Does medical education reform change who is selected? A national cross-sectional survey from China.

OBJECTIVES: Approximately 10 years ago, China introduced an education plan to improve the overall quality of medical education and to better serve the population's health needs. Many medical schools were then recognised and financed by China's Ministry of Education to develop and operationalise new pilot programmes (PPs) aligned with this plan. These ran in parallel with the traditional programmes (TPs). One way to achieve the plan's first aim, improving the quality of medical education, is to select academically stronger candidates. We, thus, examined and compared who were selected into PPs and TPs. DESIGN: Cross-sectional study. SETTING: Data were collected from 123 medical schools across China via the 2021 China Medical Student Survey. PARTICIPANTS: Participants were undergraduate clinical medicine students across all year groups. PRIMARY AND SECONDARY OUTCOME MEASURES: Medical school selection was via the National College Entrance Examination (NCEE). Medical students' NCEE performance and their sociodemographics were used as the primary and secondary outcome measures. Mann-Whitney or χ2 tests were used to compare the means between educational programmes (PPs vs TPs) and various selection outcomes. Multilevel mixed-effects regressions were employed to account for school idiosyncratic selection results. RESULTS: Of the 204 817 respondents, 194 163 (94.8%) were in a TP and 10 654 (5.2%) a PP. PP respondents (median=75.2, IQR=69.5-78.8) had significantly higher NCEE scores than their TP counterparts (median=73.9, IQR=68.5-78.7). Holding constant their NCEE score, PP respondents were significantly more likely to come from urban areas, not be first-generation college students, and have parents with higher occupational status and income. CONCLUSIONS: Assuming quality can be indicated by prior academic achievement at the point of selection, PPs achieved this mission. However, doing so limited medical students' diversity. This may be unhelpful in achieving the Education Plan's goal to better serve China's health needs.

Residue behaviors, degradation, processing factors, and risk assessment of pesticides in citrus from field to product processing.

Pesticide residues in citrus may cause health risks in related juice products, and bring much uncertainty during the processing procedures. In this study, based on the dispersive solid-phase extraction (d-SPE) and UPLC-MS/MS, the residual levels of ten analytes in citrus and its processed products were monitored. The results showed that dissipation of the pesticides followed the first-order kinetics and the half-lives in citrus varied greatly, ranging from 6.36 to 63.0 days. The terminal residues of the five pesticides at harvest time were <0.01-0.302 and <0.01-0.124 mg/kg in raw citrus and citrus flesh, respectively, all of which were lower than the corresponding maximum residue limits (MRLs) of 0.5-1 mg/kg. In the processing experiments, the residues of ten analytes in sterilized juice, concentrated juice, and citrus essential oil were in the range of <0.01 to 0.442 mg/kg, <0.01 to 1.16 mg/kg, and <0.01 to 44.0 mg/kg, respectively, and the corresponding processing factors (PFs) were 0.127-1.00, 0.023-3.06, and 0.006-39.2. Particularly, in citrus essential oil, the PFs of etoxazole, fluazinam, lufenuron and spirotetramat-keto-hydroxy were 1.68-39.2, exhibiting obvious enrichment effects. By integrating the residue data of the field trials and the PFs, the acute and chronic dietary risks of the target pesticides in citrus juice were 0.031-1.83 % and 0.002-2.51 %, respectively, which were far lower than 100 %, demonstrating no unacceptable risk to human health. This work provides basic data for the establishment of the MRLs and dietary exposure risk assessment for processed citrus products.

Development of Acid Hydrolysis-Based UPLC-MS/MS Method for Determination of Alternaria Toxins and Its Application in the Occurrence Assessment in Solanaceous Vegetables and Their Products.

