Background: As global life expectancy increases, spinal disorders and the need for spinal surgery among elderly individ uals are becoming more prevalent. Postoperative cognitive decline (POCD) is a common complication in this population, adversely affecting functional recovery and quality of life. Despite substantial research, effective preventive strategies for POCD remain limited. Aim: To determine the incidence of POCD and to identify perioperative risk factors associated with its development in elderly patients undergoing spinal surgery. Materials and Methods: A prospective cohort study was conducted at the Second Affiliated Hospital of Inner Mongolia Medical University. Of 200 elderly patients who underwent spinal surgery between, 122 met the inclusion criteria and were enrolled. Preoperative clinical assessments, intraoperative surgical and anesthetic parameters, and postoperative evaluations were systematically collected. Cognitive function was assessed using standardized and validated tools both before and after surgery. Multivariate logistic regression analyses were performed to identify independent predictors of POCD. Results: POCD was observed in a notable proportion of patients postoperatively. Multivariate analysis revealed that prolonged surgical duration (OR=0.989; p=0.005), intraoperative hypotension (OR=0.964; p=0.009), higher intensity of postoperative pain (OR=10.073; p=0.015), and elevated postoperative C-reactive protein levels (OR=1.039; p<0.001) were significantly associated with an increased risk of developing POCD. Conclusion In elderly patients undergoing spinal surgery severe postoperative pain, and systemic inflammatory respons es contribute significantly to the development of POCD. Optimizing perioperative management, including minimizing surgical time, maintaining stable hemodynamics, and controlling postoperative inflammation and pain, may mitigate the risk of cognitive decline.

S100 proteins regulate intracellular processes such as cell growth and motility, cell cycle regulation, transcription and differentiation. S100 proteins represent the largest subgroup in the EF-hand Ca²⁺ binding protein family. The S100 protein family consists of 24 members functionally distributed into three main subgroups: those that only exert intracellular regulatory effects, those with intracellular and extracellular functions and those which mainly exert extracellular regulatory effects.
Within cells, S100 proteins are involved in aspects of regulation of proliferation, differentiation, apoptosis, Ca²⁺ homeostasis, energy metabolism, inflammation and migration/invasion through interactions with a variety of target proteins including enzymes, cytoskeletal subunits, receptors, transcription factors and nucleic acids. S100 proteins have received increasing attention due to their close association with several human diseases including cardiomyopathy, neurodegenerative disorders and cancer. They have also been proven to be valuable in the diagnostic of these diseases, as predictive markers of improving clinical management, outcome and survival of patients and are considered having a potential as drug targets to improve therapies.

Background: Postpartum readmission rate has been increasing after both caesarean and vaginal delivery. Postpartum diseases, in some cases with infection and anemia, result in hospital readmission. Also it raises the issue associated with maternal hospital’s healthcare quality. There has lack of study focusing on postpartum readmission. So we will study postpartum readmission rate. Material and Methods: 112 patients who readmitted in Amgalan maternity hospital in Ulaanbaatar were involved in this study. We used patient’s medical history to determine risk factors resulted in hospital readmission after caesarean and vaginal therapy. Results: The mean age of women delivered by cesarean was 30.2±7.32 and vaginal delivery’s was 28.3±7.21. 34.8 percent of women who readmitted after vaginal delivery had 1-3 readmission days and 56.5 percent was 4-6 days and 8.7 percent was 7-10 days. Readmission day for women delivered by caesarean was 1-3 days in 21.2 percent of these, 4-6 days in 56.1 percent and 7-10 days in 19.7 percent. The mean readmission day of women delivered by vaginal delivery was 4.73±1.61 (mean±SD) and the mean of women delivered by caesarean delivery was 5.54±2.34 (mean±SD). In each category, there had 24.2-28.3 percent cases with lochia. Women who had caesarian delivery were infected their scar with 24(36.3) cases. Renal urinary system infection had in 12(26.0) women delivered by vaginal delivery. Conclusion 58.9 percent of total readmissions cases were caesarean and 41.1 percent was vaginal delivery. Lochia and renal urinary infection had influence in readmission after vaginal delivery. Also both lochia and infected wound impacted on postpartum readmission after caesarian delivery.

