Introduction In 1987 Jerome Ritchie, David Auth and colleagues first introduced rotational atherectomy (rotablation) as a technique for the endovascular treatment of obstructive atherosclerotic disease. Rotational atherectomy covers 3-5% of all procedures in big PCI centers, while <1% in smaller centers. By study of Warth DC et al. in 1994, at early period when it was first introduced, procedure complication of rotablation was about 40%, those with coronary dissection 29%, coronary artery occlusion 11.2%, side branch occlusion 1.8%, distal occlusion 0.9%, no relow phenomenon 6.1%, severe vasospasm 13.8% and vascular perforation 1-2%.
By advanced techniques and technologies that kind of complications reduced significantly, it occurs as same as other PCI procedures.
In our country PCI procedure was first introduced in Third State Central Hospital in 2000, since then 20 years has passed. During this period coronary intravascular diagnosis and treatment developed progressively performing 14751 PTCA procedures, of those 8355(56,6%) PCI cases. By statistics of 2017, myocardial infarction occurred 1145.6 in 10000 population, showing sharp increase, and cardiovascular mortality became number one cause and has tendency to increase further.
To inform first outcome of rotational atherectomy of atherosclerosis that is severely calcified and unavailable to introduce balloon catheter or stent. To conduct atherectomy treatment methods, accustoming professionals, order and get ready the treatment materials for necessity.
We successfully performed rotablation in severely calcified mLAD of 56 years of male patient by staged PCI, whose infarct related artery Lcx was revascularized 3 months previously. As a result the patient was fully revascularized, the balloon catheter passed through the narrowing and stent was implanted successfully.

Introduction: Khuumii (throat singing) is a unique form of art derived from the nomadic population of Central Asia, producing two or more “simultaneous” sounds and melodies through the organ of speech. Material and Methods: The aim of the study is to identify the anatomical structures involved in the formation of khuumii and the features and patterns of their functions and compare each type of khuumii as performed by Mongolian people. A total of 60 participants aged 18-60 years (54 men and 6 women) were selected by non-random sampling method using cross-sectional study. Statistical analysis was performed using SPSS 23 software using questionnaires, X-ray, endoscopy, sound research method, and general blood tests. Results: 90.7% of the khuumii singers were male and 9.3% were female. The average height of the participants was 172.91±0.93 cm (arithmetic mean and mean error), average body weight was 77.53±2.46 kg, and body mass index was 25.93±5.31 respectively. Heart rate was 92.19±20.71 per minute prior to khuumii while 133.19±19.09 after performing khuumii and 85.81-98.56 at 95% confidence interval. In terms of ethnicity (ethnographically), the Khalkh were the largest ethnic group (72.1%), followed by Bayad, Buryatia, Darkhad, Torguud, and Oirat (2.3%), respectively. 60.5% of the participants were professional khuumii singers who graduated from relevant universities and colleges. The process of Khuumii was recorded by X-ray examination, and laryngeal endoscopy evaluated the movement of true and false vocal chords, interstitial volume, movements of epiglottis and arytenoid cartilage, and mucosa. Khuumii increases the workload of the cardiovascular system by 70-80%. Furthermore, the sound frequency is 2-4 times higher than that of normal speech, and sound volume is 0.5-1 times higher. 95.3% of throat singers did not have a sore throat, 88.4% did not experience heavy breathing, and 74.1% had no hoarseness. During the formation of khuumii sound, thoracic cavity, diaphragm, and lungs regulate the intensity of the air reaching the vocal folds, exert pressure on the airways and vibrate the sound waves through air flows passing through the larynx and vocal folds. Mouth-nose cavity as well as pharynx are responsible for echoing the sound. Conclusion It is appropriate to divide khuumii into two main types according to structural and functional changes in the organs involved; shakhaa and kharkhiraa. Khuumii, the “Human music” originating from the people of Altai Khangai basin by imitating the sounds of nature with their own voice in ancient times, spread all over the world from Mongolia and it is proposed to classify khuumii into two main types of shakhaa and kharkhiraa in terms of structural involvement and functionality.