In this work, we proposed an acid hydrolysis-based analytical method for the detection of Alternaria toxins (ATs) in solanaceous vegetables and their products with solid-phase extraction (SPE) and ultrahigh-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). This study was the first to reveal that some compounds in the eggplant matrix bind to altenusin (ALS). Validation under optimal sample preparation conditions showed that the method met the EU criteria, exhibiting good linearity (R2 > 0.99), matrix effects (-66.6--20.5%), satisfying recovery (72.0-107.4%), acceptable precision (1.5-15.5%), and satisfactory sensitivity (0.05-2 µg/kg for limit of detection, 2-5 µg/kg for limit of quantification). Out of 393 marketed samples, only 47 samples were detected, ranging from 0.54-806 µg/kg. Though the occurrence ratio (2.72%) in solanaceous vegetables could be negligible, the pollution status in solanaceous vegetable products was much more serious, and the incidences were 41.1%. In the 47 contaminated samples, the incidences were 4.26% for alternariol monomethyl ether (AME), 6.38% for alternariol (AOH) and altenuene (ALT), 42.6% for tentoxin (TEN), and 55.3% for tenuazonic acid (TeA).

Preparation of the Enzymatic Hydrolysates from Chlorella vulgaris Protein and Assessment of Their Antioxidant Potential Using Caenorhabditis elegans.

This study aimed to assess the antioxidant potential of Chlorella vulgaris protein-derived enzymatic hydrolysate using Caenorhabditis elegans. Protein extraction was performed using an alkali solution after complete C. vulgaris swelling and hydrolysis using four commercial proteases (alcalase, neutrase, protamex, and flavourzyme). The results showed that the flavourzyme hydrolysates exhibited the strongest antioxidant activity both in vitro and in vivo. Under the optimum conditions of the enzymatic hydrolysis, the half-maximal effective concentration of the hydrolysates for superoxide and hydroxyl radicals was 0.323 mg/mL and 0.139 mg/mL, respectively. The hydrolysates could significantly extend the lifespan, improve the resistance to methyl viologen-induced oxidative stress, reduce the levels of reactive oxygen species, and enhance the activity of catalase and superoxide dismutase in C. elegans.

Structural brain assessment of temporal lobe epilepsy based on voxel-based and surface-based morphological features.

AIM OF THE STUDY: This study aimed to assess the cerebral voxel-based and surface-based morphological abnormalities of patients with temporal lobe epilepsy (TLE). MATERIALS AND METHODS: A total of 100 healthy adults and 73 patients with TLE were enrolled in this study, and their 3D T1-weighted MRI data were collected. Voxel-based morphology (VBM) and surface-based morphology (SBM) tools were used to compare the morphological differences between healthy adults and patients with TLE. Receiver-operating characteristic (ROC) curves were used to acquire the boundary values for detecting morphological abnormalities in regions of interest from the corrected VBM and SBM analysis. RESULTS: Our results showed that cortical voxels and decreased thickness areas were located in the widespread cortex and subcortical structures in the TLE group. However, after completing the analysis, we found that the left-TLE lesions were limited to the left temporal pole and left hippocampus, while the right-TLE lesions were located in the bilateral medial temporal lobe, including the right hippocampus and bilateral amygdala. ROC-curve results showed that the volume of the left hippocampus at 4,124.45 mm3 and the thickness of the left temporal pole cortex at 3.50 mm could be used as optimal boundary values based on the curves of the left-TLE group. The right-TLE group curves were poor. CONCLUSIONS: Widespread cerebral morphological TLE abnormalities were represented in this study. However, the lesions may be limited after completing a corrected comparison with clinical information. Boundary values of left-TLE group lesions were also obtained.

Systemic immune-inflammation index predicts postoperative acute kidney injury in hepatocellular carcinoma patients after hepatectomy.

