Mongolian National University of Medical Sciences

IntroductionThis study examined whether fatigue mediates the association between sleep debt and depressive symptoms among municipal employees in Japan.MethodsThis cross-sectional study was conducted as part of the Night in Japan Home Sleep Monitoring Study (NinJaSleep Study) between November 2023 and March 2024 among 1,435 municipal employees in Koka City, Japan. Sleep debt was quantified using the Sleep Debt Index, calculated from self-reported ideal and actual sleep duration. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and fatigue was assessed using the Chalder Fatigue Scale. Mediation analysis was performed using the PROCESS macro (Model 4), adjusting for age, sex, body mass index, and occupation. Indirect effects were estimated using bootstrapping with 5,000 resamples.ResultsSleep debt was significantly associated with higher fatigue scores (B = 2.37, p < 0.001), and fatigue was positively associated with depressive symptoms (B = 0.32, p < 0.001). The direct association between sleep debt and depressive symptoms was not statistically significant (B = 0.07, p = 0.36). Mediation analysis indicated that the association between sleep debt and depressive symptoms was significantly mediated by fatigue (indirect effect: B = 0.76, 95% CI: 0.61–0.91).DiscussionSleep debt is associated with depressive symptoms primarily through increased fatigue. These findings highlight fatigue as a key pathway in linking insufficient sleep to mental health outcomes and underscore the importance of addressing fatigue in workplace mental health strategies.

The Diversity and Equity Committee (DEC) of the Asian Pacific Society of Nephrology (APSN) conducted a regional review to characterise disparities in kidney disease burden, healthcare access and nephrology service delivery across the Asia-Pacific (AP) region. A descriptive summary was compiled using national reports, registries, and expert inputs from DEC representatives. Data included kidney disease prevalence, dialysis and transplant modalities, healthcare system characteristics and disparity-related indicators. Comparative insights were drawn across countries using structured tables and narrative synthesis. The AP region exhibits a disproportionate burden of chronic kidney disease (CKD) and kidney failure with marked heterogeneity in disease aetiology, healthcare financing, and infrastructure. High-income countries such as Japan, Korea, Taiwan and Australia demonstrate mature universal insurance systems, comprehensive dialysis networks and national CKD prevention programs. Middle- and lower-income countries-including Indonesia, Myanmar, Mongolia and parts of South and Southeast Asia-face critical challenges such as workforce shortages, limited dialysis and transplant capacity and geographic inequities. Despite these challenges, several countries have introduced exemplary models to enhance equity and sustainability in kidney care: PD-first policies (Hong Kong, Thailand), pay-for-performance CKD programs (Taiwan), Kidney Health Plan 2033 (Korea), HALT-CKD (Singapore), and ACT-KID (Malaysia), indigenous kidney health efforts in Australia and the inclusion of additional insurance points for patient education in Japan. Persistent gaps remain in early detection, transplantation access, rural care and minority equity. Kidney disease care in the Asia-Pacific region reflects both diversity and disparity. Although universal health coverage and national kidney health initiatives have improved access in many countries, substantial inequities persist across geography, income and cultural groups. The collective experiences highlight both common challenges and innovative solutions. Strengthening regional collaboration, policy-driven efforts and sustainable workforce development are essential to achieving equitable kidney health for all.

IntroductionThis study aimed to explore the efficacy and safety of neoadjuvant immunotherapy combination regimens in locally advanced resectable esophageal squamous cell carcinoma (ESCC), and evaluate the pros and cons of different regimens and their impacts on survival by integrating network meta-analysis (NMA) and real world studies (RWS). ESCC accounts for approximately 90% of global esophageal cancer cases, with over half occurring in China. Although neoadjuvant chemoradiotherapy improves prognosis, unmet clinical needs persist; the optimal neoadjuvant immunotherapy regimen remains controversial. Current large-scale randomized controlled trials (RCTs) suffer from limited sample sizes and fail to adequately reflect the treatment realities of patients in the Chinese real-world setting.MethodsSystematic searches of databases including PubMed, Embase, Web of Science, and CNKI identified eligible RCTs and cohort studies for NMA. Concurrently, clinical data of 113 such ESCC patients who received neoadjuvant immunotherapy combination treatment followed by surgery at National Cancer Centre of China (January 2021–December 2023) were retrospectively collected, with logistic and Cox regression analyses used to assess associations between factors (e.g., MPR, radiotherapy) and survival.ResultNMA results showed Sintilimab plus chemoradiotherapy had the highest pathological complete response (pCR) rate, Camrelizumab plus nab-paclitaxel/platinum performed best in major pathological response (MPR) and radical resection with negative surgical margins (R0 resection) rates, and Sintilimab plus nab-paclitaxel/platinum had the lowest adverse event (AE) incidence. Real-world data revealed a significantly higher MPR rate in the Camrelizumab group than the Tislelizumab group (46.9% vs 12.5%, P = 0.0213). Multivariate analysis indicated MPR and primary tumor T response were independent protective factors for overall survival (OS) and progression-free survival (PFS), while neoadjuvant radiotherapy correlated with poorer OS and PFS.ConclusionNeoadjuvant immunotherapy combinations (notably Cam+nab-TP) exhibit favorable efficacy in this ESCC subtype, and MPR serves as a reliable surrogate endpoint for long-term survival. The survival benefit of radiotherapy requires careful assessment, and clinical decisions should balance efficacy and safety, as these findings provide evidence for individualized treatment.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251174359, identifier CRD420251174359.

