Objective:To understand the contract renewal willingness and its influencing factors among rural order-oriented medical students in Shaanxi Province. M ethods This study employed an explanatory sequential mixed methods design to examine contract renewal patterns among rural order-oriented medical graduates. From February to July 2024, a questionnaire survey was conducted among rural order-oriented medical students who graduated from 2015 to 2023 in Shaanxi Province. The participants were first stratified into three strata based on their year of graduation and stage of service, and one-third of each stratum was randomly selected as the research subjects. Univariate and multivariate analysis methods were used to explore the influencing factors of their willingness to renew their service in rural areas. Secondly, qualitative research methods were employed to conduct thematic interviews with 36 targeted medical students on the influencing factors of their willingness to renew their service. Results:A total of 513 valid questionnaires were collected during the quantitative research phase, including 224 males and 289 females. Of these, 14 were from the 2015-2017 cohort, 247 from the 2018-2020 cohort, and 252 from the 2021-2023 cohort. The results showed that only 30.4%(156/513) of the orientation medical students were willing to practice in primary care after the period of service. Univariate analysis showed that there were six factors related to the willingness to renew the contract, the consistency of the source and implementation of the contract, the completion of the standardized training of residents, the satisfaction with primary work, professional identity, the ability of primary diagnosis and treatment, and the training system and the suitability of primary work. Multivariate analysis showed that the willingness to renew the contract was significantly higher in the students who had the same place of origin and the place of performance( OR=1.7, 95% CI: 1.1-2.6, P=0.022). The willingness to renew the contract was significantly higher among students who participated in the standardized residency training than those who completed the training( OR=2.0, 95% CI: 1.3-3.0, P=0.003), and students with a better fit between the training system and working in primary care were more likely to renew their contract( OR=4.1, 95% CI: 2.8-6.0, P<0.001). Four themes were extracted from the interview: subjective factors, objective environment, policy factors and other factors. Conclusions:The study shows that improving the consistency of the source of students and the implementation of the contract, strengthening the standardized training of residents, and optimizing the adaptation of the training system to the primary work are the key measures to improve the willingness of directional medical students to renew their contract at the primary level.

Objective:To explore the abnormal patterns of brain functional network connectivity in depression adolescents and their diagnostic value in adolescent depression.Methods:A total of 94 depression adolescents (adolescent depression group) admitted to Outpatient Department of Psychiatric Imaging, West China Hospital, Sichuan University from January 2020 to December 2022 were selected. In addition, 78 age- and gender-matched healthy adolescents were recruited from local community advertisements at the same time-period as healthy control group. Resting-state functional magnetic resonance imaging was performed; after image preprocessing, group-level spatial independent component analysis was performed to identify the intrinsic network connectivity, and differences in network connectivity between the two groups were compared. Functional connectivity edges were employed as classification features, and feature ranking and screening were then performed. A support vector machine (SVM) with linear kernel function was used to construct a classification model, and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of this classification model in adolescent depression.Results:No significant difference was noted in age, gender, years of education, and body mass index between the two groups ( P>0.05). Compared with the healthy control group, the adolescent depression group had significantly decreased functional connectivity intensity within and between the networks of sensorimotor network (SMN), visual network (VN), auditory network (AN), default mode network (DMN), and cognitive control network (CCN), and significantly increased functional connectivity intensity within CCN ( P<0.05). When using the 75 top-ranked functional connectivity features, this classification model had the best performance (accuracy rate: 70.35%, sensitivity: 70.21%, specificity: 71.80%, P<0.001). ROC curve showed that area under the curve of this classification model in diagnosing adolescent depression was 0.724 (95% CI: 0.648-0.800, P<0.001). A total of 51 consistent functional connectivities were identified and they were mainly located within or between the networks of SMN, VN, AN, DMN, and CCN. Conclusion:The abnormal resting-state brain functional connectivity in depression adolescents can provide imaging basis for their clinical diagnosis.

