Native artery recanalization in patients with Critical Limb Ischemia followed bypass failure

Introduction: At our department, limb-salvage angioplasty has been introduced as an alternativelast chance method with the primary goal of achieving limb salvage in selected poor surgical candidates with end-stage arterial occlusive disease and with bypass failure. The purpose of this study was to evaluate the treatment outcomes after limb-salvage PTA/S for poor surgical candidate patients with CLI following occluded bypass and who otherwise would be candidates for primary amputation. Objective: To prove the possibility of native artery recanalization in patients with critical limb ischemia followed bypass graft failure and to evaluate the outcomes of endovascular treatment for limb salvage in those critical limb ischemic patients who are otherwise would be candidates for major amputation. Materials and methods: This study was a single centre experienced, retrospective clinical analysis of 29 consecutive high surgical risk patients with CLI treated with PTA/Stent following the failure of open surgery bypass grafts reconstruction. All patients had occlusion of previous bypass graft and were considered poor candidates for a new bypass operation. Preprocedural and postprocedural ankle-brachial index (ABI), TcPO2 and TcPCO2 were used to evaluate hemodynamic and tissue perfusion improvement. All patients were studied with a color-Doppler- US, MR angiography, MsCT angiography as a diagnostic pre-procedure to define the location of lesions and to plan the revascularization strategy. Ulcers on the lower limb were photographically recorded with a digital camera for core laboratory assessment. Post procedure follow-up was scheduled 1, 3, 6 months and yearly thereafter. The data’s were analyzed with the Student t test; significant difference was assumed for p<0.05. Results: The technical success was achieved in 28 (93.3%) of 30 limbs. In these 28 limbs subintimal technique was incorporated in 92.8 % of cases. Mean lesion length was 12.3 ± 6.3 cm (4.8–29). In 7 (23.3%) limbs were positioned stent. The preprocedural level of TcPO2 was 13.8 ± 6 mmHg; in patients with technical success this parameter was increased after first week up-to 26.83 ± 13 mmHg. (p<0.05) Preprocedural mean of TcPCO2 in extremely ischemic foot was 71.2 ± 27 mmHg, but postprocedural mean, after first week, was decresed significantly and was continuing to decrease in subsequently. (p<0.001) The ABI improved to 0.86 ± 0.18 (p<0.001 versus pretreatment) and TCO2 improvement was obtained to 52.4 ± 0.22 (p<0.001). The mean area reduction of ulcers or minor amputation sites was 72% for 23 wounds observed at 3 months, increasing to 93% at 6 months. In the 28 successfully treated patients, the limb salvage rate at 6 months was at least 92.8 %. Conclusion: Native artery limb-salvage angioplasty can be successfully achieved in amputation candidate, high surgical risk patients with critical limb ischemia followed bypass failure. The outcomes of our study shows that the endovascular recanalization (PTA) technique in these high risk group patients is optimal alternative method of treatment with optimal technical success, with low morbidity and mortality, feasible even in multiple, long and high calcify steno-occlusions of limb arteries, which allows immediate clinical results and good limb salvage rate in short term follow-up

A study on structure and functions of organs involved in the formation of Mongolian Khuumii sound

Khuumii (throat or overtone singing) is a unique form of art derived from the nomadic population of Central Asia, which is a type of singing in which the singer manipulates the resonances (or formants) created as air travels from the lungs, past the vocal folds, and out of the lips to produce a melody. A total of 60 participants, aged 18-60 years (54 men and 6 women), were selected by non-random sampling method using cross-sectional study. X-ray, endoscopy, and sound research method were used in the study, and the composition of blood gas was analysed. X-ray examination determined the state during each different types of Khuumii; Shakhaa and Kharkhiraa. As the basic timbre of Shakhaa Khuumii went up progressively the larynx grew and the compression strength increased, while the basic timbre went down, and the larynx became lower. In the case of Kharkhiraa Khuumii, the larynx position was elevated to a relatively small extent compared to Shakhaa Khuumii and the distance between the sublingual bone and the larynx was large. The sublingual bone trunk lowered during Shakhaa Khuumii, while it was slightly elevated during Kharkhiraa Khuumii. The laryngeal endoscopy evaluated the movement of true and false vocal chords, glottal volume, movements of epiglottis and arytenoid cartilage, and mucosa. Furthermore, the sound frequency is 2-4 times higher than that of normal speech, and sound volume is 0.5-1 times higher. The blood gas composition test showed partial pressure (pO2), and saturation of oxygen (SaO2) decreased after performing Khuumii. In the case of Shakhaa and Kharkhiraa Khuumi, it is appropriate to divide Khuumii into two main types according to structural and functional changes in the organs involved

Molecular epidemiology of SARS‐CoV‐2 in Mongolia, first experience with nanopore sequencing in lower‐ and middle‐income countries setting

Abstract Background Coronavirus disease (COVID‐19) has had a significant impact globally, and extensive genomic research has been conducted on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) lineage patterns and its variants. Mongolia's effective response resulted in low prevalence until vaccinations became available. However, due to the lack of systematically collected data and absence of whole genome sequencing capabilities, we conducted a two‐stepped, nationally representative molecular epidemiologic study of SARS‐CoV‐2 in Mongolia for 2020 and 2021. Methods We used retrospective analysis of stored biological samples from November 2020 to October 2021 and a variant‐specific real‐time reverse transcription polymerase chain reaction (RT‐PCR) test to detect SARS‐CoV‐2 variants, followed by whole genome sequencing by Nanopore technology. Samples were retrieved from different sites and stored at −70°C deep freezer, and tests were performed on samples with cycle threshold <30. Results Out of 4879 nucleic acid tests, 799 whole genome sequencing had been carried out. Among the stored samples of earlier local transmission, we found the 20B (B.1.1.46) variant predominated in the earlier local transmission period. A slower introduction and circulation of alpha and delta variants were observed compared to global dynamics in 2020 and 2021. Beta or Gamma variants were not detected between November 2020 and September 2021 in Mongolia. Conclusions SARS‐CoV‐2 variants of concerns including alpha and delta were delayed in circulation potentially due to public health stringencies in Mongolia. We are sharing our initial experience with whole genome sequencing of SARS‐CoV‐2 from Mongolia, where sequencing data is sparse