Background: Carotid artery stenting is increasingly being selected as the treatment for severe (≥70%) carotid artery stenosis, creating a growing need to prevent potential secondary complications associated with the procedure. In-stent restenosis (ISR) remains an important complication during long-term follow-up after carotid artery stenting. In this clinical case, we have addressed risk factors, pathogenesis, diagnosis, treatment, and monitoring of in-stent restenosis. Case Presentation: We describe the case of a 70-year-old man with severe, symptomatic IRS detected 1.8 years after carotid artery stenting (CAS). Conclusion IRS following carotid artery stenting is a clinically significant complication that may adversely affect cerebral perfusion and increase the risk of recurrent ischemic stroke. Early detection and follow-up with carotid duplex ultrasonography, regular follow-up, and lifestyle modifications, particularly smoking cessation, are essential for prevention of adverse cerebrovascular events.

Background: Branch atheromatous disease (BAD) is believed to be one subtype of ischemic stroke brought on by plaque accumulation that obstructs or stenoses the entrance of penetrating branches. Based on clinical status, risk factors, laboratory results, and radiographic features of infarct and blood vessel morphologies, BAD has been differentiated from large-vessel occlusion and small-vessel disease. BAD-induced stroke has been strongly associated with worse outcomes than lacunar strokes, including high rates of early neurological deterioration (END), recurrent transient ischemic attacks and strokes, and disability. Determining treatment options and each patient’s prognosis depends on early identification of BAD. Case Presentation: A 34-year-old male with a history of recurrent acute ischemic stroke within 7 months, caused by stenosis of the M1 segment of the right middle cerebral artery, was hospitalized twice at the Third Central Hospital of Mongolia. Intravenous Thrombolytic therapy (tPA) was administered during each admission. Conclusion Precise diagnosis of BAD is crucial for planning subsequent treatment and secondary prevention.

Background: Sarcopenia is a multifactorial geriatric syndrome characterized by age-related loss of muscle mass, muscle strength, and physical performance. In recent years, neurotrophic and neuromuscular biomarkers have been investigated as potential diagnostic indicators of sarcopenia; however, evidence regarding their sex-specific differences remains limited. Aim: To evaluate the sex-specific associations of serum BDNF, GDNF, and CAF22 levels with sarcopenia and muscle-related parameters among older adults. Materials and Methods: This analytical cross-sectional study included adults aged 60 years and older. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS 2019) criteria. Serum BDNF, GDNF, and CAF22 levels were measured using ELISA. Group differences were analyzed using independent t-tests, correlations were assessed using Pearson correlation analysis, and diagnostic performance for sarcopenia was evaluated using receiver operating characteristic (ROC) analysis. Multivariable logistic regression analysis was also performed. Results: No statistically significant differences were observed in serum BDNF, GDNF, and CAF22 levels between sarcopenic and non-sarcopenic participants in either the male or female groups (all p>0.05). ROC analysis demonstrated AUC values ranging from 0.540 to 0.542 in males and from 0.508 to 0.530 in females for BDNF, GDNF, and CAF22. Multivariable logistic regression analysis revealed that age (OR=1.12, 95% CI: 1.04–1.21, p=0.003) and lower fat-free mass index (OR=0.78, 95% CI: 0.66–0.91, p=0.001) were significantly associated with sarcopenia, whereas BDNF, GDNF, and CAF22 showed no independent association with sarcopenia. Conclusions 1. No statistically significant sex-specific differences were observed in serum BDNF, GDNF, and CAF22 levels between sarcopenic and non-sarcopenic older adults (all p>0.05). 2. CAF22 levels were weakly negatively correlated with muscle mass and fat-free mass index in males (p<0.05), whereas BDNF levels showed weak positive correlations with handgrip strength and fat-free mass index in females (p<0.05). CAF22 levels also demonstrated a weak positive correlation with age (p<0.05). 3. ROC and multivariable logistic regression analyses indicated limited diagnostic utility of BDNF, GDNF, and CAF22 for sarcopenia (AUC=0.508–0.542), and none of these biomarkers showed an independent association with sarcopenia (all p>0.05). In contrast, older age (OR=1.12, p=0.003) and lower fat-free mass index (OR=0.78, p=0.001) were significantly associated with sarcopenia.