Purpose To explore the value of amide proton transfer(APT)imaging combined with diffusion kurtosis imaging(DKI)in the differential diagnosis of prostate carcinoma and benign prostatic hyperplasia.Materials and Methods A retrospective analysis was conducted on 120 patients who underwent multi-parameter prostate MRI and pathological biopsy at the First Affiliated Hospital of Xinxiang Medical University from January 2020 to August 2021,including 66 cases of benign prostatic hyperplasia and 54 cases of prostate carcinoma.The parameters of APT imaging and DKI,including magnetization transfer ratio asymmetry(MTRasym),mean kurtosis(MK),mean diffusion coefficient(MD)and fraction anisotropy were measured,and the parameters between the two groups were compared and analyzed.The receiver operating characteristic curve and Delong test were used to analyze the efficacy of each parameter,APT or DKI sequence alone and their combined diagnosis,and the correlation among the parameters was analyzed.Results Compared with the benign prostatic hyperplasia group,the MTRasym,MK and fraction anisotropy of the prostate carcinoma group were significantly higher,while the MD was significantly lower,with statistical significance(t=8.23,12.53,2.20,-11.12,all P<0.05).The areas under the curve for the above parameters were 0.852,0.933,0.615 and 0.910,respectively.The diagnostic efficacy of APT combined with DKI for differentiating prostate carcinoma from benign prostatic hyperplasia is numerically higher than that of APT alone or DKI alone,with the areas under the curve being 0.994,0.988 and 0.852,respectively,as well as a sensitivity of 96.30%and a specificity of 98.48%.There was a statistically significant difference in efficacy between the APT+DKI combined approach and APT alone(Z=4.387,P<0.05),while no statistically significant difference exists between the combined approach and DKI alone(Z=1.375,P>0.05).MTRasym was positively correlated with MK(r=0.45,P<0.001).MD was negatively correlated with MTRasym and MK(r=-0.439,-0.500,both P<0.001).Conclusion The parameters MTRasym,MK and MD of APT and DKI have relatively high value in distinguishing prostate carcinoma from benign prostatic hyperplasia,and the combined diagnostic efficiency of the two sequences tends to increase,with some parameters showing correlation.

Purpose To explore the value of magnetic resonance amide proton transfer(APT)imaging combined with diffusion weighted imaging(DWI)in the differential diagnosis of prostate cancer and benign prostatic hyperplasia.Materials and Methods A retrospective analysis was made on 52 patients with prostate cancer and 60 patients with benign prostatic hyperplasia in the First Affiliated Hospital of Xinxiang Medical University from February 2020 to August 2021.The APT parameter values magnetization transfer ratio asymmetry(MTRasym)and DWI parameter values apparent diffusion coefficient(ADC)of the two groups were measured,respectively.The parameter differences between the two groups were compared and analyzed,the significant parameters and the efficacy of their joint diagnosis were evaluated.Then compared the performance of each parameter and joint diagnosis,and analyze the correlation between the two parameters.Results The MTRasym in the prostate cancer group[(3.70±0.94)%]was significantly higher than that in the prostate hyperplasia group[(2.35±0.60)%](t=8.89,P＜0.05);ADC value in prostate cancer group[(0.93±0.15)×10-3 mm2/s]was significantly lower than that in the prostate hyperplasia group[(1.32±0.22)×10-3 mm2/s](t=-11.01,P＜0.05).The areas under the curve for identifying prostate cancer and benign prostatic hyperplasia using MTRasym value,ADC value and their combination were 0.886,0.914 and 0.966,respectively.There was no statistically significant difference in the diagnostic efficacy between the MTRasym value and the ADC value(P＞0.05),and the combined diagnostic efficacy of the two was superior to the individual diagnostic efficacy of the MTRasym value and ADC value(Z=3.125,2.776,P＜0.05).The MTRasym was negatively correlated with the ADC value(r=-0.469,P＜0.001).Conclusion APT and DWI have high efficacy in distinguishing between prostate cancer and benign prostatic hyperplasia.The combination of the two sequences has higher diagnostic efficacy.

