Mongolian National University of Medical Sciences

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Zezen Khana, Mongolia
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Lkhagvasuren B.,Kyushu University | Lkhagvasuren B.,Mongolian National University of Medical Sciences | Oka T.,Kyushu University
Physiological Reports | Year: 2017

The histaminergic system modulates numerous physiological functions such as wakefulness, circadian rhythm, feeding, and thermoregulation. However, it is not yet known if this system is also involved in psychological stress-induced hyperthermia (PSH) and, if so, which histamine (H) receptor subtype mediates the effect. Therefore, we investigated the effects of pretreatments with intraperitoneal injections of mepyramine (an H1 receptor inverse agonist), cimetidine (an H2 receptor antagonist), and ciproxifan (an H3 receptor inverse agonist) on cage-exchange stress-induced hyperthermia (a model of PSH) by monitoring core body temperature (Tc) during both light (10:00 am–12:00 pm) and dark (10:00 pm–12:00 am) phases in conscious, freely moving rats. We also investigated the effects of these drugs on stress-induced changes in locomotor activity (La) to rule out the possibility that effects on Tc are achieved secondary to altered La. Cage-exchange stress increased Tc within 20 min followed by a gradual decrease back to baseline Tc during both phases. In the light phase, mepyramine and cimetidine markedly attenuated PSH, whereas ciproxifan did not affect it. In contrast, in the dark phase, mepyramine dropped Tc by 1°C without affecting cage-exchange stress-induced hyperthermia, whereas cimetidine and ciproxifan did not affect both postinjection Tc and PSH. Cage-exchange stress induced an increase in La, especially in the light phase, but none of these drugs altered cage-exchange stress-induced La in either circadian rhythm phase. These results suggest that the histaminergic system is involved in the physiological mechanisms underlying PSH, particularly through H1 and H2 receptors, without influencing locomotor activity. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.


Nakao M.,Kurume University | Yamauchi K.,Kurume University | Ishihara Y.,Kurume University | Omori H.,Kumamoto University | And 2 more authors.
PLoS ONE | Year: 2017

The burden of chronic obstructive pulmonary disease (COPD) is expected to increase in the coming decades. In Ulaanbaatar, Mongolia, air pollution, which has been suggested to correlate with COPD, is a growing concern. However, the COPD prevalence in Ulaanbaatar is currently unknown. This study aims to estimate the prevalence of airflow limitation and investigate the association between airflow limitation and putative risk factors in the Mongolian population. Five cross-sectional studies were carried out in Ulaanbaatar. Administration of a self-completed questionnaire, body measurements, and medical examination including spirometry were performed in 746 subjects aged 40 to 79 years living in Ulaanbaatar. The age- and sex-standardized prevalence of airflow limitation in Ulaanbaatar varied widely from 4.0 to 10.9% depending on the criteria for asthma. Age, body mass index (BMI), and smoking habit were independent predictors for airflow limitation while residential area and household fuel type were not significant. In conclusion, prevalence of putative COPD was 10.0% when subjects with physician-diagnosed asthma were excluded from COPD. Older age, lower BMI, and current smoking status were putative risk factors for airflow limitation. This prevalence was consistent with reports from Asian countries. © 2017 Nakao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Meara J.G.,Harvard University | Meara J.G.,Boston Childrens Hospital | Leather A.J.M.,King's College London | Hagander L.,Lund University | And 44 more authors.
The Lancet | Year: 2015