Background: Bone mineral density (BMD) is a key indicator reflecting bone strength and resistance to fracture. It is influenced by multiple factors, including age, sex, genetic background, body composition, nutrition, and physical activity. During young adulthood, peak bone mass is actively formed; therefore, identifying early variations in this period is essential for predicting future skeletal health risks. Accordingly, assessing BMD and evaluating its relationship with physical characteristics among first-year nursing students provides a scientific rationale for this study. Aim: To examine the relationship between bone mineral density and selected physical parameters among students. Materials and Methods: A total of 297 first-year students aged 17-35 years from the School of Nursing, Mongolian National University of Medical Sciences were included. Bone mineral density was assessed by measuring the speed of sound through the radius using an ultrasound bone densitometry device. Handgrip strength was measured using an electronic dynamometer. Physical parameters including age, sex, height, and body weight were measured using standardized procedures, and statistical analysis was performed. The study was approved by the Research Ethics Committee of MNUMS on November 21, 2025 (No. 26/1) and March 28, 2026 (No. 26/03-B02), with no ethical violations identified. Results: According to T-scores, 37.1% (n=110) of participants had normal bone status and 62.9% (n=187) showed reduced bone density. Based on Z-scores, 52.5% (n=159) were normal, while 45.6% (n=138) had decreased values. T-score values were 1.87±0.69 (<20 years), 1.44±0.55 (20–30 years), and 1.10±0.31 (>30 years), while Z-score values were −0.73±1.38, −0.43±1.23, and −0.02±1.27, respectively. ANOVA analysis revealed statistically significant differences among age groups (p<0.01). A positive correlation was observed between T-score and age, whereas no significant correlations were found with other physical parameters. Z-score showed a positive correlation with handgrip strength. Conclusions 1. A high prevalence of reduced bone mineral density was observed among the students, which may be associated with incomplete attainment of peak bone mass in adolescents and young adults. 2. A significant difference in bone mineral density was found between age groups (p<0.01), indicating that age is an important factor influencing bone mineral density.

Background: Cardiovascular disease remains a leading cause of mortality worldwide, and unhealthy diet, physical inactivity, excess body weight, central obesity, and metabolic alterations during young adulthood may increase cardiovascular risk later in life. In addition to conventional lipid parameters, the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C), total cholesterol-to-high-density lipoprotein cholesterol (TC/HDL-C), and low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol (LDL-C/HDL-C) ratios have been investigated as additional indicators of alterations in lipid metabolism and atherogenic risk. Although lipid parameters and metabolic risk factors have been investigated among university students in Mongolia, assessment of metabolic risk among nursing students is of practical importance because of the characteristics of their future professional roles. This provided the rationale for the present study. Aim: To determine peripheral blood lipid ratios among students of the School of Nursing, Mongolian National University of Medical Sciences (MNUMS), and assess their associations with selected metabolic risk factors. Materials and Methods: An analytical cross-sectional study was conducted among 98 first- to fourth-year students aged 18–24 years. Data were collected using a 33-item structured questionnaire, anthropometric measurements, blood pressure measurements, and peripheral blood biochemical testing. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose were measured using a Sinocare portable analyzer, and TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were calculated. Body mass index (BMI), waist circumference, and systolic and diastolic blood pressure were measured using standardized procedures. Differences between groups were assessed using the Mann–Whitney U and Kruskal–Wallis tests, and associations between variables were evaluated using Spearman’s correlation analysis. A p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 20.85±1.52 years, and 75.5% were female. Mean TC, TG, HDL-C, and LDL-C levels were 3.69±0.75, 1.17±0.67, 1.24±0.38, and 2.00±0.65 mmol/L, respectively. Mean TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were 1.06±0.92, 3.28±0.87, and 1.80±0.66, respectively. Mean BMI was 22.93±4.11 kg/m², waist circumference was 75.96±11.28 cm, glucose was 5.63±0.72 mmol/L, and systolic and diastolic blood pressure were 113.31±9.88 and 70.72±8.49 mmHg, respectively. The TG/HDL-C ratio was positively correlated with BMI (rₛ=0.336), waist circumference (rₛ=0.381), glucose (rₛ=0.278), systolic blood pressure (rₛ=0.294), and diastolic blood pressure (rₛ=0.322). The TC/HDL-C ratio was significantly associated with BMI, waist circumference, and systolic and diastolic blood pressure, whereas the LDL-C/HDL-C ratio was significantly associated with waist circumference and systolic blood pressure. Waist circumference was significantly associated with all three lipid ratios, with the strongest correlation observed for TC/HDL-C (rₛ=0.485, p<0.001). Conclusion BMI, waist circumference, glucose, and selected blood pressure measures were positively associated with lipid ratios among the study participants. In particular, waist circumference was significantly associated with all three lipid ratios: TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C. These findings indicate the importance of considering waist circumference and lipid parameters in addition to BMI when assessing metabolic risk among university students.

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: The craniofacial region is one of the most frequently injured parts of the human body, with mandibular fractures being the most common type of facial skeletal injury. The leading causes of mandibular fractures include traffic accidents, falls, interpersonal violence, and sports-related injuries. In Mongolia, mandibular fractures are prevalent, with a higher incidence among males. However, to date, no national-level analysis of mandibular fractures has been conducted. This study aims to comprehensively examine mandibular fractures in Mongolia by identifying demographic factors and causes of injury. Aim: To determine the incidence and causes of mandibular fractures recorded in Mongolia over the past ten years. Materials and Methods: This study collected data on mandibular fractures recorded in the Health Development Center of Mongolia between 2014 and 2023. Cases were identified using the International Classification of Diseases (ICD-10) code S02.6. Information on patient age, gender, and hospital diagnosis was collected, along with the cause of injury, classified according to ICD-10 codes. Patient age was categorized based on the classification system of the National Statistics Office. Statistical analysis was performed using SPSS 26.00 software, employing the chi-square test for data analysis. Results: During the study period, a total of 2,872 patients were diagnosed with mandibular fractures, with the highest incidence occurring in the 20-40 age group. The average patient age was 31.1±12 years. Males were 5.6 times more likely to sustain mandibular fractures compared to females. The primary causes of injury were interpersonal violence (42%), mechanical trauma (17%), falls (16%), and traffic accidents (15%). Conclusion Between 2014 and 2023, 2,872 cases of mandibular fractures were recorded in Mongolia, with the majority occurring in individuals aged 20-40 years. The leading causes of mandibular fractures were interpersonal violence, mechanical trauma, falls, and traffic accidents. Specialized trauma care services were accessed differently in urban and rural areas.

