Purpose: This study aimed to examine changes in nurse staffing grades and nursing fee revenues in intensive care units (ICUs) following the third amendment of the resource-based relative value scale, which was implemented in January 2024. Methods: Changes in staffing grades from the fourth quarter of 2023 to the first quarter of 2024 were analyzed among 588 general ICUs, 94 neonatal ICUs, and 13 pediatric ICUs. Annual nursing fee revenues per nurse were estimated based on the new nursing fee structure for each grade. Results: In general ICUs, the highest grade (grade S) and the second-highest grade (grade A) accounted for 7.3% and 41.5%, respectively, in tertiary hospitals, whereas 3.8% were grade S and 11.5% were grade A in general hospitals. In neonatal ICUs, the proportion of higher grades (S, A, and 1) was greater in general hospitals (54.3%) than in tertiary hospitals (38.6%). In pediatric ICUs, 30.8% were grade S and 61.5% were grade A. When applying the same grading criteria (i.e., beds per nurse) across both quarters, staffing levels remained unchanged in most ICUs. Nursing fees and their revenues did not increase proportionally to staffing requirements (i.e., the number of nurses required per patient). Conclusion Revisions to staffing grade and nursing fee systems are necessary to induce medical institutions to improve their ICU staffing levels.

Background/Aims: This study aimed to evaluate the performance of the Model for End-Stage Liver Disease (MELD) 3.0 for predicting mortality and liver-related complications compared with the Child-Pugh classification, albumin-bilirubin (ALBI) grade, the MELD, and the MELD sodium (MELDNa) score. Methods: We evaluated a multicenter retrospective cohort of incorporated patients with cirrhosis between 2013 and 2019. We conducted comparisons of the area under the receiver operating characteristic curve (AUROC) of the MELD3.0 and other models for predicting 3-month mortality. Additionally, we assessed the risk of cirrhosis-related complications according to the MELD3.0 score. Results: A total of 3,314 patients were included. The mean age was 55.9±11.3 years, and 70.2% of the patients were male. Within the initial 3 months, 220 patients (6.6%) died, and the MELD3.0had the best predictive performance among the tested models, with an AUROC of 0.851, outperforming the Child-Pugh classification, ALBI grade, MELD, and MELDNa. A high MELD3.0score was associated with an increased risk of mortality. Compared with that of the group with a MELD3.0 score <10 points, the adjusted hazard ratio of the group with a score of 10–20 pointswas 2.176, and that for the group with a score of ≥20 points was 4.892. Each 1-point increase inthe MELD3.0 score increased the risk of cirrhosis-related complications by 1.033-fold. The risk of hepatorenal syndrome showed the highest increase, with an adjusted hazard ratio of 1.149, followed by hepatic encephalopathy and ascites. Conclusions The MELD3.0 demonstrated robust prognostic performance in predicting mortality in patients with cirrhosis. Moreover, the MELD3.0 score was linked to cirrhosis-related complications, particularly those involving kidney function, such as hepatorenal syndrome and ascites.

Purpose: This study aimed to examine changes in nurse staffing grades and nursing fee revenues in intensive care units (ICUs) following the third amendment of the resource-based relative value scale, which was implemented in January 2024. Methods: Changes in staffing grades from the fourth quarter of 2023 to the first quarter of 2024 were analyzed among 588 general ICUs, 94 neonatal ICUs, and 13 pediatric ICUs. Annual nursing fee revenues per nurse were estimated based on the new nursing fee structure for each grade. Results: In general ICUs, the highest grade (grade S) and the second-highest grade (grade A) accounted for 7.3% and 41.5%, respectively, in tertiary hospitals, whereas 3.8% were grade S and 11.5% were grade A in general hospitals. In neonatal ICUs, the proportion of higher grades (S, A, and 1) was greater in general hospitals (54.3%) than in tertiary hospitals (38.6%). In pediatric ICUs, 30.8% were grade S and 61.5% were grade A. When applying the same grading criteria (i.e., beds per nurse) across both quarters, staffing levels remained unchanged in most ICUs. Nursing fees and their revenues did not increase proportionally to staffing requirements (i.e., the number of nurses required per patient). Conclusion Revisions to staffing grade and nursing fee systems are necessary to induce medical institutions to improve their ICU staffing levels.

