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Abstract Background In the current era of assisted reproductive technology, the strategy of single vitrified-warmed blastocyst transfer (SVBT) is acknowledged for positively impacting clinical outcomes and preventing the risk of multiple conceptions. Previous studies have indicated that blastocyst grade and the day of blastocyst positively correlate with outcomes. Moreover, storage duration has no significant effect on survival rates, clinical outcomes, and neonatal outcomes. However, some researchers express controversial opinions on cryostorage duration, and their findings suggest a negative impact on clinical outcomes. These results remain subject to controversy, and limited studies exist regarding the outcomes after SVBT. Therefore, our study aims to investigate the impact of the day of blastocyst, blastocyst grade, and blastocyst cryostorage duration on clinical and neonatal outcomes following SVBT in patients who underwent clomiphene-citrate-based minimal stimulation. Material and methods In this study, retrospective cohort study data collected from June 2015 to April 2023 included 2107 patients with first SVBT cycles who underwent a clomiphene-based minimal ovarian stimulation protocol or a drug-free natural protocol at the Ojinmed IVF Center. Patients were categorized into four groups based on blastocyst cryostorage duration: group 1 (

Objective: This study aimed to estimate the 30 days readmissions and predictors of readmission at selected referral hospitals in Mongolia. Methods: We studied the electronic medical recording database of patients admitted to The State First Central Hospital of Mongolia, The State Second Central Hospital of Mongolia, and The State Third Central Hospital of Mongolia, from January 01, 2023, to June 30, 2023. The Institute for Healthcare Improvement’s Whole system measures white paper adopted the measurement methods for hospital readmission percentages. A descriptive analysis was conducted to calculate the percentage of hospital readmissions. We examined principal diagnoses, length of stay and age and gender are variables. Results: 31,675 hospital discharged data were recorded in hospitals over the 6-month study period. The average readmission percentage across the three hospitals were 1988 (6.3%). Most of the principal diagnosis leading to readmissions were cancer and chronic diseases. Conclusion: The highest hospital readmission rates were observed in patients with cancer and chronic diseases, particularly among individuals aged 46-64 years in the referral hospitals.

Objective: Ameloblastoma (AM) is a prevalent benign odontogenic tumor affecting the jaw bone. Its potential for recurrence and malignant transformation is closely associated with the regulation of signaling pathways. The objective of this study was to examine the expression and clinical significance of Notch1 in AM, along with exploring the correlation between Notch1 expression and AM imaging patterns. Methods: The streptavidin-peroxidase (S-P) immunohistochemical technique was employed to detect the expression of Notch1 protein in the oral mucosa of 70 AM patients and 25 normal controls. Additionally, the preoperative cone-beam computed tomography (CBCT) images of the patients were classified, and the results were analyzed in relation to the expression of Notch1 protein in AM. Results: The positive expression rate of Notch1 in the 70 AM patients was 74.29% (52/70), while the Notch1 expression rate in 26 oral mucosa patients was 19.23% (5/26), indicating a statistically significant difference (P < 0.05). The expression rate of Notch1 was 58.06% in single-room AM and lower in multi-room AM (85.29%) and honeycomb AM (100%) (P < 0.01). However, there was no significant difference in the expression rate of Notch1 between multi-room AM and honeycomb AM (P > 0.05). Conclusion: Notch1 may serve as an important diagnostic indicator in AM, and the apoptosis inhibition ability and cell proliferation ability of single-room AM are lower compared to those of the room and honeycomb types

Bacterial vector-borne pathogens (BVBPs) negatively impact canine health worldwide, with several also being zoonotic, posing an additional disease risk to humans. To date, BVBPs have been reported in humans and various sylvatic and domestic animal hosts across multiple Mongolian aimags (provinces); however, there has been no published data on these pathogens within Mongolia’s canine populations. Collection of such data is important given Mongolia’s size, diverse number of climatic regions, and large population of dogs, most of which closely share their environment with humans and livestock. Therefore, a bacteria-targeting next-generation sequencing metabarcoding (mNGS) assay was used to test the feasibility of mNGS as a proof-of-concept study to ascertain the detection of BVBP in 100 Mongolian dogs. The majority of dogs (n = 74) were infected with at least one of six BVBPs identified; including three species of haemoplasmas (also known as haemotropic mycoplasmas, n = 71), Bartonella rochalimae (n = 3), Ehrlichia spp. (n = 2) and Anaplasma platys (n = 1). Univariable analysis found sex, housing, and role of the dog to be associated with BVBP infection. Male dogs had 4.33 (95% CI: 1.61–11.62, P = 0.003) times the odds of infection with BVBPs compared to females. The majority of dogs included in this study were kept outdoors and had regular direct contact with both livestock and humans, indicating that dogs may contribute to the transmission and dissemination of BVBPs in Mongolia and could act as epidemiological sentinels. This study underscores the importance of pathogen surveillance studies in under-researched regions, reinforces the efficacy of mNGS as an explorative diagnostic tool, and emphasises the need for further larger-scale seroprevalence studies of Mongolian dogs.