BACKGROUND: The limbe is a traditional Mongolian instrument that has been used since the ancient times, and the performer uses a unique method called circular breathing to play it. The circular breathing technique is significant heritage of the Mongolian people, and has been recognized by UNESCO World Heritage. Aim: To study the anatomy and physiology that take part in playing the Mongolian limbe with the circular breathing technique. METHODS: We have studied 20 flutists using case control study method. The flutists’ change of gas compound in blood have been studied with a gas analyzer after playing for 10 minutes with the circular breathing. When the flutists play it with circular breathing, the anatomical structures and their function have been studied and documented by an endoscopy, X-ray and a 320 row area detector CT. RESULTS: The 20 participants were between the ages of 22-56 with the circular breathing experience of 2 to 37 years. After playing the instrument for 10 minutes, we found the following results: 67.7% of the participants developed alkolosis, 23.5% hypocapnia, 5.9% hypercapnia, 94.1% hypoxia, and all participants’ oxygen saturation decreased. The lingual muscles, upper and under muscles of the hyoid bone, larynx and vocal cords are the main structures of the circular breathing. CONCLUSION: Playing Mongolian limbe with the circular breathing leads to hypoxia, thus the circular breathing stops. It is important to note that this process does not depend on flutist’s age, their practice time, and their personal technique. However, we concluded that the time of performance without interruption depends on individual’s physiological characteristics. In order to study the issues of anatomy and physiology that take part in playing the Mongolian limbe with the circular breathing, we have studied 20 flutists using case control study method. The flutists’ change of gas compound in blood have been studied with a gas analyzer after playing 10 minutes by the circular breathing. When the flutists play it with circular breathing, the anatomical structures and their function have been studied and documented by an endoscopy and X-ray. The lingual muscles, upper and under muscles of the hyoid bone, larynx and vocal cords take part in the circular breathing by limbe as a main rule. Playing Mongolian limbe with the circular breathing lead to hypoxia thus the circular breathing stops. This process does not depend on flutist’s age, their practice time, and their private technique. But we concluded that how long time they play it without interruption depends on individual’s physiological singularity.

Anomalies of the fetal orbit are caused by chromosomal and non-chromosomal abnormalities. The World Health Organization (WHO) recommended that the evaluation of the fetal growth and development using ultrasound to use their own national standard dimensions for obstetric and neonatal use. Nowadays, most countries have been using the own reference ranges for the fetal orbital dimensions in prenatal diagnosis for their nationality and ethnic group. In Mongolia, the extension of the standard parameters of biophetometer has been used for the fetus with 15-40 weeks of gestation. However, there is no study about fetal orbital dimensions. The purpose of our study was to determine the reference range of fetal orbital distances that can be diagnosed by ultrasound and to evaluate the relationships between the fetal orbital distances and the gestational ages (weeks).The study group included in 781 normal and fertility ages, pregnant women, which are relatively healthy and without any medical complications of pregnancy by prenatal examination of the routine ultrasound and genetic disorder at 16-36 weeks of gestation on a voluntary basis. Statistical analysis, including the linear regression and correlation were performed based on the obtained data.Correlations were observed between fetal orbital distances and the gestational ages. Strong linear relationships were observed between the fetal orbital (OD) (r= 0.81, p< 0.0001), biorbital (BOD) (r= 0.83, p< 0.0001), and inter-orbital (IOD) (r= 0.77, p < 0.0001)distances and the gestational ages (weeks). The fetal orbital distance (OD) was positively correlated with biparietal diameter (BPR) (r=0.77, p<0.0001), and the head circumference (HC) (r=0.83, p<0.0001). Moreover, strong correlations were observed between the biorbital distance (BOD) and the biparietal diameter (BPR) (r=0.804, p<0.0001), and the head circumference (HC) (r=0.86, p<0.0001). In addition, the inter-orbital distance (IOD) was positively correlated with biparietal diameter (BPR) (r=0.74, p<0.0001), and the head circumference (HC) (r=0.79, p<0.0001).The normal size of the orbital distance was slightly higher in Mongolian fetus compared to other countries. However, the inter-orbital distance was similar to other countries; and the bi-orbital distance was smaller in Mongolian fetus. These data may be helpful in the detection of fetal hypotelorism or hypertelorism.

GoalThis study was performed to construct Mongolian ethnic specific crown-rump length (CRL)nomogram and to compare its ability to predict gestational age with previously published widelyused nomograms in the world.Materials and MethodsA regression model was developed for estimation of gestational age using CRL measurements of1170 singleton fetuses in the Mongolian population. Measurements were obtained by placing thecalipers of the ultrasound machine from the crown to the rump. The appropriateness of previouslyestablished widespread CRL nomograms for predicting the gestational age was assessed in theMongolian population to determine comparability between nomograms.ResultsCRL corresponds to other nomograms up to 9 weeks of gestational age. There is a 4-5mm differenceof Robinson Hadlock; 7mm of Osaka at 10-12 weeks but the same with Campbell, 4 mm long ofCampbell at 13 weeks.Conclusions:CRL measurements are used as a reliable method for estimation of the gestational age as well asa baseline for comparing gestational ages later. CRL corresponds to other widely used nomogramup to 9 weeks gestational age. There is a 3mm differences of M.A.Esetov, 4-5mm Robinson, andHadlock; 7mm of Osaka at 10-12 weeks but the same with Campbell, 4 mm long of Campbell at13 weeks. Difference with the established nomograms may be due to ethnic differences of theMongolian fetal development. After 13 weeks, CRL measurement is unreliable due to flexion of thefetus.