Background: Currently, colorectal cancer (CRC) ranks as the third most common cancer and the second leading cause of cancer-related mortality worldwide. CRC frequently metastasizes to the liver (50%), lungs (10–15%), peritoneum (4%), bones (10.7%–23.7%), brain (0.3%–6%), and spinal cord. Approximately 35% of CRC cases are diagnosed before distant metastasis, 36% upon lymph node involvement, and 23% after distant organ metastasis. Although several studies have established primary tumor models in mice in our country, there are limited studies on experimental lung metastasis models, prompting the need for this research. Aim: To establish and evaluate a lung metastasis model of colorectal cancer in C57BL/6J mice using the MC38 cell line. Materials and Methods: This study was conducted at the Institute of Biomedical Sciences, Mongolian National University of Medical Sciences. Approval was obtained from the Ethics Review Board of the Mongolian National University of Medical Sciences (2023/3-09) and all laboratory safety regulations and protocols were strictly followed. Male C57BL/6J mice bred at the Experimental Animal Center of Mongolian National University of Medical Sciences were used. MC38 murine colorectal carcinoma cells were cultured and injected intravenously (via the tail vein) at a concentration of 0.25×10⁶ cells per mouse (n=12) to induce lung metastasis. Histological analysis was subsequently performed. Results: Histological examination revealed significant alterations in lung tissue architecture, characterized by areas of dense infiltration by pleomorphic, hyperchromatic cells, disrupting the normal alveolar structure. No histological abnormalities were observed in other organs. Conclusion Intravenous injection of MC38 colorectal adenocarcinoma cells into the tail vein of C57BL/6J mice successfully induced lung metastases, characterized by hyperchromatic, pleomorphic cell infiltrates forming glandular structures within the lung parenchyma.

Background: Atopic dermatitis (AD) is a common chronic and relapsing inflammatory skin disease in young children, clinically characterized by pruritus and skin rashes. Epidemiological studies have reported that AD affects 5–30% of children and 1-10% of adults worldwide. In recent years, the use of mineral waters for the treatment of chronic skin conditions has become increasingly popular globally. Although mineral waters, particularly from Shargaljuut springs, have been traditionally used in Mongolia for various dermatological conditions, no studies have been conducted on their use in atopic dermatitis, providing the rationale for this study Aim: To evaluate the result of Shargaljuut mineral spray on disease severity, pruritus intensity, and selected physiological parameters of the skin in children with atopic dermatitis. Materials and Methods: This clinical trial study with a placebo-controlled group included children aged 2-16 years with AD. The participants were treated with Shargaljuut spray and the clinical assessment was conducted before and after the treatment, evaluating severity using SCORAD (Severity Scoring of Atopic Dermatitis), itching intensity using VAS (Visual Analog Scale), skin hydration (SCH) and transepidermal water loss (TEWL). Results: Among all participants, 81.7% (n=49) had mild atopic dermatitis based on SCORAD scores, and 18.3% (n=11) had moderate severity. According to the VAS scores, 40% (n=24) of the participants reported mild pruritus. Skin hydration was found to be severely decreased in 96.7% (n=58) of the cases, while TEWL values were within normal limits in 76.7% (n=46). Statistically significant differences were observed between the experimental and control groups at day 30 in terms of disease severity and pruritus intensity, as well as in certain skin physiological parameters (p=0.001, p=0.002). Within the experimental group, statistically significant differences were also detected in disease severity (p=0.001), pruritus intensity (p=0.002), skin hydration (p=0.002), and TEWL (p=0.001) between baseline, day 15, and day 30. A correlation was found between transepidermal water loss (TEWL) and skin hydration (r=0.566, p=0.0001). Conclusions 1. Among the children with atopic dermatitis (AD) included in the study, 81.7% (n=49) had a mild severity score according to SCORAD, 40% (n=24) had mild itching intensity based on the VAS assessment, 96.7% (n=58) had excessively dry skin, and 76.7% (n=46) showed good transepidermal water loss (TEWL) levels. 2. In the experimental group, comparisons of disease severity, itching intensity, skin hydration, and TEWL levels before and after the use of the Shargaljuut spring water spray revealed that skin hydration increased, TEWL decreased, and both disease severity and itching intensity were reduced following treatment