As in other countries, health financing reform in Mongolia is based on the concept of universal coverage [1]. The Mongolia the Ministry of Finance of Mongolia with the technical assistance of the Asian Development Bank launched the “Health Sector Financing Improvement Project” in 2019-2022. This allows the need to achieve universal health coverage and to provide quality care and services that meet the health demands and needs of the people in an equally accessible way, without incurring financial risks [2,3]. Mongolia’s health care sector financing model has changed from an input-based financing model to an output-oriented model, and implemented the performance-based financing of health care and services as a reform [2]. Universal health coverage (UHC) is a growing policy priority in many countries, as well as a significant and increasing focus of attention at the international level, forming one of the targets of sustainable development goal 3 [4]. Performance‐based financing (PBF) or paying for performance (P4P) has received increased attention as a strategy for improving the performance of healthcare providers, organizations and governments since the early 2010s [5,6]. In PBF people are given money or other rewards if they carry out a particular task or meet a particular target [7]. This is a strategic purchasing mechanism which [8] becomes a common strategy to improve health sector quality [9].

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The extensive Mongolian grasslands hosts a high variety of micro-habitats which wildlife uses as corridors that enable species to expand their range. Between May 2017 and March 2018, we conducted an intensive survey in the Mongolian-Manchurian Grassland Ecoregion using camera trapping, field transects, live trapping and opportunistic observations, in mountain outcrops, grass steppe and sand dune habitats across seasons. Our aim was to compile the first satisfactory inventory of mammals based on scientific methods for a diverse landscape in the Mongolian provinces of Tov and Dundgovi. Furthermore, our research seeks to fill in knowledge gaps on species distribution and range expansions in the endangered west Mongolian-Manchurian Grassland ecoregion and identify biodiversity hotspot areas encompassed in this biogeographic crossroad. We recorded 31 species of non-volant mammals, including a globally Endangered species and two Near Threatened species, according to the IUCN Red List, and three species listed in Appendix II of CITES.

Numerous investigations on the development of the relaxor-PbTiO3 ferroelectric crystals have been carried out since their extraordinary properties were revealed. Recent developments on these crystals have offered further advances in electromechanical applications. In this review, recent developments on relaxor-PbTiO3 crystals and their practical applications are reviewed. The single crystal growth methods are first discussed. Two different strategies, poling and doping, for piezoelectric improvement are surveyed in the following section. After this, the anisotropic features of the single crystals are discussed. Application perspectives arising from the property improvements for electromechanical devices are finally reviewed.

The ongoing refugee crisis in Europe has seen many countries rush to construct border security fencing to divert or control the flow of people. This follows a trend of border fence construction across Eurasia during the post-9/11 era. This development has gone largely unnoticed by conservation biologists during an era in which, ironically, transboundary cooperation has emerged as a conservation paradigm. These fences represent a major threat to wildlife because they can cause mortality, obstruct access to seasonally important resources, and reduce effective population size. We summarise the extent of the issue and propose concrete mitigation measures.

Objective: Epilepsy is a prevalent neurological disorder in the pediatric population, often accompanied by comorbidities, drug-related burdens, and psychosocial issues. Emotional intelligence (EI) is a crucial aspect of neurocognitive functioning that may be impaired in various clinical conditions. This study aimed to assess EI and its associated risk factors in children with epilepsy., Methods: In a case-control design, we recruited 47 children with epilepsy (37 males, mean age 10.5 ± 3.1 years) and age- and gender-matched controls. Participants were evaluated using the Emotional Quotient Inventory: Youth Version (EQ-I:YV). We included risk factors, including comorbidities, perinatal complications, epilepsy characteristics, and magnetic resonance imaging results to predict EI., Results: Results indicate that children with epilepsy demonstrated significantly lower EI scores compared to controls (Total EQ score: p = 0.031, intrapersonal: p < 0.001, adaptability: p = 0.03, and general mood: p < 0.001). Multiple linear regression analysis indicated that lower total EQ scores were associated with the number of anti-epileptic drugs, age, seizure frequency, MRI abnormalities, aura, and early onset of seizures., Conclusions: The study provides evidence that children with epilepsy exhibit lower EQ scores than control group, with notable differences in intrapersonal skills, adaptability, and general mood. Additionally, age, and some seizure-related factors predicted decreased total EQ scores. These findings emphasize the need to consider EI in the context of pediatric epilepsy, as impaired EI may contribute to further psychosocial challenges faced by affected children., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors.)