Remarkable gains have been made in global health in the past 25 years, but progress has not been uniform. Mortality and morbidity from common conditions needing surgery have grown in the world's poorest regions, both in real terms and relative to other health gains. At the same time, development of safe, essential, life-saving surgical and anaesthesia care in low-income and middle-income countries (LMICs) has stagnated or regressed. In the absence of surgical care, case-fatality rates are high for common, easily treatable conditions including appendicitis, hernia, fractures, obstructed labour, congenital anomalies, and breast and cervical cancer. In 2015, many LMICs are facing a multifaceted burden of infectious disease, maternal disease, neonatal disease, non-communicable diseases, and injuries. Surgical and anaesthesia care are essential for the treatment of many of these conditions and represent an integral component of a functional, responsive, and resilient health system. In view of the large projected increase in the incidence of cancer, road traffi c injuries, and cardiovascular and metabolic diseases in LMICs, the need for surgical services in these regions will continue to rise substantially from now until 2030. Reduction of death and disability hinges on access to surgical and anaesthesia care, which should be available, aff ordable, timely, and safe to ensure good coverage, uptake, and outcomes. Despite growing need, the development and delivery of surgical and anaesthesia care in LMICs has been nearly absent from the global health discourse. Little has been written about the human and economic eff ect of surgical conditions, the state of surgical care, or the potential strategies for scale-up of surgical services in LMICs. To begin to address these crucial gaps in knowledge, policy, and action, the Lancet Commission on Global Surgery was launched in January, 2014. The Commission brought together an international, multidisciplinary team of 25 commissioners, supported by advisors and collaborators in more than 110 countries and six continents. We formed four working groups that focused on the domains of health-care delivery and management; workforce, training, and education; economics and fi nance; and information management. Our Commission has fi ve key messages, a set of indicators and recommendations to improve access to safe, aff ordablesurgical and anaesthesia care in LMICs, and a template for a national surgical plan. Our fi ve key messages are presented as follows: 5 billion people do not have access to safe, aff ordable surgical and anaesthesia care when needed. Access is worst in low-income and lower-middle-income countries, where nine of ten people cannot access basic surgical care. 143 million additional surgical procedures are needed in LMICs each year to save lives and prevent disability. Of the 313 million procedures undertaken worldwide each year, only 6% occur in the poorest countries, where over a third of the world's population lives. Low operative volumes are associated with high case-fatality rates from common, treatable surgical conditions. Unmet need is greatest in eastern, western, and central sub-Saharan Africa, and south Asia. 33 million individuals face catastrophic health expenditure due to payment for surgery and anaesthesia care each year. An additional 48 million cases of catastrophic expenditure are attributable to the nonmedical costs of accessing surgical care. A quarter of people who have a surgical procedure will incur fi nancial catastrophe as a result of seeking care. The burden of catastrophic expenditure for surgery is highest in low-income and lower-middle-income countries and, within any country, lands most heavily on poor people. Investing in surgical services in LMICs is aff ordable, saves lives, and promotes economic growth. To meet present and projected population demands, urgent investment in human and physical resources for surgical and anaesthesia care is needed. If LMICs were to scale-up surgical services at rates achieved by the present best-performing LMICs, two-thirds of countries would be able to reach a minimum operative volume of 5000 surgical procedures per 100 000 population by 2030. Without urgent and accelerated investment in surgical scale-up, LMICs will continue to have losses in economic productivity, estimated cumulatively at US $12.3 trillion (2010 US$, purchasing power parity) between 2015 and 2030. Surgery is an "indivisible, indispensable part of health care."1 Surgical and anaesthesia care should be an integral component of a national health system in countries at all levels of development. Surgical services are a prerequisite for the full attainment of local andglobal health goals in areas as diverse as cancer, injury, cardiovascular disease, infection, and reproductive, maternal, neonatal, and child health. Universal health coverage and the health aspirations set out in the post-2015 Sustainable Development Goals will be impossible to achieve without ensuring that surgical and anaesthesia care is available, accessible, safe, timely, and aff ordable. In summary, the Commission's key fi ndings show that the human and economic consequences of untreated surgical conditions in LMICs are large and for many years have gone unrecognised. During the past two decades, global health has focused on individual diseases. The development of integrated health services and health systems has been somewhat neglected. As such, surgical care has been aff orded low priority in the world's poorest regions. Our report presents a clear challenge to this approach. As a new era of global health begins in 2015, the focus should be on the development of broad-based health-systems solutions, and resources should be allocated accordingly. Surgical care has an incontrovertible, cross-cutting role in achievement of local and global health challenges. It is an important part of the solution to many diseases-for both old threats and new challenges-and a crucial component of a functional, responsive, and resilient health system. The health gains from scaling up surgical care in LMICs are great and the economic benefi ts substantial. They accrue across all disease-cause categories and at all stages of life, but especially benefi t our youth and young adult populations. The provision of safe and aff ordable surgical and anaesthesia care when needed not only reduces premature death and disability, but also boosts welfare, economic productivity, capacity, and freedoms, contributing to longterm development. Our six core surgical indicators(table 1) should be tracked and reported by all countries and global health organisations, such as the World Bank through the World Development Indicators, WHO through the Global Reference List of 100 Core Health Indicators, and entities tracking the SDGs. At the opening meeting of the Lancet Commission on Global Surgery in January, 2014, Jim Kim, President of the World Bank, stated that: "surgery is an indivisible, indispensable part of health care" and "can help millions of people lead healthier, more productive lives. In 2015, good reason exists to ensure that access to surgical and anaesthesia care is realised for all.