Background: However kidney transplantation has being performed in Mongolia since 2006, because of pre-transplant sensitization, ABO incompatibility, hepatitis B and C virus activation many patients are taken kidney transplantation in abroad. The transplantation centers use own immunosuppressive regimens. Objective: Our aim was to assess the immunosuppressive regimens efficacy and toxicity in kidney transplant Mongolian recipients. Methods: We analyzed data from 96 adult kidney transplant recipients who had taken kidney transplantation in different transplant centers from August 2006 through January 2014. There were 3 kinds of regimens Group I Simulect induction with standard triple /FK506/CyA+MMF/AZA+steroid/, Group II Campath-1H induction with CNI monotherapy and Group III Campath-1H induction with standard triple /FK506/CyA+MMF/AZA+steroid/. We retrospectively collected the post-transplant first two years serum creatinine. The study was performed in 2014. The questionnaire was taken and blood samples collected for determination of tacrolimus through level and for other laboratory tests. The primary end point was the first two years serum creatinine, the secondary end points included rejection episodes, blood through level of tacrolimus and some laboratory findings. Results: The post-transplant first two years serum creatinine levels were significantly different in 3 groups. Group III showed similar results compared to Group I. There was not enough data of biopsy proven acute rejection episodes however group II said more rejections occurred. However participants said that rejection occurred in 15 (15.6%) biopsy was done only 3 (3.1%) cases. Blood through level of tacrolimus was significantly different in three groups. Some laboratory findings showed different between three groups. Conclusions A regimen of Campath-1H induction with CNI monotherapy (Group II) may be advantageous for short-term renal function and cost effective but there were more rejection complications and increased creatinine. The regimen of Campath-1H induction 11 with standard triple (Group III) may be advantageous for long-term renal function, allograft survival, but there should consider about infection complications and polycythemia. Simulect induction with standard triple could be best choice but transplantations were performed in experienced centers. The study enrolled few cases and cases which were performed at the beginning of transplant program so many things could influence on the result. The study was compared beginner transplant center with experienced centers. Longitudinal cohort study needed in the future.

Background: Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO₂ gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management.The goal of this study was to evaluate the influence of Pneumoperitoneum and Trendelenburg position on respiratory mechanics and ventilation. Methods: Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO₂ were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH₂O, then after PP10, PP20, PP30 minutes in the 20° Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated. Results: During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure by 6 cmH₂O, plateau pressure by 5 cmH₂O, while dynamic lung compliance decreased by 11 ml/cmH₂O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes. Conclusion The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO₂ significantly increased after pneumoperitoneum and CO₂ deflation.

IntroductionThe hospital mortality rate in low and middle-income countries is much higher than developed countries,thus enhancing the critical and emergency services will reduce rate of mortality. Providing life savingtreatment, continuous monitoring for the critically ill patient survival is defi nitely linked to availabilityand capability of equipment, drugs, medicine and trained personnel. Therefore, the challenges aredetermined and introduce stepwise method to reduce in-hospital mortality.GoalDetermining second level hospital’s capability to provide critical care and suffi ciency of medical supply.Materials and MethodProvince and district hospitals were included in the research and cross-sectional study conducted. Thesecond level hospitals were selected from 9 Provincials hospitals in 4 regions of Mongolia, 5 districthospitals in the capital city of Ulaanbaatar were involved, clustering and randomised in research. Theresearch conducted after obtaining Medical Ethical Committee approval. Statistical analysis usingSPSS-17. Data and some materials were analyzed with Shapiro-Wilk test for assessing the populationis normally distributed.ResultNone of the hospital is able to provide with 24-specialist doctor service in the emergency room and 3 (21,4%) hospitals have available for 24 hours intensive care doctor service.In the emergency settings, capability for FAST ultrasound examination is 8 (57, 1%) hospitals and noneof the hospital is able to provide echocardiography.Even though the number of intensive care bed is 5.6, the number of ventilators of hospitals are 2.5ventilators in 100.000 populations. 1 hospital is equipped with air-oxygen system. 3 (21.4%) of hospitalsare always able to perform central venous catheterization, and only 3 of the hospitals havevet thecapability of non-invasive ventilation. Drug and medicine use for cardiopulmonary resuscitation, availableof atropine and amiodoran were 9 (64.3%) and 5 (35.7%), respectively.Conclusion: None of the intensive care units of hospital, which participated in our research, able toprovide evidence-based emergency care on acutely ill patients.

Ilioinguinal (II) and iliohypogastric (IH) nerve blocks are often performed to provide intra- andpostoperative analgesia for hernia repair in children and adults. Several techniques are describedin the literature. Recently an ultrasound guided technique for II and IH nerve blocks were describedin the international journals. The block success rates are variable specially for using anatomicallandmark blind techniques. In the present study, the anatomical variations in course of the II andIH nerves are described. Knowledge of the course of these nerves in the inguinal region, and anunderstanding of variations seen in their topography, can decrease the incidence of postoperativecomplications and adverse effects. Ultrasound guidance of block performance will shorten the time,reduce the number of needle passes and shorten the block onset time. Blocks may be performedusing lower local anesthetic doses.

