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Background Although medical education has developed rapidly in the last decade, and the National College Entrance Examination (NCEE) is used as the "gold standard" for admission to medical college in mainland China, there is a lack of literature regarding the influence of NCEE score and other factors on the academic performance of medical students. This study aimed to examine potential predictors of first-year grade point average (GPA) for medical students. Methods This study included 1,285 students who matriculated at a first-tier medical university in mainland China in 2011. The precollege motivational attitudes for each matriculate were investigated via questionnaire. A hierarchical linear model was fitted to regress first-year GPA on a 100-point scale on NCEE score and other student-level and major-level characteristics. Results NCEE score was a significant predictor of both within-major and between-major variation of first-year GPA for medical students. Majors with higher mean NCEE scores had higher mean GPAs, and higher GPAs were observed among those individuals with higher NCEE scores after controlling for major-level characteristics. First-year GPA differed by certain individual socio-demographic variables. Female students had a 2.44-higher GPA on average than did male students. NCEE repeaters had a 1.55-lower GPA than non-repeaters. First-year GPA was associated negatively with parental income but positively with academic self-concept. Conclusions NCEE score is an important predictor of the first-year GPA of medical students, but it is not the sole determinant. Individual socio-demographic characteristics and major-level characteristics should be taken into account to understand better and improve the first-year GPA of medical students.

AIM: To investigate coxsackievirus B3 infection and its gene mutation in Keshan disease. METHODS: The expression of Coxsackievirus B3 RNA was detected in autopsy specimens of acute (12 cases), sub-acute (27 cases) and chronic (15 cases) Keshan disease by in situ hybridization. In sub-acute Keshan disease specimens, 3 cases with positive result by in situ hybridization were selected RT-PCR analysis. The DNA segments were then sequenced. RESULTS: Coxsackievirus B3 RNA was detected in the cytoplasm of myocardiocyte. The positive rate was 83% in acute, 67% in sub-acute and 80% in chronic Keshan disease. In the conservative region of Coxsackievirus B3 genome, there was a mutation in 234 (C-T) compared to the non-cardiovirulent strain, CVB3/0. CONCLUSION: Coxsackievirus B3 RNA can survive and replicate in heart muscle of Keshan disease, which may play an important role in the occurrence of Keshan disease. The possible mechanism of occurrence of Keshan disease is associated with point a mutation in Coxsackievirus B3 genome.