BACKGROUND:Osteonecrosis is an orthopedic disease that severely limits joint function,with complex pathogenesis involving multiple risk factors.Cathepsins,as a class of enzymes that play a key role in bone metabolism,are closely related to the proliferation,differentiation of bone cells,and remodeling of the bone matrix.However,previous studies have mostly focused on descriptive analyses,lacking direct evidence of causal relationships.OBJECTIVE:To clarify the potential causal relationship between cathepsins and osteonecrosis and to explore their possible mechanisms by analyzing large-scale sample data from the FinnGen database.METHODS:We obtained osteonecrosis-related data from the FinnGen database,including R9(a total of 359 399 samples:1 385 cases and 358 014 controls)and R10 versions(a total of 392 580 samples:1 543 cases and 391 037 controls).Single nucleotide polymorphisms associated with nine cathepsins(cathepsin B,E,F,G,H,O,S,L2,and Z)were acquired from a previous study(3 301 individuals).Univariate Mendelian randomization,reverse univariate Mendelian randomization,and multivariate Mendelian randomization analyses were conducted using the inverse variance weighted method,MR-Egger method,weighted median method,simple mode method,and weighted mode method.Initially,Mendelian randomization analysis was performed using osteonecrosis data from R9.Additionally,sensitivity analyses were conducted using Cochran's Q test,MR-Egger intercept,MR-PRESSO global test,and leave-one-out analysis to check for horizontal pleiotropy and heterogeneity.Subsequently,a validation analysis study was carried out on the R10 dataset,and a meta-analysis was conducted to combine the two datasets to explore the joint effect.RESULTS AND CONCLUSION:Univariate Mendelian randomization analysis results showed that higher levels of cathepsin B were significantly associated with a reduced risk of osteonecrosis(inverse variance weighted:odds ratio(OR)=0.865,95％confidence interval(CI):0.762-0.982,P=0.025),and no reverse causal relationship was found between the nine cathepsins and osteonecrosis(P＞0.05).These associations were validated by meta-analysis.Multivariate analysis,using the nine cathepsins as covariates,revealed a reverse causal relationship between the levels of cathepsin Band the risk of osteonecrosis(inverse variance weighted:OR=0.8710,95％CI:0.761-0.997,P=0.045),consistent with the results before adjustment.Sensitivity analyses based on heterogeneity and horizontal pleiotropy suggested that the results were relatively robust.This study suggests that there is a causal relationship between high levels of cathepsin B and the reduced risk of osteonecrosis,and it may serve as a biomarker for osteonecrosis,providing new directions and insights for the diagnosis and treatment of osteonecrosis.Although this study is based on data analysis of European populations,these findings have important implications for Chinese biomedical research,especially in understanding disease mechanisms,developing biomarkers,and formulating treatment strategies.They also encourage similar studies conducted on Chinese populations to explore the impact of racial and genetic background differences on the occurrence of osteonecrosis.

Purpose To explore the value of amide proton transfer(APT)imaging combined with diffusion kurtosis imaging(DKI)in the differential diagnosis of prostate carcinoma and benign prostatic hyperplasia.Materials and Methods A retrospective analysis was conducted on 120 patients who underwent multi-parameter prostate MRI and pathological biopsy at the First Affiliated Hospital of Xinxiang Medical University from January 2020 to August 2021,including 66 cases of benign prostatic hyperplasia and 54 cases of prostate carcinoma.The parameters of APT imaging and DKI,including magnetization transfer ratio asymmetry(MTRasym),mean kurtosis(MK),mean diffusion coefficient(MD)and fraction anisotropy were measured,and the parameters between the two groups were compared and analyzed.The receiver operating characteristic curve and Delong test were used to analyze the efficacy of each parameter,APT or DKI sequence alone and their combined diagnosis,and the correlation among the parameters was analyzed.Results Compared with the benign prostatic hyperplasia group,the MTRasym,MK and fraction anisotropy of the prostate carcinoma group were significantly higher,while the MD was significantly lower,with statistical significance(t=8.23,12.53,2.20,-11.12,all P<0.05).The areas under the curve for the above parameters were 0.852,0.933,0.615 and 0.910,respectively.The diagnostic efficacy of APT combined with DKI for differentiating prostate carcinoma from benign prostatic hyperplasia is numerically higher than that of APT alone or DKI alone,with the areas under the curve being 0.994,0.988 and 0.852,respectively,as well as a sensitivity of 96.30%and a specificity of 98.48%.There was a statistically significant difference in efficacy between the APT+DKI combined approach and APT alone(Z=4.387,P<0.05),while no statistically significant difference exists between the combined approach and DKI alone(Z=1.375,P>0.05).MTRasym was positively correlated with MK(r=0.45,P<0.001).MD was negatively correlated with MTRasym and MK(r=-0.439,-0.500,both P<0.001).Conclusion The parameters MTRasym,MK and MD of APT and DKI have relatively high value in distinguishing prostate carcinoma from benign prostatic hyperplasia,and the combined diagnostic efficiency of the two sequences tends to increase,with some parameters showing correlation.