In Mongolia, there is limited data on the prevalence and correlates of common mental health conditions. This study addresses this data gap by exploring anxiety, depression, and brain overwork. The aim of this study was to determine normative data on these conditions in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. A total of 613 participants (190 men and 423 women) with a mean age of 41.8 ± 12.4 years were recruited. The participants completed the Hospital Anxiety and Depression Scale (HADS) and the Brain Overwork Scale (BOS-10). Vital signs, body measurements, and lifestyle determinants were also assessed. The prevalence of anxiety was 9.9%, depression was 4.9%, and brain overwork was 18.3% among the participants. Anxiety and depression were correlated with brain overwork symptoms. Brain overwork was associated with young age, unemployment, low income, and alcohol use. These findings suggest that anxiety, depression, and brain overwork are a significant problem in the general population of Mongolia. Further research is needed to develop effective interventions to reduce the prevalence and risk factors of anxiety, depression, and brain overwork., (© 2024. The Author(s).)

Objective: Alexisomia is characterized by difficulty in identifying and describing bodily feelings. Shitsu-taikan-sho scale (STSS) is a self-report tool that assesses alexisomia. This study aimed to validate the Mongolian version of STSS in a nonclinical student sample. Methods: A total of 593 undergraduate students (217 males, 376 females, 18-25 years), who were studying at medical universities, were recruited. Participants completed the Mongolian version of STSS, which was translated from Japanese to Mongolian, back-translated, and finalized by an expert committee. Construct validity was examined using exploratory and confirmatory factor analyses for a three-factor structure. Internal consistency and test-retest reliability were measured using Cronbach's α and the intraclass correlation coefficients (ICC), respectively. Results: The mean scores of STSS were 18.6 ± 5.7 for difficulty identifying bodily feelings (DIB), 18.8 ± 4.0 for overadaptation (OA), 23.7 ± 4.1 for lack of health management (LHM), and 61.1 ± 10.5 for the total score (possible range: 7-35 for DIB, OA, LHM, and 21-105 for the total score, respectively). Exploratory factor analysis indicated a three-factor structure consisting of 21 items that explained 40.3% of the variance (KMO = 0.916, RMSEA = 0.049, χ 2   = 372, p  < .001). Confirmatory factor analysis provided a good fit to the data (CFI = 0.876, TLI = 0.861, RMSEA = 0.068, χ 2  = 703, p  < .001). Cronbach's alpha for the STSS was 0.860, indicating good internal consistency. Test-retest reliability analysis demonstrated good reliability (ICC = 0.791). Conclusion: The 21-item Mongolian version of STSS demonstrated evidence of good reliability and validity for assessing alexisomia in a nonclinical population in Mongolia. This suggests that the Mongolian version of the STSS may allow for the comparison of alexisomia among adults in Mongolia with those in other countries., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

No data on the quality of life (QOL) of the general population are available for Mongolia. This study aimed to determine normative data on the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. We used the WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS) in our study and evaluated their associations with vital signs, body measurements, and lifestyle determinants. A total of 714 participants (261 men and 453 women) with a mean (standard deviation) age of 40.7 (13.2) years were recruited. The mean scores of WHOQOL-BREF subscales were 61.5 for physical health, 73.5 for psychological health, 70.1 for social relationship, and 67.2 for environmental health domains. The prevalence of poor QOL was 16.9% among the participants. Participants living in an apartment in urban areas with high HADS scores had a low QOL. All domains of WHOQOL-BREF were inversely correlated with anxiety score (r = -0.353 - -0.206, p < 0.001) and depression scores (r = -0.335 - -0.156, p < 0.001). Physical health was predicted by residency location, anxiety, and depression (R2 = 0.200, p < 0.001); psychological health by anxiety and depression (R2 = 0.203, p < 0.001); social relationship by residency location, age group, anxiety and depression (R2 = 0.116, p < 0.001); and environmental health by employment, anxiety, and depression (R2 = 0.117, p < 0.001). This is the first report on normative data on the QOL in the general population of Mongolia. Physical health was low compared with that determined using international data. Poor QOL was observed among those with mental health issues living in the urban areas., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Bat-Erdene 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.)

Background: The relationship between tension-type headache (TTH) and autonomic functions is poorly understood, although TTH is one of the most prevalent disorders in the general population. The aim of this study was to investigate the direct and indirect effects of TTH on the autonomic functions measured by heart rate variability (HRV)., Methods: This population-based cross-sectional study was carried out in the general population of Ulaanbaatar between July and September in 2020. After physical examination, trained researchers applied structured interviews to examine the remote history of TTH and mental distress, followed by a recording of HRV to detect autonomic activity. Psychological factors and the quality of life were measured using Hospital Anxiety Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF). Binary logistic regression and GLM mediation model analysis were used to examine the effects of risk factors on the associations between TTH and autonomic functions., Results: Among participants (n = 217, mean age=41.8 ± 11.5 years), a total of 117 (53.9%) participants had a remote history of TTH. The age and sex-adjusted prevalence was 43%. Groups did not differ statistically in the HRV indices. LF/HF (ratio of low-frequency to high frequency), the index of sympathovagal balance, was correlated with the HADS anxiety. TTH was associated with mental distress. Binary logistic regression analysis confirms the relationship suggesting that TTH was associated with increased likelihood of mental distress, and decreasing RMSSD (root mean square of the sum of the squares of differences between adjacent NN intervals) and pNN50 (NN50 divided by the total number of NN intervals) were the independent predictors of TTH. GLM mediation model indicated that the relationship between TTH and RMSSD was mediated by mental distress., Conclusions: The present study suggests that mental distress is a critical factor in the association between TTH and autonomic dysfunction. Additionally, our findings demonstrate the influence of age and gender on TTH. These results highlight the need to understand the mechanisms underlying pathophysiology to facilitate targeted and efficacious prevention and management approaches for TTH., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