PubMed | Mongolian National University of Medical Sciences, University of Eastern Finland and Gothenburg University
Type: Journal Article | Journal: International journal for equity in health | Year: 2016

The social health insurance coverage is relatively high in Mongolia; however, escalation of out-of-pocket payments for health care, which reached 41% of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia.We used the data from the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national and The Wold Bank poverty lines are used.About 5.5% of total households suffered from catastrophic health expenditures, when the threshold is 10% of the total household expenditure. At the threshold of 40% of capacity to pay, 1.1% of the total household incurred catastrophic health expenditures. About 20,000 people were forced into poverty due to paying for health care.Despite the high coverage of social health insurance, a significant proportion of the population incurred catastrophic health expenditures and was forced into poverty due to out-of-pocket payments for health care.


Dashtsoodol N.,RIKEN | Dashtsoodol N.,Mongolian National University of Medical Sciences | Shigeura T.,RIKEN | Aihara M.,RIKEN | And 7 more authors.
Nature Immunology | Year: 2017

Although invariant V α 14 + natural killer T cells (NKT cells) are thought to be generated from CD4 + CD8 + double-positive (DP) thymocytes, the developmental origin of CD4 - CD8 - double-negative (DN) NKT cells still remains unresolved. Here we provide definitive genetic evidence obtained, through studies of mice with DP-stage-specific ablation of expression of the gene encoding the recombinase component RAG-2 (Rag2) and by a fate-mapping approach, that supports the proposal of the existence of an alternative developmental pathway through which a fraction of DN NKT cells with strong T-helper-type-1 (T H 1)-biased and cytotoxic characteristics develop from late DN-stage thymocytes, bypassing the DP stage. These findings provide new insight into understanding of the development of NKT cells and propose a role for timing of expression of the invariant T cell antigen receptor in determining the functional properties of NKT cells.


Shagdarsuren D.,Mongolian National University of Medical Sciences | Gerelmaa B.,Mongolian National University of Medical Sciences
Asian Bioethics Review | Year: 2016

In Western medical ethics, compassion serves mainly to define the responsibilities and duties of medical professionals. In contrast, Eastern medical ethics consider developing compassion as a prerequisite in becoming a physician and recognise its curing effects. In the traditional medicine of Tibet and Mongolia, where Mahayana buddhism prevails, a physician is seen as an enlightened person who has been thoroughly trained in Buddhist philosophy. In order to become a physician, one should develop compassion, which is considered as a path to enlightenment. Compassion is not a characteristic but a skill used for therapeutic purposes, which should be mastered through training and meditation, stage by stage. © 2016 The Authors.


Munkhdelger Y.,Mongolian National University of Medical Sciences | Gunregjav N.,National Center for Communicable Diseases | Dorjpurev A.,National Center for Communicable Diseases | Juniichiro N.,Kagoshima University | Sarantuya J.,Mongolian National University of Medical Sciences
Journal of Infection in Developing Countries | Year: 2017