ABSTRACT: The systemic immune-inflammation index (SII) is an independent prognostic predictor of hepatocellular carcinoma (HCC). The present investigation examined whether an association exists between preoperative SII value and postoperative acute kidney injury (pAKI) in HCC patients.The study included 479 hepatitis B virus (HBV)-associated HCC patients undergoing hepatectomy. The SII was calculated as P × N/L, where P, N, and L represent the counts of platelets, neutrophils, and lymphocytes in routine blood test, respectively. After propensity score matching, logistic regression analysis was used to explore independent predictors of pAKI in HCC patients.pAKI was confirmed in 51 patients (10.8%). The average SII value was higher in patients with pAKI than patients without pAKI. After multivariate logistic regression analysis, SII, history of hypertension, and tumor size, among others, were found to be predictors of pAKI. The optimal threshold value of SII for predicting pAKI was found to be 547.84 × 109/L. Multivariate analysis performed after propensity score matching confirmed that SII ≥ 547.84 × 109/L was an independent predictor of pAKI.The preoperative SII qualifies as a novel, independent predictor of pAKI in HCC patients with HBV infection who underwent hepatectomy.

Residue behavior and dietary risk assessment of six pesticides in pak choi using QuEChERS method coupled with UPLC-MS/MS.

A reliable and simple modified QuEChERS method with UPLC-MS/MS was developed for the simultaneous determination of six pesticides (dimethomorph, imidaclothiz, lufenuron, methoxyfenozide, pyridaben, spinetoram) and their metabolites in pak choi. Method validation indicated good linearity (R2 ≥ 0.99), accuracy (recoveries of 75%-112%), sensitivity (limits of quantification, 0.002-0.01 mg kg-1), and precision (relative standard deviations ≤ 21%), and matrix effects were -36-28%. The half-lives of the six pesticides in pak choi were 2.2-12 d under open field and greenhouse conditions. Considering the short growth cycle of pak choi, the terminal residue levels (0.046-7.8 mg kg-1) and the relevant maximum residue limits (MRLs) of some countries, 5 d was recommended as the pre-harvest interval for the six pesticides on pak choi. Dietary risk assessment revealed that the risk quotients were 3.1%-58% for different gender and age groups in China, indicating none unacceptable public health risk for general population. The results showed that all the six pesticides degraded faster and the terminal residues were much lower under open field conditions than those under greenhouse conditions, which was mainly due to the influence of rainfall, sunlight and other environmental factors. This work was thus significant in assessing the dissipation fate and food safety risks of the six pesticides on pak choi and facilitated the establishment of maximum residue limits.

Dissipation rates and residue levels of diflubenzuron and difenoconazole on peaches and dietary risk assessment.

The dissipation kinetics, residue levels, and potential risks of diflubenzuron and difenoconazole on peaches were investigated under open field conditions. Two years of field trials were carried out in Shanghai, China, and the half-lives of diflubenzuron and difenoconazole on peaches ranged from 4.4 to 25d. Their terminal residue concentrations on peaches were 0.022-5.7 mg/kg after three of the tested sampling intervals. Based on the maximum residue levels (MRLs) of difenoconazole on peaches, a preharvest interval (PHI) of 14 d was proposed. A PHI of 10 d was proposed for diflubenzuron after a dietary safety assessment. During the safety assessment, the hazard quotient (HQ) and risk quotient (RQ) on peaches were determined. The results showed that the HQs (3.6-8.3%) and RQs(51-55%) of diflubenzuron were acceptable, proving that diflubenzuron poses no potential health risks. For difenoconazole, the HQs (0.027-0.071%) were satisfactory, but the RQs (115-116%) exceeded 100%, which indicated potential risk.

Attitude towards working in rural area and self-assessment of competencies in last year medical students: A survey of five countries in Asia.