Against the backdrop of rapid development in artificial intelligence and intelligent educational technology, English teaching urgently needs to shift from the traditional model focused on knowledge transmission and outcome evaluation to a new teaching paradigm emphasizing the learning process and ability development. Addressing current problems in English classrooms such as student inattention, insufficient interaction, delayed evaluation, and lack of learning support, this paper introduces the Attention-Interaction-Assessment-Support (AIAS) model. Guided by attention theory, social constructivism, and formative assessment and learning support theories, it systematically explores the construction and practical path of English teaching methodology based on the AIAS model. Starting with conceptual definition and theoretical foundations, the study comprehensively reconstructs English teaching objectives, content, process, and evaluation, forming a teaching methodology system centered on the learning process and characterized by interaction-driven and continuous support. It also proposes actionable practical paths from aspects such as teaching preparation, classroom implementation, after-class extension, and teacher professional development. The study concludes that the AIAS model helps improve student engagement and interaction quality, optimizes evaluation and support mechanisms, and promotes the coordinated development of language ability, thinking ability, and self-directed learning ability, thus having a positive significance for promoting innovation in English teaching models.

Background: Climate change is increasingly recognized as a major global health threat, yet its mental health consequences remain insufficiently synthesized, particularly among vulnerable populations. While physical health impacts are well documented, growing evidence indicates that climate-related stressors exert profound psychological effects through both direct and indirect pathways. Objective: This systematic review aimed to critically examine the mental health impacts of climate change, identify the environmental and socioeconomic pathways linking climate stressors to psychological well-being, and highlight priority populations and areas for intervention. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, PsycINFO, and ScienceDirect for peer-reviewed studies published between 220 and 2025. Following PRISMA 2020 guidelines, studies were screened, appraised using Joanna Briggs Institute tools, and synthesized using a narrative thematic approach. Ten high-quality studies met the inclusion criteria. Results: The review found consistent evidence linking climate change to anxiety, depression, stress-related disorders, post-traumatic stress symptoms, and emerging climate-specific conditions such as eco-anxiety, climate grief, and solastalgia. Women, pregnant mothers, children, and socioeconomically vulnerable populations were disproportionately affected. Mental health impacts occurred through both acute exposures to extreme weather events and chronic stressors such as displacement, livelihood insecurity, and environmental degradation. Conclusion: Climate change represents a substantial and growing threat to global mental health. Integrating mental health into climate adaptation, disaster preparedness, and public health policy is essential to reduce future psychological burden and protect vulnerable populations.

Abstract Introduction: Identifying pathogenic variants in the F8 gene in patients with hemophilia A (HA) is crucial for improving genetic counseling, understanding genotype–phenotype correlations, assessing inhibitor risk, and establishing family-specific mutation profiles. Methods Long-distance were used to detect intron-22 and intron-1 inversions. While Sanger sequencing identified point mutations. Inhibitors were assessed via an activated partial thromboplastin time (APTT)-based mixing assay. Results Thirty male patients with HA from 25 unrelated families (28 severe, one moderate, and one mild) were analyzed. Pathogenic variants were found in 95.6%(22/23) of patients with severe HA. Large structural rearrangements were detected in 20 patients from 17 families, including intron-22 inversion in 16 cases of 14 families, intron-1 inversion in three cases from two families, and one gross deletion involving exons 1–13 identified in a single family. The one severe case had no pathogenic variant entire F8 . Small scale changes were identified in the remaining patients, including missense in three families and two frameshift variants, all associated with severe phenotype. We found novel c.2240del variant and classified as pathogenic. A known polymorphism (c.3864A &gt; C) was identified in one patient with moderate HA, while a novel intronic deletion (c.1010-106delA) was detected in a patient with mild disease. Inhibitor testing was performed in 13 patients; inhibitor development was observed in only one patient with severe HA. Conclusions Intron-22 (60.8%) and intron-1 (8.6%) inversions in severe patients were observed at higher frequencies than previously reported. A novel pathogenic frameshift variant (c.2240del) was associated with severe HA.