Identifying mental distress is a complex task, particularly when individuals experience physical symptoms. Traditional self-report questionnaires that detect psychiatric symptoms using emotional words may not work for these individuals. Consequently, there is a need for a screening tool that can identify both the physical and mental symptoms of mental distress in individuals without a clinical diagnosis. Our study aimed to develop and validate a scale that measures mental distress by measuring the extent of brain overwork, which can be extrapolated as the burden of mental distress. In this population-based cross-sectional study, we recruited a total of 739 adults aged 16-65 years from 64 sampling centers of a cohort in Mongolia to validate a 10-item self-report questionnaire. Internal consistency was measured using McDonald's ω coefficient. Test-retest reliability was analyzed using intraclass correlation coefficients. Construct and convergent validities were examined using principal component analysis (PCA) and confirmatory factor analysis (CFA). The Hospital Anxiety and Depression Scale (HADS) and the abbreviated version of World Health Organization Quality of Life (WHOQOL-BREF) were used to evaluate criterion validity. Among the participants, 70.9% were women, 22% held a bachelor's degree or higher, 38.8% were employed, and 66% were married. The overall McDonald's ω coefficient was 0.861, demonstrating evidence of excellent internal consistency. The total intraclass correlation coefficient of the test-retest analysis was 0.75, indicating moderate external reliability. PCA and CFA established a three-domain structure that provided an excellent fit to the data (RMSEA = 0.033, TLI = 0.984, CFI = 0.989, χ 2 = 58, p = 0.003). This 10-item scale, the Brain Overwork Scale (BOS-10), determines mental distress in three dimensions: excessive thinking, hypersensitivity, and restless behavior. All the items had higher item-total correlations with their corresponding domain than they did with the other domains, and correlations between the domain scores had a range of 0.547-0.615. BOS-10 correlated with HADS, whereas it was inversely correlated with WHOQOL-BREF. In conclusion, the results suggest that BOS-10 is a valid and reliable instrument for assessing mental distress in the general population. The scale screens for mental distress that is characterized by subjective symptoms such as excessive thinking, hypersensitivity, and restless behavior. The current findings also demonstrate that the BOS-10 is quantitative, simple, and applicable for large group testing. This scale may be useful for identifying at-risk individuals who may require further evaluation and treatment for mental distress.

There is currently no validated tool to measure the quality of life (QOL) in the Mongolian language. This study aimed to validate the Mongolian version of the World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire for the general population of Mongolia. The subjects were 301 adults aged 18-65 years selected randomly by a computer from 30 centers in 8 districts of Ulaanbaatar, Mongolia, in 2020. Reliability was measured using Cronbach's α and intraclass correlation coefficients. Convergent, discriminant, and construct validities were examined using exploratory and confirmatory factor analyses for a four-domain factor structure. Among the participants, 56.1% were women, 32.9% held a bachelor's degree or higher, 48.8% were employed, and 61.8% were married. The overall Cronbach's α coefficient of the WHOQOL-BREF questionnaire was 0.804. Correlations between the component scores of the WHOQOL-BREF ranged from 0.581-0.822. All items showed higher item-total correlations with their corresponding domains than with other domains, except the mobility item from the physical domain. Discriminative validity was evident in physical and psychological domains. Exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 24 items that provided an acceptable fit to the data (RMSEA=0.084; CFI=0.860). In conclusion, the Mongolian version of the WHOQOL-BREF demonstrated evidence of good reliability and validity for assessing QOL in the general population of Mongolia. These findings indicate that it allows the comparison of QOL of adults in Mongolia with those in other countries., Competing Interests: The authors declare no conflict of interest.

