Anesthesia care in a medium-developed country: a nationwide survey of Mongolia

Study ObjectiveTo evaluate the current status of anesthesia and its allied disciplines in Mongolia.DesignNationwide questionnaire survey.SettingTwo university hospitals.MeasurementsA total of 44 hospitals that include a department of surgery and that were registered at the Mongolian Ministry of Health were queried. The questionnaire included 44 questions in two sections. The first section consisted of 6 general questions about the hospital, and the second section included 40 questions on anesthesia and perioperative patient care. The Mann-Whitney U-test, Chi²-tests, and a bivariate correlation analysis were used for statistical analysis.Main Results44 (100%) questionnaires were returned. Twenty-two (50%) hospitals were located in the capital city of Ulaanbaatar. Nine hundred (median; interquartile range: 413-1,468) surgical interventions were performed annually in the study hospitals. Physician anesthesiologists delivered anesthesia in all hospitals. Techniques for general anesthesia included endotracheal intubation (95.5%), laryngeal mask ventilation (13.6%), mask ventilation (27.3%), dissociative ketamine anesthesia (84.1%), and combined general/regional anesthesia (63.6%). Regional anesthetic techniques included spinal (97.7%), epidural (43.2%), axillary plexus (40.9%), peripheral nerve (13.6%), and local anesthesia (15.9%). The most frequently used hypnotics were ketamine (86.4%) and thiopental sodium (70.5%). Halothane was available in all hospitals. Oxygen was available during anesthesia in 95.5% of hospitals. The most widely available intraoperative monitoring equipment were a stethoscope (84.1%), oximeter (81.8%), and sphygmomanometer (84.1%). A recovery room was available in 22 (50%) hospitals.ConclusionsAnesthesia is an underdeveloped and under-resourced medical specialty in Mongolia.     

Developmental changes in the mammalian gonadotropin-inhibitory hormone (GnIH) ortholog RFamide-related peptide (RFRP) and its cognate receptor GPR147 in the rat hypothalamus

The mammalian gonadotropin-inhibitory hormone (GnIH) ortholog RFamide-related peptide (RFRP) is considered to act on gonadotropin-releasing hormone (GnRH) neurons and on the pituitary to inhibit gonadotropin release and synthesis. To understand the functional significance of this neuropeptide, we investigated the physiological changes in RFRP at mRNA and peptide levels, as well as at the mRNA level of its cognate receptor, G protein-coupled receptor 147 (GPR147), in the rat hypothalamus during development. We also investigated the effects of gonadal steroids on mRNA expression levels of these molecules. In male rats, mRNA expressions of both RFRP and GPR147 increased from postnatal days 12 and 16, peaking at postnatal days 35 and 42, respectively. However, their expressions fell at postnatal day 49. In female rats, mRNA expression of RFRP continued to increase throughout development; mRNA expression of GPR147 in female rats increased from postnatal day 16, peaking at postnatal day 28, but decreased from postnatal day 35. The hypothalamic contents of RFRP on postnatal days 28 and 42 were significantly higher than on postnatal day 4 in male rats, and those on postnatal day 42 were significantly higher than those on postnatal days 4 and 28 in females. Neither orchidectomy nor ovariectomy influenced mRNA expression levels of RFRP or GPR147 in the prepubertal period when endogenous sex steroid levels were low in males and females. Administration of estradiol-17β (E2) increased mRNA expression of RFRP in prepubertal females. These results suggest that the hypothalamic RFRP system changes during development. An ovarian sex steroid, E2, may stimulate mRNA expression of RFRP in the prepubertal period when the basal E2 concentration is low.     