Weight gain associated with antiretroviral therapy, particularly second-generation integrase strand transfer inhibitors (INSTIs), is an increasingly recognized concern. However, literature remains mixed regarding whether these effects differ by sex/gender. This scoping review aims to map the pattern, timing, severity and risk factors for weight gain among cis and trans women initiating or switching to second-generation INSTIs, such as dolutegravir, bictegravir or cabotegravir. Four databases (EMBASE, MEDLINE, Web of Science and CINAHL) were searched for studies reporting on weight gain after initiating or switching to second-generation INSTIs in cis and trans women or mixed cohorts with data disaggregated by sex/gender between 2010 and 2024. Three reviewers independently conducted the screening, and two reviewers extracted data. Forty articles were included. Most studies reported trends of increased and excessive weight gain in cis women compared to cis men taking dolutegravir or bictegravir-based regimens, although findings were inconsistent and the extent of weight gain varied. Weight gain was particularly pronounced among treatment-naive cis women, those of Black ethnicity or in African settings, and participants receiving dolutegravir in combination with tenofovir alafenamide. Studies on weight gain in cis women taking cabotegravir-based regimens and trans women on any regimen were scarce. Second-generation INSTIs, especially dolutegravir, appear to be associated with greater average and excessive weight gain among cis women, although this effect varies by setting, regimen and clinical context. Further research, especially in diverse populations, is needed to explore underlying mechanisms, determine risk factors and evaluate these trends in newer antiretroviral medications.

Background: Early decline in kidney function is a major complication of type 2 diabetes mellitus (T2DM). The extent to which achievement of glycemic, blood pressure, lipid, and weight targets influences short-term renal trajectories remains insufficiently characterized. Methods: We conducted a retrospective analysis of 125 T2DM patients who had baseline and 1-year follow-up eGFR measurements at the Mongolia Japan Hospital of the MNUMS during 2023-2024. Clinical and metabolic control was categorized using standard thresholds. Renal outcomes were assessed using absolute 1-year eGFR change and the occurrence of ≥30% decline. Results: Mean eGFR declined from 91.2 ± 24.1 to 88.4 ± 25.5 mL/min/1.73 m2 over one year (mean change -3.77 ± 11.3 mL/min/1.73 m2); 7.2% experienced ≥30% decline. Individuals with pre-existing CKD showed significantly greater deterioration than those without (interaction p < 0.001). Poor glycemic control was consistently associated with greater decline: participants with HbA1c > 7.5% had a significant reduction and regression analyses showed an additional adjusted decline of -4.7 mL/min/1.73 m2 (p = 0.029) compared with those at target. Elevated blood pressure (>130/80 mmHg) was also associated with greater annual decline (adjusted β = -6.40, p = 0.024). Lower BMI (<25 kg/m2) predicted larger decreases in eGFR in both CKD and non-CKD groups. Lipid target achievement demonstrated small, inconsistent associations with renal outcomes. Conclusions: In this clinical cohort, poor glycemic control and elevated blood pressure were the strongest modifiable predictors of short-term kidney function decline, particularly among individuals without pre-existing CKD.

Fascioliasis is a parasitic liver disease of mammals induced by liver flukes, Fasciola hepatica and Fasciola gigantica. Fasciola spp. rely on their definitive hosts, ruminants, and intermediate hosts, snails, to survive and can incidentally infect humans as definitive hosts. Ruminant (goat, sheep, and cattle) liver and fecal samples were collected from the Kharaa River Basin (KRB) of Mongolia during 2018-2020. A total of 807 adult liver flukes were found in livers of 18 goats, 21 sheep, and 1 cattle, with morphological identification of F. hepatica species. A total of 350 fecal samples selected using a "risk-based surveillance" method in the KRB were tested for Fasciola spp. eggs with 50.3% (n = 151/350) positive. By animal, cattle had the highest percentage of Fasciola spp. positive samples of 70% (14/20), followed by sheep with 49.4% (87/176) and goats with 32.5% (50/154). Six-hundred Lymnaied spp. snails, an intermediate host of Fasciola, were obtained from 18 locations in six provinces and one provincial municipality and morphometrically identified as Radix bactriana (94.8%) and Lymnaea stagnalis (5.2%). This study represents the first report of fascioliasis in indigenous animals in Mongolia and when paired with the detected prevalence of Fasciola spp. eggs in feces, suggests endemic circulation in the KRB region.