Background: Wasabi (Eutrema japonicum) is a common pungent spice used in Japan. 6-Methylsulfinylhexyl isothiocyanate (6-MSITC) found in the rhizome of wasabi has been shown to have anti-inflammatory and antioxidant effects, as well as improve neuroinflammation and memory. Therefore, we hypothesized that these effects would be beneficial for treating myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The present study was conducted to investigate the effectiveness of wasabi extract containing 6-MSITC on ME/CFS in an open-label trial., Methods: Fifteen patients (3 males, 12 females, 20-58 years old) were orally administered wasabi extract (9.6 mg of 6-MSITC/day) for 12 weeks. The following parameters and test results were compared pre- and post-treatment: performance status (PS), self-rating questionnaires, pressure pain threshold (PPT) on the occiput, Trail Making test-A (TMT-A), and hemodynamic patterns determined by an active standing test., Results: After treatment with 6-MSITC, PS improved significantly (p = 0.001). Although the scores on the 11-item Chalder Fatigue scale (CFS-11) and numerical rating scale (NRS) of fatigue did not show significant changes, subjective symptoms improved significantly, including headache frequency (4.1 to 3.0 times/week, p = 0.001) and myalgia (4.1 to 2.4 times/week, p = 0.019), NRS brain fog scores (5.7 to 4.5, p = 0.011), difficulty finding appropriate words (4.8 to 3.7, p = 0.015), photophobia (4.8 to 3.5, p = 0.008), and the Profile of Mood Status vigor score (46.9 to 50.0, p = 0.045). The PPT of the right occiput (17.3 to 21.3 kPa, p = 0.01) and TMT-A scores (53.0 to 38.1 s, p = 0.007) also changed, suggesting reduced pain sensitivity, and improved cognitive function, respectively. Orthostatic patterns determined by a standing test did not show remarkable changes. There were no serious adverse reactions., Conclusion: This study suggests that 6-MSITC improves PS as well as subjective symptoms such as pain and cognitive dysfunction, and psychological vitality of patients with ME/CFS. It also improved cognitive performance and increased pain thresholds in these patients. 6-MSITC may be a promising therapeutic option especially for improving cognitive dysfunction associated with ME/CFS., (© 2022. The Author(s).)

Background: Alexisomia refers to difficulties in the awareness and expression of somatic feelings. This idea was proposed by Dr. Yujiro Ikemi as a characteristic observed in patients with psychosomatic diseases and is based on his observations that patients with psychosomatic diseases have difficulty in the awareness and expression of not only their emotions, i.e., alexithymia, but also somatic feelings and sensations, i.e., alexisomia. He also proposed that treating alexisomia is important in the treatment of psychosomatic diseases and that yoga might help improve alexisomia. However, no study has investigated if yoga actually affects alexisomia. This open-label pilot study investigated whether practicing yoga in a class results in change in patients with alexisomia and alexithymia., Methods: The Shitsu-taikan-sho Scale (STSS) and the Toronto Alexithymia Scale (TAS-20) were administered to 305 participants, including 64 healthy participants, 111 participants who had subjective symptoms without abnormal findings, and 130 participants with chronic diseases. Participants were tested before and 3 months after attending yoga classes., Results: Yoga practice reduced the STSS and the TAS-20 difficulty in identifying feelings (DIF) subscale scores. Multiple linear regression indicated that a reduction in the TAS-20 DIF subscale scores predicted a decrease in the STSS score, whereas reductions in the STSS difficulty in identifying bodily feelings (DIB) and the lack of health management based on bodily feelings (LHM) subscale scores predicted a decrease in the TAS-20 scores., Conclusion: We found that regular yoga practice improves alexisomia. Yoga-induced improvement of alexisomia may be mediated, at least in part, by an improvement of DIF in alexithymia. Yoga would be a promising therapeutic approach to improve alexisomia., (© 2022. The Author(s).)

No epidemiological study on central nervous system tumours is available for Mongolia. The aim of this study was to determine the incidence, mortality and survival of people diagnosed with central nervous system tumours in Mongolia. It reports cancer data for the entire population (3.3 million) during the period between 2015 and 2019. Data was obtained from the National Cancer Registry of Mongolia. Diagnosis of tumours was established according to the diagnostic criteria of the International Classification of Diseases-10 (ICD-10). Incidence and mortality rates were calculated as mean annual numbers per 100,000 population. Age-standardized incidence and age-standardized mortality rates were calculated from age-specific rates by weighting directly from the World Standard Population. The three-year survival from 2015 through 2017 was calculated between treatment types by the Kaplan-Meier survival analysis. It found 515 (adults: 83 %; children: 17%) newly diagnosed central nervous system tumour cases over the five year period. The national age-standardized incidence of central nervous system tumours for the entire population was 3.7 per 100,000. The rate was higher for males than females (4.2 versus 3.4 per 100,000, respectively). Only 23% of the diagnosed cases were confirmed histologically. The most common tumour was glioma (57.6% of histologically verified tumours). In children (age 0-19 years) the age-specified incidence rate of tumours was 1.4 per 100,000. Geographically, the age-standardized incidences of the Eastern region were higher than the country average rates for both genders. During the period, 381 deaths were registered with an age-standardized mortality rate of 3.0 per 100,000 population. Furthermore, the overall three-year survival rate was 40.6% (out of 283 patients, 115 survived). The five-year prevalence of tumours was 183 and the mean per 100,000 population was 5.5. In conclusion, the data from the National Cancer Registry indicate that the incidence and survival rates of central nervous system tumours in Mongolia are relatively low. The most common location of central nervous system tumours was the brain. Glioma was the most common tumour among histologically confirmed cases. Despite the limitations, data from this study should provide information for national health policy and health care assessment. To improve the diagnosis, prognosis and treatment of central nervous system tumours, expansion of the cancer registry through collecting data on non-malignant tumours, increasing the rate of histological verification, conducting studies on cancer epidemiology and the introduction of advanced treatment technologies for central nervous system tumours are recommended., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s). Published by IMR Press.)

