploration of more effective therapeutic approaches. Aim: The aim of this study was to evaluate the clinical efficacy of Traditional Mongolian Medicine (TMM) combined with acupuncture in the management of postoperative ileus secondary to adhesion-related small bowel obstruction. Case Presentation: We report the case of a 47-year-old female patient who developed postoperative ileus. The therapeutic intervention consisted of a combined regimen of traditional herbal pharmacotherapy and electroacupuncture. The clinical outcomes were assessed based on the resolution of symptoms and the restoration of gastrointestinal function. Result: Following the administration of the integrated treatment, the patient exhibited a marked reduction in abdominal pain. Objective clinical improvement was noted through the successful restoration of intestinal peristalsis and the normalization of flatus and defecation. Conclusion The findings of this case study suggest that Traditional Mongolian Medicine, particularly when integrated with electroacupuncture, may be an effective and viable modality for promoting the recovery of gastrointestinal motility in patients with adhesion-related small bowel obstruction.

Background: Rosai–Dorfman disease (RDD) is a rare, benign disorder of non-Langerhans cell histiocytic origin with an unknown etiology, which can affect the skin and other organ systems. The incidence in the United States is approximately 1:200,000. In Mongolia, four cases have been registered over the past five years under the ICD-10 code D76.0. Case presentation: A 59-year-old female patient initially presented to the Dermatology Department of the National Center for Dermatology with clustered, elevated lesions on the medial aspect of the right thigh, including papules, plaques, and nodules of round to oval shape. Additionally, multiple erythematous macules and papules were observed on both lower legs. For diagnostic purposes, a histopathological examination was performed, revealing histiocytes with abundant cytoplasm and lymphocytes within the cytoplasm (emperipolesis). The diagnosis was confirmed based on dermoscopic and immunohistochemical findings. Management: The patient was referred to the Mongolian-Japanese Hospital of MNUMS, where the remaining nodular lesions were surgically excised in the surgical department. Further follow-up was referred to a hematologist. Computed tomography (CT) imaging was recommended. Cutaneous-limited RDD may resolve spontaneously in some cases; however, when multiple organ systems are involved or when associated forms are present, referral to hematology and oncology specialists for systemic therapy is required. Conclusion It is important to differentiate this disease from other dermatological conditions presented with macules, papules, and nodules through clinical evaluation, histopathology, immunohistochemistry, and dermoscopic examination.

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: Gliomas are common primary brain tumors of glial origin in adults with a poor prognosis. Tumor-related inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and aquaporin-4 (AQP-4) water channel protein have been reported to be expressed in gliomas Aim: This study aimed to determine their serum levels in patients with primary brain tumors compared to healthy controls and to evaluate their potential diagnostic value. Materials and Methods: Serum AQP-4 levels were measured by ELISA in 28 patients with primary brain tumors (PBT) and 26 healthy controls. IL-6 and TNF-α were assessed by flow cytometry in 59 PBT patients and 52 controls. Results: Among the primary brain tumor cases, 45.61% were meningiomas, 26.32% anaplastic astrocytomas, 8.77% glioblastomas, and 12.28% other tumors (including chondroma, ependymoma, schwannoma, craniopharyngioma). Serum IL-6, TNF-α, and AQP-4 levels were significantly higher in the PBT group compared with healthy controls. Conclusion Elevated serum levels of AQP-4, IL-6, and TNF-α in patients with primary brain tumors suggest that these biomarkers molecules could represent valuable non-invasive biomarkers for the early detection of PBT.

Background: Hearing loss (HL) is one of the most common sensory disorders, affecting over 5-8% of the world's population. Approximately half of HL cases are attributed to genetic factors. In hereditary deafness, about 75-80% is inherited through autosomal recessive inheritance, and common pathogenic genes include GJB2 and SLC26A4. Pathogenic variants in the SLC26A4gene are the leading cause of hereditary hearing loss in humans, second only to the GJB2 gene. Variants in the SLC26A4gene cause hearing loss, which can be non-syndromic autosomal recessive deafness (DFNB4, OMIM #600791) associated with enlarged vestibular aqueduct (EVA) or Pendred syndrome (Pendred, OMIM #605646). DFNB4 is characterized by sensorineural hearing loss combined with EVA or less common cochlear malformation defect. Pendred syndrome is characterized by bilateral sensorineural hearing loss with EVA and an iodine defect that can lead to thyroid goiter. Currently, it is known that EVA is associated with variants in the SLC26A4 gene and is a penetrant feature of SLC26A4-related HL. Predominant mutations in these genes differ significantly across populations. For instance, predominant SLC26A4 mutations differ among populations, including p.T416P and c.1001G>A in Caucasians, p.H723R in Japanese and Koreans, and c.919-2A>G in Han Taiwanese and Han Chinese. On the other hand, there has been no study of hearing loss related to SLC26A4 gene variants among Mongolians, which is the basis of our research. Aim: We aimed to identify the characteristics of the SLC26A4 gene variants in Mongolian people with Enlarged vestibular aqueduct and Mondini malformation. Materials and Methods: In 2022-2024, We included 13 people with hearing loss and enlarged vestibular aqueduct, incomplete cochlea (1.5 turns of the cochlea with cystic apex- incomplete partition type II- Mondini malformation) were examined by CT scan of the temporal bone in our study. WES (Whole exome sequencing) analysis was performed in the Genetics genetic-laboratory of the National Taiwan University Hospital. Results: Genetic analysis revealed 26 confirmed pathogenic variants of bi-allelic SLC26A4 gene of 8 different types in 13 cases, and c.919-2A>G variant was dominant with 46% (12/26) in allele frequency, and c.2027T>A (p.L676Q) variant 19% (5/26), c.1318A>T(p.K440X) variant 11% (3/26), c.1229C>T (p.T410M) variant 8% (2/26) ) , c.716T>A (p.V239D), c.281C>T (p.T94I), c.1546dupC, and c.1975G>C (p.V659L) variants were each 4% (1/26)- revealed. Two male children, 11 years old (SLC26A4: c.919-2A>G) and 7 years old (SLC26A4: c.919-2A>G:, SLC26A4: c.2027T>A (p.L676Q))had history of born normal hearing and progressive hearing loss. Conclusions 1. 26 variants of bi-allelic SLC26A4 gene mutation were detected in Mongolian people with EVA and Mondini malformation, and c.919-2A>G was the most dominant allele variant, and rare variants such as c.1546dupC, c.716T>A (p.V239D) were detected. 2. Our study shows that whole-exome sequencing (WES) can identify gene mutations that are not detected by polymerase chain reaction (PCR) or NGS analysis.