Effects of lipopolysaccharide exposure at different postnatal time points on the response of LH to homotypic stress in adulthood

Early-life immune stress may have long-lasting effects, known as programming effects, on the physiological response to stress in adulthood. There may be a critical window after birth during which such a challenge can induce long-lasting alterations. However, there are few reports regarding the consequences of this phenomenon for later reproductive function. Here we report on induction by early-life LPS injection of long-lasting alterations in the adult LH response to homotypic immune stress in male rats. First, we investigated developmental changes in the LH response to LPS, since immune challenge during the stress hyporesponsive period can induce long-lasting effects on physiological functions. Rat serum LH concentrations were decreased by LPS (100 μg/kg) injection on postnatal day 15 or 25, but not day 10, suggesting that the period prior to postnatal day 10 is the stress hyporesponsive period for LH. Serum LH concentrations and body weight were decreased by adult LPS (400 μg/kg) injection in rats given saline or LPS (100 μg/kg) on postnatal day 25, but not in rats given LPS (100 μg/kg) on postnatal day 10. Expression of hypothalamic IL-1β and TNF-α mRNA, which suppress serum LH during immune stress, were equally increased in these groups by adult LPS (400 μg/kg) injection. The present data suggest that the period prior to postnatal day 10 is the critical window in which immune stress can induce long-lasting alterations in the LH response, but that IL-1β and TNF-α are not involved in mediating the altered response.     

Effect of immune stress on body weight regulation is altered by ovariectomy in female rats

It has been suggested that obesity and loss of ovarian function alter the inflammatory response to immune stress. Ovariectomized (OVX) rats, which are used as a model of human menopause, exhibit both hyperphagia-induced obesity and gonadal steroid deficiency. To evaluate the effects of ovariectomy on inflammatory responses, we compared the anorectic response to LPS in OVX rats and gonad intact female rats. As leptin and hypothalamic interleukin-1β (IL1β) play pivotal roles in the anorectic response to immune stress, these factors were also measured. It was found that the OVX rats exhibited an increased anorectic response to LPS compared with the sham-operated rats. The OVX rats showed higher serum leptin concentrations and a greater increase in hypothalamic IL1β mRNA expression after LPS injection. In addition, in order to determine whether gonadal steroid deficiency contributes to the changes in the inflammatory responses of OVX rats, we compared responses between OVX rats treated with gonadal steroids and untreated OVX rats. There were no differences in appetite, the serum leptin level, and hypothalamic IL1β mRNA expression between the two groups after LPS injection. These findings suggest that the loss of ovarian function increases the induction of leptin and hypothalamic IL1β synthesis and consequently increases the anorectic response under immune stress conditions. It is possible that these alterations are caused by OVX-induced obesity rather than the direct effects of gonadal steroid deficiency.     

Changes in the responsiveness of serum leptin and hypothalamic neuropeptide Y mRNA levels to food deprivation in developing rats

Neuropeptide Y (NPY) is an important orexigenic peptide that acts in the brain. The increase in hypothalamic NPY mRNA expression induced by fasting is mainly caused by a decrease in the effects of leptin. We investigated the developmental changes in the sensitivities of leptin and hypothalamic neuropeptide Y to fasting. Hypothalamic NPY mRNA levels were increased by fasting in postnatal days 15 and 25 rats, but not in postnatal day 5 rats. Serum leptin levels were decreased by fasting in rats at all ages (days 5, 15, and 25). In addition, hypothalamic OB-Rb mRNA levels were decreased by fasting in postnatal day 25 rats, but not in postnatal day 5 or 15 rats. Although the percentage of fating-induced decrease in the serum leptin level was larger in the postnatal day 15 rats than in the postnatal day 25 rats, the percentage of increase in the hypothalamic NPY mRNA level in the postnatal day 15 rats was smaller than that in the postnatal day 25 rats. There was a strong inverse correlation between serum leptin levels and hypothalamic NPY mRNA levels in the postnatal day 25 rats, whereas no significant correlation was found between these parameters in the postnatal day 5 or 15 rats. These findings indicate that the sensitivity of hypothalamic NPY mRNA expression to food deprivation and hypoleptinemia has developed by postnatal day 25.     

High Prevalence of Chronic Viral Hepatitis and Liver Fibrosis Among Mongols in Southern California

Digestive Diseases and Sciences - Mongolia is a highly endemic region for chronic hepatitis B (HBV), hepatitis delta (HDV), and hepatitis C (HCV) infections. Aim of this study was to...