Obstructive sleep apnea (OSA) disrupts sleep. This study examined factors related to OSA severity. A cross-sectional, prospective, hospital-based study was conducted with 205 patients who underwent polysomnography (PSG). Demographic, anthropometric, clinical, PSG, and sleep quality assessment data were analyzed. Participants (N = 205) were classified into four groups based on apnea-hypopnea index (AHI); no OSA (AHI < 5/h; N = 14), mild (mOSA, 5 < AHI < 15/h; N = 50), moderate (modOSA, 15 < AHI < 30/h; N = 41), severe (sOSA, 30 < AHI < 60/h; N = 50), and very severe (vsOSA, AHI ≥ 60; N = 50). Men had more severe OSA than women ( p < 0.001). Anthropometric characteristics differed with OSA severity ( p < 0.001). OSA patients had decreased sleep quality and increased excessive daytime sleepiness (EDS). Body mass index (BMI), neck/waist circumference, and blood pressure (BP) differed between groups ( p < 0.001). Patients with vsOSA had the highest Mallampati grades ( p < 0.001). Multiple linear regression indicated that OSA severity was related to gender and sleep quality. PSG parameters (oxygen saturation, systolic BP, and arousal/respiratory arousal) were strongly related to OSA severity. In conclusion, about half of study-referred patients had severe/very severe OSA; these groups were predominantly obese men with high BP. OSA severity associated with high BP, BMI, waist circumference, and neck circumference.

Background: Our previous study demonstrated that 42% of yoga class participants in Japan had chronic diseases requiring medication. This raises the question as to whether those with chronic diseases would benefit from practicing yoga or if they are at higher risk for specific adverse events compared to healthy individuals receiving the same instruction., Methods: To address these questions, 328 adults who started practicing yoga for the first time were asked to complete the Profile of Mood States (POMS), Perceived Stress Scale (PSS), and Medical Outcomes Study Short Form 8, standard version (SF-8™) and to record any adverse events on the first day of the yoga class and again three months later. The participants consisted of three groups: a healthy (H) group (n = 70), a poor health (PH) group (n = 117), and a chronic disease (CD) group (n = 141). The degree of subjective symptoms was also compared between the pre- and post-intervention period in the PH and CD groups., Results: Typically, yoga classes were held once a week for 60-90 min. The programs included asanas, pranayamas, meditation, isometric yoga, and sukshma vyayama. In the PH and CD groups, the POMS tension-anxiety and fatigue scores decreased and the vigor score increased significantly after the first class. Furthermore, PSS scores decreased and the SF-8™ scores increased significantly three months later. The degree of subjective symptoms such as easy fatigability, shoulder stiffness, and insomnia also decreased over three months. Individuals in these groups experienced more frequent adverse events than those in the H group. The PH and CD groups also experienced a greater variety of symptoms, including psychological ones, not reported by the H group. Adverse events were not so serious that participants stopped practicing yoga during the class. About 60% of all participants were highly satisfied with participating in yoga classes., Conclusions: If yoga classes are conducted with attention to possible adverse events, yoga practice in a yoga studio may have beneficial effects for people with functional somatic symptoms and chronic diseases, as well as healthy participants. These benefits include reductions in perceived stress and uncomfortable symptoms as well as improved mood and quality of life., (© 2021. The Author(s).)

The neural regulation of glucose homeostasis in normal and challenged conditions involves the modulation of pancreatic islet-cell function. Compromising the pancreas innervation causes islet autoimmunity in type 1 diabetes and islet cell dysfunction in type 2 diabetes. However, despite the richly innervated nature of the pancreas, islet innervation remains ill-defined. Here, we review the neuroanatomical and humoral basis of the cross-talk between the endocrine pancreas and autonomic and sensory neurons. Identifying the neurocircuitry and neurochemistry of the neuro-insular network would provide clues to neuromodulation-based approaches for the prevention and treatment of diabetes and obesity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lkhagvasuren, Mee-inta, Zhao, Hiramoto, Boldbaatar and Kuo.)