Background: Generation Z students, born after 1995, are characterized by their ability to multitask, low tolerance for traditional learning methods, impatience, short attention span, and preference for working independently rather than collaboratively. They are also considered more vulnerable to mental health challenges compared to previous generations. Aim: To assess the level of academic engagement among Generation Z students studying in the School of Nursing. Materials and Methods: This descriptive, cross-sectional quantitative study was conducted from February 1 to April 1, 2025. A total of 420 students majoring in nursing, midwifery, physical therapy, occupational therapy, and traditional medicine nursing at the School of Nursing, Mongolian National University of Medical Sciences, participated in the study. The Student Course Engagement Questionnaire (Handelsman, 2005) was used to evaluate students’ engagement levels. The reliability of the questionnaire was confirmed with a Cronbach’s α of 0.955. Statistical analysis was performed using SPSS version 25, and results were considered statistically significant at p<0.05. Results: Among the 420 participants, 91.9% were female and 8.1% were male. By major, 57.1% studied nursing, 22.6% midwifery, 8.8% physical therapy, and the remainder were from other disciplines. Student engagement was analyzed across three domains: academic involvement, personal responsibility and effort, and learning attitude and motivation. Pearson correlation analysis revealed strong positive correlations between academic involvement and personal responsibility/ effort (r=0.828), learning attitude and motivation (r=0.825), and between responsibility/effort and learning attitude/ motivation (r=0.903) (p<0.01). Age showed a weak positive correlation with year of study (r=0.381), while major and year of study had a weak negative correlation (r= -0.146) (p<0.01). Year of study and learning motivation also showed a weak negative correlation (r=-0.107, p<0.05). Conclusion The learning motivation and class engagement of Generation Z nursing students were found to be strongly correlated with their sense of responsibility, effort, and learning attitude (r=0.82–0.90, p<0.01). Most students demonstrated consistent participation and motivation to learn, showed less interest in traditional teaching approaches, and preferred practical training.

Background: Down syndrome (DS) is a chromosomal disorder and a leading cause of intellectual and physical developmental delay in children. In Mongolia, there is no current national guideline recommending the use of the quadruple biomarker test for prenatal screening of DS. Instead, triple marker testing during the second trimester remains standard practice. However, the quadruple test offers higher specificity and sensitivity. Therefore, this study was conducted to determine gestational age specific normative values for the quadruple markers, adjusted for ethnic characteristics. Currently, multiple of the median (MoM) values for Mongolian women are calculated using reference medians derived from Caucasian populations. This study aims to establish population-specific reference values for Mongolian women. Objective: To determine the normative serum levels of second-trimester quadruple biomarkers — alpha-fetoprotein (AFP), free beta-subunit of human chorionic gonadotropin (β-hCG), unconjugated estriol (uE3), and inhibin A (Inh-A) — in Mongolian pregnant women. Methods: A retrospective study was conducted involving pregnant women between 14 and 21 weeks of gestation. The concentrations of each biomarker were analyzed using multivariable quantile regression models, adjusting for gestational age and maternal weight. Results: MoM values calculated using the Mongolian model differed significantly from those based on the Caucasian model (Wilcoxon signed-rank test; p < 0.001). Specifically, the concentrations and MoM values for AFP and uE3 were significantly lower, while those for β-hCG and Inh-A were notably higher in the Mongolian cohort. Conclusion The serum levels of β-hCG and Inh-A were significantly elevated in Mongolian pregnant women compared to the ethnicity-adjusted Caucasian reference model, highlighting the importance of using population-specific normative data for accurate prenatal screening.

Introduction: Mostly fever change influences for heart and vital vessel and it is important for future treatment to compare difference of diagnosis and treatment feature of heart-disease in fever change. Goal: To compare difference of pain, feature, treatment and diagnosis when reduced fever change in heart Materials and Methods: The study was conducted using methods of ‘Comparing manuscript sources studies’, ’Analyses and syntheses’ for determining numbers and described with ‘Hermeneutics’ methodology. The study was based on approved methodology and ethical review in December 2018 Result: Fever could be directly matter of death because it should be needed to pay attention for method of treatment, to make research for general medicine of fever, to make research other organs & heart, to take medicine within ice sweet, to reduce fever and to treat through cautery, oily cream and ointment. Conclusion
1. Most diagnostic and pain of fever influence for heart and it depends on process of fever accordance with our research collection.
2. It is possible to consider similarly pain, diagnosis and treatment of heart pneumonia and heart fever based on classification of general heart disease of science of medicine.