Purpose To explore the value of magnetic resonance amide proton transfer(APT)imaging combined with diffusion weighted imaging(DWI)in the differential diagnosis of prostate cancer and benign prostatic hyperplasia.Materials and Methods A retrospective analysis was made on 52 patients with prostate cancer and 60 patients with benign prostatic hyperplasia in the First Affiliated Hospital of Xinxiang Medical University from February 2020 to August 2021.The APT parameter values magnetization transfer ratio asymmetry(MTRasym)and DWI parameter values apparent diffusion coefficient(ADC)of the two groups were measured,respectively.The parameter differences between the two groups were compared and analyzed,the significant parameters and the efficacy of their joint diagnosis were evaluated.Then compared the performance of each parameter and joint diagnosis,and analyze the correlation between the two parameters.Results The MTRasym in the prostate cancer group[(3.70±0.94)%]was significantly higher than that in the prostate hyperplasia group[(2.35±0.60)%](t=8.89,P＜0.05);ADC value in prostate cancer group[(0.93±0.15)×10-3 mm2/s]was significantly lower than that in the prostate hyperplasia group[(1.32±0.22)×10-3 mm2/s](t=-11.01,P＜0.05).The areas under the curve for identifying prostate cancer and benign prostatic hyperplasia using MTRasym value,ADC value and their combination were 0.886,0.914 and 0.966,respectively.There was no statistically significant difference in the diagnostic efficacy between the MTRasym value and the ADC value(P＞0.05),and the combined diagnostic efficacy of the two was superior to the individual diagnostic efficacy of the MTRasym value and ADC value(Z=3.125,2.776,P＜0.05).The MTRasym was negatively correlated with the ADC value(r=-0.469,P＜0.001).Conclusion APT and DWI have high efficacy in distinguishing between prostate cancer and benign prostatic hyperplasia.The combination of the two sequences has higher diagnostic efficacy.

BACKGROUND:Osteonecrosis is an orthopedic disease that severely limits joint function,with complex pathogenesis involving multiple risk factors.Cathepsins,as a class of enzymes that play a key role in bone metabolism,are closely related to the proliferation,differentiation of bone cells,and remodeling of the bone matrix.However,previous studies have mostly focused on descriptive analyses,lacking direct evidence of causal relationships.OBJECTIVE:To clarify the potential causal relationship between cathepsins and osteonecrosis and to explore their possible mechanisms by analyzing large-scale sample data from the FinnGen database.METHODS:We obtained osteonecrosis-related data from the FinnGen database,including R9(a total of 359 399 samples:1 385 cases and 358 014 controls)and R10 versions(a total of 392 580 samples:1 543 cases and 391 037 controls).Single nucleotide polymorphisms associated with nine cathepsins(cathepsin B,E,F,G,H,O,S,L2,and Z)were acquired from a previous study(3 301 individuals).Univariate Mendelian randomization,reverse univariate Mendelian randomization,and multivariate Mendelian randomization analyses were conducted using the inverse variance weighted method,MR-Egger method,weighted median method,simple mode method,and weighted mode method.Initially,Mendelian randomization analysis was performed using osteonecrosis data from R9.Additionally,sensitivity analyses were conducted using Cochran's Q test,MR-Egger intercept,MR-PRESSO global test,and leave-one-out analysis to check for horizontal pleiotropy and heterogeneity.Subsequently,a validation analysis study was carried out on the R10 dataset,and a meta-analysis was conducted to combine the two datasets to explore the joint effect.RESULTS AND CONCLUSION:Univariate Mendelian randomization analysis results showed that higher levels of cathepsin B were significantly associated with a reduced risk of osteonecrosis(inverse variance weighted:odds ratio(OR)=0.865,95％confidence interval(CI):0.762-0.982,P=0.025),and no reverse causal relationship was found between the nine cathepsins and osteonecrosis(P＞0.05).These associations were validated by meta-analysis.Multivariate analysis,using the nine cathepsins as covariates,revealed a reverse causal relationship between the levels of cathepsin Band the risk of osteonecrosis(inverse variance weighted:OR=0.8710,95％CI:0.761-0.997,P=0.045),consistent with the results before adjustment.Sensitivity analyses based on heterogeneity and horizontal pleiotropy suggested that the results were relatively robust.This study suggests that there is a causal relationship between high levels of cathepsin B and the reduced risk of osteonecrosis,and it may serve as a biomarker for osteonecrosis,providing new directions and insights for the diagnosis and treatment of osteonecrosis.Although this study is based on data analysis of European populations,these findings have important implications for Chinese biomedical research,especially in understanding disease mechanisms,developing biomarkers,and formulating treatment strategies.They also encourage similar studies conducted on Chinese populations to explore the impact of racial and genetic background differences on the occurrence of osteonecrosis.