Background: In a previous randomized controlled trial, we found that practicing seated isometric yoga regularly for 2 months improved the fatigue of patients with chronic fatigue syndrome (CFS) who are resistant to conventional therapy. The aim of this pilot study was to investigate the possible mechanisms behind this finding by comparing blood biomarkers, autonomic nervous function, and psychological indices before versus after an intervention period of seated isometric yoga practice., Methods: Fifteen patients with CFS who did not show satisfactory improvements after at least 6 months of conventional therapy practiced seated isometric yoga (biweekly 20-min sessions with a yoga instructor and daily practice at home) for 2 months. The longitudinal effects of seated isometric yoga on fatigue, blood biomarkers, autonomic function, and psychological state were investigated by comparing the following parameters before and after the intervention period: Fatigue severity was assessed by the Chalder fatigue scale (FS) score. Levels of the blood biomarkers cortisol, DHEA-S, TNF-α, IL-6, prolactin, carnitine, TGF-β1, BDNF, MHPG, HVA, and α-MSH were measured. The autonomic nervous functions assessed were heart rate (HR) and HR variability. Psychological indices included the 20-item Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS)., Results: Practicing seated isometric yoga for 2 months resulted in significant reductions in the Chalder FS ( P  = 0.002) and HADS-depression ( P  = 0.02) scores. No significant changes were observed in any other parameter evaluated. The change in Chalder FS score was not correlated with the change in HADS-depression score. However, this change was positively correlated with changes in the serum TNF-α levels ( P  = 0.048), the high frequency component of HR variability ( P  = 0.042), and TAS-20 scores ( P  = 0.001)., Conclusions: Regular practice of seated isometric yoga for 2 months reduced the fatigue and depressive symptom scores of patients with CFS without affecting any other parameters we investigated. This study failed to identify the markers responsible for the longitudinal fatigue-relieving effect of seated isometric yoga. However, considering that the reduced fatigue was associated with decreased serum TNF-α level and TAS-20 scores, fatigue improvement might be related to reduced inflammation and improved alexithymia in these patients., Trial Registration: University Hospital Medical Information Network (UMIN CTR) UMIN000009646. Registered Dec 27, 2012., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Background: In a previous randomized controlled trial, we found that sitting isometric yoga improves fatigue in patients with chronic fatigue syndrome (CFS) who are resistant to conventional therapy. The aim of this study was to investigate possible mechanisms behind this finding, focusing on the short-term fatigue-relieving effect, by comparing autonomic nervous function and blood biomarkers before and after a session of isometric yoga., Methods: Fifteen patients with CFS who remained symptomatic despite at least 6 months of conventional therapy practiced sitting isometric yoga (biweekly 20 min practice with a yoga instructor and daily home practice) for eight weeks. Acute effects of sitting isometric yoga on fatigue, autonomic function, and blood biomarkers were investigated after the final session with an instructor. The effect of a single session of sitting isometric yoga on fatigue was assessed by the Profile of Mood Status (POMS) questionnaire immediately before and after the session. Autonomic nervous function (heart rate (HR) variability) and blood biomarkers (cortisol, DHEA-S, TNF-α, IL-6, IFN-γ, IFN-α, prolactin, carnitine, TGF-β1, BDNF, MHPG, and HVA) were compared before and after the session., Results: Sitting isometric yoga significantly reduced the POMS fatigue score ( p  < 0.01) and increased the vigor score ( p  < 0.01). It also reduced HR ( p  < 0.05) and increased the high frequency power ( p  < 0.05) of HR variability. Sitting isometric yoga increased serum levels of DHEA-S ( p  < 0.05), reduced levels of cortisol ( p  < 0.05) and TNF-α ( p  < 0.05), and had a tendency to reduce serum levels of prolactin ( p  < 0.1). Decreases in fatigue scores correlated with changes in plasma levels of TGF-β1 and BDNF. In contrast, increased vigor positively correlated with HVA., Conclusions: A single session of sitting isometric yoga reduced fatigue and increased vigor in patients with CFS. Yoga also increased vagal nerve function and changed blood biomarkers in a pattern that suggested anti-stress and anti-inflammatory effects. These changes appear to be related to the short-term fatigue-relieving effect of sitting isometric yoga in patients with CFS. Furthermore, dopaminergic nervous system activation might account for sitting isometric yoga-induced increases in energy in this patient population., Trial Registration: University Hospital Medical Information Network (UMIN CTR) UMIN000009646. Registered Dec 27, 2012., Competing Interests: The study was approved by the ethics committee of Kyushu University. Written informed consent was obtained from all study participants.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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 ( T c ) 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 ( L a ) to rule out the possibility that effects on T c are achieved secondary to altered L a Cage-exchange stress increased T c within 20 min followed by a gradual decrease back to baseline T c 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 T c by 1 °C without affecting cage-exchange stress-induced hyperthermia, whereas cimetidine and ciproxifan did not affect both postinjection T c and PSH Cage-exchange stress induced an increase in L a , especially in the light phase, but none of these drugs altered cage-exchange stress-induced L a 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.)