Background: Insomnia is one of the most prevalent neurological disorders in the United States, affecting up to half of primary care patients and often necessitating psycho-behavioral interventions. Acupuncture, a key component of traditional Chinese and Mongolian medicine, has been increasingly studied as a treatment for insomnia in recent years. Aim: Evaluating the effectiveness of acupuncture for insomnia Materials and Methods: The study was conducted using a randomized controlled clinical trial design. 148 participants, aged 18-65 years, with a diagnosis of Nonorganic Insomnia (F51.0) according to the ICD-10, and Pittsburgh Sleep Quality Index (PSQI) >7, were divided into the transverse acupuncture, conventional acupuncture, and the control group. The results were analyzed using a Cardiopulmonary Coupling - CPC machine before and after treatment in the 3 groups to assess 1. Total sleep (hours), 2. Deep sleep (hours), 3. Light sleep (hours), 4. REM (hours), 5. Wake time (minutes), 6. Time to first fall asleep (minutes), 7. Sleep rate (%), 8. Number of apneas, and sleep quality was assessed using the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. The research approval was reviewed and granted by the Research Ethics Review Committee of the Mongolian National University of Medical Sciences on January 19, 2024 (Approval No. 24/19/01). Results: The mean age of participants was 51.5±10.8 years, with 79.7% (n=118) being female and 20.3% (n=30) male. In the transverse acupuncture group, post-treatment results demonstrated a 53.8% increase in total sleep time, a 102.8% increase in deep sleep time, a 19.8% increase in light sleep time, a 36.1% increase in REM sleep time, and a 22.1% improvement in sleep normalization rate. The mean differences between pre- and post-treatment scores were statistically significant based on a one-sample t-test. In contrast, no statistically significant improvements were observed in the control group, except for sleep quality. Conclusion Both transverse acupuncture and conventional acupuncture significantly improved sleep quality indicators following treatment.

Background: Vaginal candidiasis is a highly prevalent infectious disease among women caused by a wide range of pathogenic organisms. Although it can be treated with standard pharmacological methods, it has detrimental effects on women’s reproductive health. The absence of research to date on the anti-vaginal inflammatory effects of Jirug-6 suppositories - a traditional formulation derived from ancient medicinal recipes and long-used in traditional mongolian medicine has provided the rationale for conducting this study. Aim: Study of the effects of Jirug-6 suppositories on the vaginal inflammatory lesion model induced by Candida albicans. Materials and Methods: To establish the vaginal inflammatory lesion model in experimental animals, the inoculum was prepared according to the McFarland standard method, and 10 µL of the inoculum was intravaginally administered daily for 4 consecutive days. Fifty-six mice with induced vaginal candidiasis were divided into 7 groups. On treatment days 1, 3, 5, 7, and 10, the vaginal cavity of the mice was washed with 100 µL of phosphate buffer. From the lavage fluid, 20 µL was collected, mixed with 480 µL of phosphate buffer, and thoroughly homogenized. Using a 20 µL micropipette, three aliquots were inoculated onto Sabouraud Dextrose Agar (SDA) medium and incubated at 37°C for 48 hours. Colonies were counted, and at the end of the experiment, serum was isolated from blood samples, and IFN-γ and IL-10 levels in the samples were quantified using ELISA. Histopathological analysis was performed on vaginal tissues from the experimental animals. Results: In the experimental animals, Jirug-6 suppositories 0.4 mg/kg dose exhibited the mildest clinical signs of hyperemia, swelling, hemorrhage, infiltration, or fluid loss into soft tissues in the vaginal and cervical regions (p<0.01). For cervical inflammation, Jirug-6 suppositories 0.4 mg/kg demonstrated a strong anti-inflammatory effect with a score of 1.99±0.78, which was comparable to the positive control group (p<0.01). In serum, the concentrations of IFN-γ and IL-10 in Jirug-6 suppositories 0.4 mg/kg were determined to be 8.18±0.61 and 7.91±1.30, respectively, showing reduced levels similar to those of the positive control group (p<0.01). Conclusions 1. Jirug-6 suppositories reduce inflammatory symptoms and suppresses fungal dissemination during the vaginal lesion model induced by C. albicans. 2. At a Jirug-6 suppositories 0.4 mg/kg demonstrates anti-inflammatory effects by increasing IFN-γ concentration and decreasing IL-10 concentration in the C. albicans-induced vaginal lesion model. Furthermore, it enhances immunity and reduces swelling during inflammation, exhibiting positive therapeutic effects against clinical symptoms.