Objective:To understand the contract renewal willingness and its influencing factors among rural order-oriented medical students in Shaanxi Province. M ethods This study employed an explanatory sequential mixed methods design to examine contract renewal patterns among rural order-oriented medical graduates. From February to July 2024, a questionnaire survey was conducted among rural order-oriented medical students who graduated from 2015 to 2023 in Shaanxi Province. The participants were first stratified into three strata based on their year of graduation and stage of service, and one-third of each stratum was randomly selected as the research subjects. Univariate and multivariate analysis methods were used to explore the influencing factors of their willingness to renew their service in rural areas. Secondly, qualitative research methods were employed to conduct thematic interviews with 36 targeted medical students on the influencing factors of their willingness to renew their service. Results:A total of 513 valid questionnaires were collected during the quantitative research phase, including 224 males and 289 females. Of these, 14 were from the 2015-2017 cohort, 247 from the 2018-2020 cohort, and 252 from the 2021-2023 cohort. The results showed that only 30.4%(156/513) of the orientation medical students were willing to practice in primary care after the period of service. Univariate analysis showed that there were six factors related to the willingness to renew the contract, the consistency of the source and implementation of the contract, the completion of the standardized training of residents, the satisfaction with primary work, professional identity, the ability of primary diagnosis and treatment, and the training system and the suitability of primary work. Multivariate analysis showed that the willingness to renew the contract was significantly higher in the students who had the same place of origin and the place of performance( OR=1.7, 95% CI: 1.1-2.6, P=0.022). The willingness to renew the contract was significantly higher among students who participated in the standardized residency training than those who completed the training( OR=2.0, 95% CI: 1.3-3.0, P=0.003), and students with a better fit between the training system and working in primary care were more likely to renew their contract( OR=4.1, 95% CI: 2.8-6.0, P<0.001). Four themes were extracted from the interview: subjective factors, objective environment, policy factors and other factors. Conclusions:The study shows that improving the consistency of the source of students and the implementation of the contract, strengthening the standardized training of residents, and optimizing the adaptation of the training system to the primary work are the key measures to improve the willingness of directional medical students to renew their contract at the primary level.

Objective:To explore the abnormal patterns of brain functional network connectivity in depression adolescents and their diagnostic value in adolescent depression.Methods:A total of 94 depression adolescents (adolescent depression group) admitted to Outpatient Department of Psychiatric Imaging, West China Hospital, Sichuan University from January 2020 to December 2022 were selected. In addition, 78 age- and gender-matched healthy adolescents were recruited from local community advertisements at the same time-period as healthy control group. Resting-state functional magnetic resonance imaging was performed; after image preprocessing, group-level spatial independent component analysis was performed to identify the intrinsic network connectivity, and differences in network connectivity between the two groups were compared. Functional connectivity edges were employed as classification features, and feature ranking and screening were then performed. A support vector machine (SVM) with linear kernel function was used to construct a classification model, and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of this classification model in adolescent depression.Results:No significant difference was noted in age, gender, years of education, and body mass index between the two groups ( P>0.05). Compared with the healthy control group, the adolescent depression group had significantly decreased functional connectivity intensity within and between the networks of sensorimotor network (SMN), visual network (VN), auditory network (AN), default mode network (DMN), and cognitive control network (CCN), and significantly increased functional connectivity intensity within CCN ( P<0.05). When using the 75 top-ranked functional connectivity features, this classification model had the best performance (accuracy rate: 70.35%, sensitivity: 70.21%, specificity: 71.80%, P<0.001). ROC curve showed that area under the curve of this classification model in diagnosing adolescent depression was 0.724 (95% CI: 0.648-0.800, P<0.001). A total of 51 consistent functional connectivities were identified and they were mainly located within or between the networks of SMN, VN, AN, DMN, and CCN. Conclusion:The abnormal resting-state brain functional connectivity in depression adolescents can provide imaging basis for their clinical diagnosis.