When animals suffer from viral infections, they develop a set of symptoms known as the "sickness response." Recent studies suggest that psychological stress can modulate the sickness response. However, it remains uncertain whether acute and chronic psychosocial stresses have the same effect on viral infection-induced sickness responses. To address this question, we compared changes in polyI:C-induced sickness responses, such as fever, change of body weight and food intake, mechanical allodynia, and depressive-like behavior, in rats that had been pre-exposed to single and repeated social defeat stresses. Intraperitoneal injection of polyI:C induced a maximal fever of 38.0°C 3h after injection. Rats exposed to prior social defeat stress exhibited blunted febrile responses, which were more pronounced in the repeated stress group. Furthermore, only the repeated stress group showed late-onset and prolonged mechanical allodynia lasting until 8days after injection in the von Frey test and prolonged immobility time in the forced swim test 9days post-injection. To assess the role of glucocorticoids and microglia in the delayed and persistent development of these sickness responses in rats exposed to repeated stress, we investigated the effect of pretreatment with RU486, a glucocorticoid receptor antagonist, and minocycline, an inhibitor of microglial activation, on polyI:C-induced allodynia and depressive-like behavior. Pretreatment with either drug inhibited both the delayed allodynia and depressive-like behavior. The present study demonstrates that repeated, but not single, social defeat stress followed by systemic polyI:C administration induced prolonged allodynia and depressive-like behavior in rats. Our results show that even though a single-event psychosocial stress does not have any effect by itself, animals may develop persistent allodynia and depressive-like behavior when they suffer from an infectious disease if they are pre-exposed to repeated or chronic psychosocial stress. Furthermore, this study suggests that stress-induced corticosterone and microglial activation play a pivotal role in this phenomenon., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Patients with chronic fatigue syndrome (CFS) often complain of persistent fatigue even after conventional therapies such as pharmacotherapy, cognitive behavioral therapy, or graded exercise therapy. The aim of this study was to investigate in a randomized, controlled trial the feasibility and efficacy of isometric yoga in patients with CFS who are resistant to conventional treatments., Methods: This trial enrolled 30 patients with CFS who did not have satisfactory improvement after receiving conventional therapy for at least six months. They were randomly divided into two groups and were treated with either conventional pharmacotherapy (control group, n = 15) or conventional therapy together with isometric yoga practice that consisted of biweekly, 20-minute sessions with a yoga instructor and daily in-home sessions (yoga group, n = 15) for approximately two months. The short-term effect of isometric yoga on fatigue was assessed by administration of the Profile of Mood Status (POMS) questionnaire immediately before and after the final 20-minute session with the instructor. The long-term effect of isometric yoga on fatigue was assessed by administration of the Chalder's Fatigue Scale (FS) questionnaire to both groups before and after the intervention. Adverse events and changes in subjective symptoms were recorded for subjects in the yoga group., Results: All subjects completed the intervention. The mean POMS fatigue score decreased significantly (from 21.9 ± 7.7 to 13.8 ± 6.7, P < 0.001) after a yoga session. The Chalder's FS score decreased significantly (from 25.9 ± 6.1 to 19.2 ± 7.5, P = 0.002) in the yoga group, but not in the control group. In addition to the improvement of fatigue, two patients with CFS and fibromyalgia syndrome in the yoga group also reported pain relief. Furthermore, many subjects reported that their bodies became warmer and lighter after practicing isometric yoga. Although there were no serious adverse events in the yoga group, two patients complained of tiredness and one of dizziness after the first yoga session with the instructor., Conclusions: Isometric yoga as an add-on therapy is both feasible and successful at relieving the fatigue and pain of a subset of therapy-resistant patients with CFS., Trial Registration: University Hospital Medical Information Network (UMIN CTR) UMIN000009646.

Psychological stress-induced hyperthermia is a fundamental autonomic response in mammals. However, the central circuitry underlying this stress response is poorly understood. Here, we sought to identify sympathetic premotor neurons that mediate a hyperthermic response to social defeat stress, a psychological stress model. Intruder rats that were defeated by a dominant resident conspecific exhibited a rapid increase in abdominal temperature by up to 2.0  °C. In these defeated rats, we found that expression of Fos, a marker of neuronal activation, was increased in the rostral medullary raphe region centered in the rostral raphe pallidus and adjacent raphe magnus nuclei. In this region, Fos expression was observed in a large population of neurons expressing vesicular glutamate transporter 3 (VGLUT3), which are known as sympathetic premotor neurons controlling non-shivering thermogenesis in brown adipose tissue (BAT) and thermoregulatory constriction of skin blood vessels, and also in a small population of tryptophan hydroxylase-positive serotonergic neurons. Intraperitoneal injection of diazepam, an anxiolytic agent, but not indomethacin, an antipyretic, significantly reduced both the stress-induced hyperthermia and Fos expression in these medullary raphe neuronal populations. Systemic blockade of β3 -adrenoreceptors, which are abundantly expressed in BAT, also attenuated the stress-induced hyperthermia. These results suggest that psychological stress signals activate VGLUT3-expressing medullary raphe sympathetic premotor neurons, which then drive hyperthermic effector responses including BAT thermogenesis through β(3) -adrenoreceptors., (© 2011 The Authors. European Journal of Neuroscience © 2011 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.)