Introduction: The severity of urinary tract infection (UTI) produced by uropathogenic Escherichia coli (UPEC) is due to the expression of a wide spectrum of virulence genes. E. coli strains were divided into four phylogenetic groups (A, B1, B2 and D) based on their virulence genes. The present study aimed to assess the relationship between virulence genes, phylogenetic groups, and antibiotic resistance of UPEC. Methodology: A total of 148 E. coli were tested for antimicrobial resistance against 10 drugs using the disk diffusion method. The isolates were screened by polymerase chain reaction (PCR) for detection of virulence genes and categorized into the four major phylogenetic groups. Results: Phylogenetic group B2 was predominant (33.8%), followed by D (28.4%), A (19.6), and B1 (18.2%). A higher prevalence of fimH (89.9%), fyuA (70.3%), traT (66.2%), iutA (62.2%), kpsMTII (58.8%), and aer (56.1%) genes were found in UPEC, indicating a putative role of adhesins, iron acquisition systems, and protectins that are main cause of UTIs. The most common antibiotic resistance was to cephalotin (85.1%), ampicillin (78.4%) and the least to nitrofurantoin (5.4%) and imipenem (2%). In total, 93.9% of isolates were multidrug resistant (MDR). Conclusions: This study showed that group B2 and D were the predominant phylogenetic groups and virulence-associated genes were mostly distributed in these groups. The virulence genes encoding components of adhesins, iron acquisition systems, and protectins were highly prevalent among antibiotic-resistant UPEC. Although the majority of strains are MDR, nitrofurantoin is the drug of choice for treatment of UTI patients in Ulaanbaatar. © 2017 Munkhdelger et al.


PubMed | Mongolian National University of Medical Sciences, Taipei Medical University Hospital, Hwa Hsia University of Technology, National Yang Ming University and Tzu Chi University
Type: Journal Article | Journal: Oncology letters | Year: 2017

Fisetin (3,7,3,4-tetrahydroxyflavone), which belongs to the flavonoid group of polyphenols and is found in a wide range of plants, has been reported to exhibit a number of biological activities in human cancer cells, including antioxidant, anti-inflammatory, antiangiogenic, anti-invasive and antiproliferative effects. Although previous


Odkhuu E.,Aichi Medical University | Mendjargal A.,Mongolian National University of Medical Sciences | Koide N.,Aichi Medical University | Naiki Y.,Aichi Medical University | And 2 more authors.
Immunobiology | Year: 2015

The effect of lipopolysaccharide (LPS) on the expression of p53 protein in RAW 264.7 macrophage cells was examined. LPS downregulated the expression of p53 protein 4-24 h after the stimulation. LPS-induced p53 inhibition was restored with pharmacological inhibitors of c-jun N-terminal kinase (JNK) and phosphatidylinositol 3-kinase (PI3K). It was also restored by inhibitors of MDM2 activation and proteasome. LPS-induced p53 inhibition corresponded to activation of MDM2. LPS-induced MDM2 activation was prevented by inhibitors of JNK and PI3K. The expression of p65 NF-κB at a late stage after LPS stimulation was downregulated in the presence of a MDM2 inhibitor. Nutlin-3 as a MDM2 inhibitor reduced LPS-induced production of nitric oxide but not tumor necrosis factor-α. Administration of LPS into mice downregulated the in vivo expression of p53 in the livers. Taken together, LPS was suggested to downregulate the expression of p53 via activation of MDM2 and enhance the activation of NF-κB at a late stage. Copyright © 2014 Elsevier GmbH. All rights reserved.


Enkh-Oyun T.,Mongolian National University of Medical Sciences | Kotani K.,Jichi Medical University | Swanson E.,Brian Allgood Army Community Hospital
International Health | Year: 2016

Ischemic heart disease (IHD) is considered to be a pivotal health problem in Mongolia. To summarize the existing epidemiology of IHD in the general Mongolian population is crucial for primary prevention. The present review summarized population-based epidemiological data of IHD in Mongolia. When epidemiological studies were extracted from databases, very limited studies were available. The frequencies of IHD and IHD-attributable death rates appeared to be high and have an increased tendency in Mongolia. This could to be due to a gradually worsening state of potential IHD-related risk factors, such as smoking, hypertension, hypercholesterolemia, obesity and diabetes mellitus. This might indicate an urgent need of strategies for IHD and related risk factors. Anti-IHD strategies, such as more epidemiological studies and campaigns to increase awareness of IHD, at nationwide public health levels would be required in Mongolia for more effective prevention. © The Author 2015.

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