BACKGROUND: Five countries in Asia including Bangladesh, China, India, Thailand and Vietnam formed a network called Asia-Pacific Network for Health Professional Education Reforms (ANHER). This network collectively conducted a survey at the national level and at the institutional level (for medical, nursing and public health education). We also undertook an assessment of final year graduates from these schools on their attitudes, competencies and willingness to work in rural areas. METHODS: Pretested anonymous questionnaire comprised of four sections including demographic data, attitudes towards working in rural area, where to work after graduation and perception about competency of respondents was used. Descriptive and analytical statistics were used for data analyses. RESULTS: About 60 % of students from Bangladesh and Thailand had positive attitude towards working in rural area, 50 % in both China and India and only 33 % in Vietnam. Students' positive attitudes towards their school in terms of preparing or inspiring them to work in rural areas were low across all five countries. Upon graduation and in the next five years, majority of students wanted to work in public sectors. Interestingly confidence about overall competency was quite low. DISCUSSION: Positive attitude towards working in rural areas varied significantly across five countries in Asia. Medical schools should improve the preparation and inspiration towards working in rural areas for their students. CONCLUSION: Medical schools should put more effort in improving students' attitude towards working in rural areas.

Career preferences of graduating medical students in China: a nationwide cross-sectional study.

BACKGROUND: China faces major challenges in the distribution of health professionals with serious shortages in rural areas and in the development of Primary Care Providers (PCPs). This study investigates the career preferences of medical students in China and the impact of rural backgrounds on these preferences. METHODS: Medical students in the final year of their program in 16 medical schools across China completed a 58-item survey that included questions regarding their demographic characteristics, attitudes toward practice in low resource areas, postgraduate planning, self-assessed competency, university facilities assessment, and financial situation. Descriptive calculation and Logit model were used for the analysis. RESULTS: Completed surveys from 3020 students were included in the analysis. Upon graduation, 48.5% of the medical students preferred to work in urban public hospitals and this percentage rose to 73.6% when students were asked to state their anticipated preference five years after graduation. Students' top three ranked reasons for preferred careers were "good career prospects", "living close to parents/families", and "remuneration". Those who preferred to work in rural areas upon graduation were more likely to be those who lived in rural areas when 1-15 years old (ß = 2.05, p < 0.001), had high school in rural areas (ß = 1.73, p < 0.001), or had parents' place of current residence in rural areas (ß = 2.12, p < 0.001). Similar results were found for those students who preferred to work in PCPs. CONCLUSIONS: To address the serious shortages of health professionals in rural areas and PCPs, medical schools should consider strategies to recruit more medical applicants with rural backgrounds and to orient students to rural and primary care interests.

Assessment of culprit lesions by intravascular ultrasound in patients with acute myocardial infarction.

BACKGROUND: Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment of culprit lesion morphology during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). METHODS: We performed 18 intravascular ultrasound assessments preintervention during the primary PCI for AMI. intravascular ultrasound analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM >1.0. Culprit lesions were identified by a combination of electrocardiogram (ECG) and coronary angiography. RESULTS: There was an average of 1.44 infarct-related artery (IRA) plaques per patient. The incidences of thrombus and plaque ruptures were 28% (5) and 33% (6), respectively. Hypoechoic plaque was observed in 72% (13) of AMI patients. Calcified lesions could be found in 33% (6) of culprit lesions. Sixty percent of the culprit lesion sites presented with positive remodeling. CONCLUSIONS: Intravascular ultrasound is a safe and feasible imaging modality in patients with AMI and can help identify plaque rupture, intracoronary thrombus or calcification. The culprit lesion site in AMI cases often presents with positive remodeling.

[Application of near-infrared diffuse reflectance spectroscopy to the detection and identification of transgenic corn].

With the rapid development of the GMO, more and more GMO food has been pouring into the market. Much attention has been paid to GMO labeling under the controversy of GMO safety. Transgenic corns and their parents were scanned by continuous wave of near infrared diffuse reflectance spectroscopy range of 12000-4000 cm(-1); the resolution was 4 cm(-1); scanning was carried out for 64 times; BP algorithm was applied for data processing. The GMO food was easily resolved. Near-infrared diffuse reflectance spectroscopy is unpolluted and inexpensive compared with PCR and ELISA, so it is a very promising detection method for GMO food.