BackgroundThere are 137 soums of 17 provinces have plague foci in Mongolia. The 51.7% of them is case, 23.4%- low, 9.5% - high, 0.7% - hyper active. Main host of plague foci is marmot in Mongolia. According last20 year’s surveillance study, about 75.5% of Y.pestis was isolated from marmot, marmot carcassesand their flea. Human plague cases has been caused illegal hunting marmot in Mongolia. Even legaldocument which prohibited marmot hunting was appeared since 2005, people has been hunting marmotfor selling marmot meat, skin and other products. It is depends economy crises and other public issues inMongolia. Also influenced increase risk of human plague and being reverse result in plague preventionactivities.Materials and MethodsStudy was used data of rodent for zoonotic diseases suspicious which tested plague in National centerfor zoonotic disease (NCZD) in 2005-2015 and 13 local center for zoonotic diseases in 1988-2015. Datawas kept in NCZD and National archival authority. For mapping we used Arc View 3.2.ResultsTotally 397 event information of suspicious rodents and other animals was received in NCZD from 8 districtsof Ulaanbaatar city in 2002-2015. Most of information was received from Songinokhairkhan-64.2%district and smallest number was from Nalaikh district-0.3%. 92.2% of them were marmot, 0.1% of themwere marmot raw products for treatment purpose. Totally 1285 animal samples were tested by plaguedisease and the result was negative. Five hundred thirty tree marmots were carried to Ulaanbaatar from10 provinces. In that time plague foci were active and Y.pestis was isolated in provinces which marmotwas carried to Ulaanbaatar.In 1988-2015, totally 257 marmots and animals of 515 event information was received in15 provinces.Including 13.2% of them were birds, 84% of them marmot, 1.6% of them were livestock, 1.2% of themother animals. About 216 marmots were tested by plague. 51.2% of them were detected positive results.We develop conclusion based laboratory investigation result even it need high cost to take earlyprevention and response measures.Conclusion1. It is high risk to spread plague by carrying suspicious animal in urban area. Therefore, it is importantto take early response measures even it high cost. In further, increase cost and support rapid test ofhigh technology.2. To organize rational advertisement and increase knowledge of population about not doing illegalhunting, not selling marmot raw products in urban area, not using marmot raw products for treatmentuse and avoid contact with marmot carcasses.3. It is important to cooperate joint response measures with policeman, inspection agency andveterinary and human health sectors in Mongolia.

Thoracic surgery usually used for anesthesia double lumen endotracheal tubes, then ventilated one lung in NCC of Mongolia The clinical records of the 160 cases patients who had double-lumen endotracheal tubes to place in NCC of Mongolia. In patients during one lung anesthesia done 2012- 2014 were reviewed. All cases were performed high level thoracic epidural catheterization and put double lumen tube for jugular internal vena We are reporting 2012- 2014 anesthesia department at National Cancer Center of Mongolia. In our study involved all 160 open thoracic surgery cases with DLT. In study had anesthesia tidal volume 7.77+1.07ml/kg, one lung volume5.87+0.46 ml/kg, the Mongolian women DLT size 35.43+2.25Fr, deep 27.68+2.47 cm, Mongolian man DLT size 37.09+4.69cm, deep 28.43+2.6 cm. During anesthesia monitored average SpO2-95%+ 1.07,in analyzed arterial blood average SaO2- 92.65 %+ 5.69. (p<0.032) One lung anesthesia separating two lungs by double lumen tube (DLT) – the advantages of the method are allowing surgeons to operate safely in collapsed side of lung; there are a few reports of airway damages. The bronchoscope procedure is in need to use during the all operations in Mongolia. Other types of separation tube are required to be (especially in children) introduced. In the future lungs, esophagus, mediastinal tumors and heart, spine and vascular surgery need double lumen tube to global standards anesthesia widely available in Mongolia. The thoracic anesthesia use double lumen tube outside the epidural anesthesia decided that it can be combined with postoperative pain control. Correct technique of placing the double lumen tube one lung anesthesia surgical team and the shortness of time and the surgical risk patients with post-surgical complications and reduce mortality is of high importance in Mongolia. In our study is a dominant decided that it was linked to smoking habits

The aim of this study was to evaluate of analgesic effect of ultrasound guided transversus abdomines plane block in children undergoing open appendectomy surgery and compare to children were used GA alone.Twenty children aged 5-15 years with ASA I-II classification were randomly enrolled in this study.Each group had 10 children and all children were received GA with same techniques. Study group(transversus abdomines plane block group) were assigned to receive ultrasound guided block using 0.3 ml/kg of Bupivacaine 0.25%. Intraoperative hemodynamic changes, postoperative maximum pain score, the time the first analgesic requirement, correllation between inflammatory process, surgical disease complication and pain intensity were studied. Statistic analysis was made in Excel usingdescriptive analysis, correlation and regressive analysis. A p-value<0.05 was considered significant.There was no differencies between the two studied groups regarding demographic and clinicalcharacteristics. Intraoperative systolic blood pressure changes was higher in control group than studygroup (17%), and HR and BP were more stable in the study group. Level of WBC had direct positive relationship with appendix inflammation (r=0.71 (p-утга <0.001) and weak positive correlation (r=0.44 p-утга <0.05) with pain intensity. Postoperative pain score was higher in control group and the first analgesic requirement time was 2h. In the study group had mild to moderate pain and the the firstanalgesic requirement time was 4h.Transversus abdomines plane block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing open appendectomy surgery.