Background: The most common clinical manifestation of HCV infection, which includes both hepatic and extrahepatic manifestations, is mixed cryoglobulinemia, which is characterized by the precipitation of certain proteins in the blood at temperatures below 37°C (in vitro), aggregation, and deposition in the walls of small and medium-sized vessels, causing vasculitis, which is clinically manifested by a triad of joint pain, fatigue, and rash on the soles of the feet. Cryoglobulinemia is commonly diagnosed in people with HCV infection, with a prevalence ranging from 10% to 70%. Vasculitis that occurs when cryoglobulinemia is detected mainly affects the small vessels of the skin, kidneys, and peripheral nerves, causing complications in other organ systems. Aim : To determine the prevalence of cryoglobulinemia in people with HCV infection, study it in relation to the stage of liver fibrosis, and determine its clinical relevance. Materials and Methods : 200 chronic HCV infected individuals were included in the study according to the inclusion and exclusion criteria. After obtaining informed consent from each participant, a questionnaire was used to collect information, perform physical measurements, and collect peripheral blood samples. Complete blood count and biochemical tests (liver and kidney function) were performed. The degree of liver fibrosis was assessed non-invasively (APRI, FIB4). The glomerular filtration rate was calculated electronically using the MDRD GFR Equation. Skin examination was performed to assess the presence of rash, ulcers, and scarring on the shins and ankles of cryoglobulinemia. To determine cryoglobulinemia, 8 ml of blood was collected in a tube without anticoagulant, and the sample was kept motionless for 1 hour at room temperature until clotting was complete. After centrifugation, the samples were separated and stored in a refrigerator at +4°C for 7 days, and then at room temperature for 30 minutes, the precipitate was detected. Results : A total of 200 people participated in the study, of which 71 were men (35.5%), the average age was 53.39±13.0. Cryoglobulinemia protein precipitates were determined in a total of 148 people, of which 50 were men (33.8%), the average age was 52.95±13.0. Cryoglobulinemia protein precipitates were detected in 89 people, or 60.1% of the study participants. Of the total study participants, 176 (88.0%) had chronic hepatitis C (CHC). Of these, 57 people had CHC with cryoglobulinemia. Comparing laboratory parameters, the mean GGT level in the cryoglobulinemia group was statistically significantly higher than in the non-cryoglobulinemia group (p=0.039). However, when laboratory parameters were grouped by increasing or decreasing, AST and ALT levels were significantly higher in the cryoglobulinemia group, indicating more hepatocellular damage (p<0.000). Increased creatinine levels may be associated with the risk of renal dysfunction. The FIB-4 index and APRI index showed a more severe degree of fibrosis in the cryoglobulinemia group (p<0.005; p<0.000). Univariate logistic regression analysis showed that age was associated with the occurrence of cryoglobulinemia (OR=2.48; 95% CI:1.31–4.70; p=0.005). Platelet count had a statistically significant positive effect in multivariate analysis (OR=14.38; 95% CI:1.26–163.89; p=0.032). Conclusion The prevalence of cryoglobulinemia among HCV-infected patients was 60.1%, and older age and decreased platelet count among infected individuals were associated with the occurrence of cryoglobulinemia.