[Effects of cognition-related lifestyles on early cognitive decline in community older adults in China].

Objective: To investigate the distribution characteristics of cognition-related lifestyles of elderly in communities and explore the integrated effects on early cognitive decline. Methods: The participants were from the Project of Prevention and Intervention of Neurodegenerative Disease for Elderly in China. A total of 2 537 older adults aged ≥60 years without dementia in the 2015 baseline survey and the 2017 follow-up survey were included. The information about their cognition-related lifestyles, including physical exercise, social interaction, leisure activity, sleep quality, smoking status, and alcohol consumption, were collected through questionnaire survey and the integrated scores were calculated. Multivariate logistic regression analysis was used to assess the association between integrated cognition-related lifestyle score and early cognitive decline. Results: In the 2 537 older adults surveyed, 28.7% had score of 5-6, while only 4.8% had high scores for all 6 healthy lifestyles. Significant differences in healthy lifestyle factor distributions were observed between men and women. Multivariate logistic regression model showed that the risks for early cognitive decline in the older adults who had lifestyle score of 4 and 5-6 were lower than that in those with lifestyle score of 0-3 (OR=0.683, 95%CI: 0.457-1.019; OR=0.623, 95%CI: 0.398-0.976; trend P=0.030). In the women, the risks for early cognitive decline was lower in groups with score of 4 and 5-6 than in group with score of 0-3 (OR=0.491, 95%CI: 0.297-0.812; OR=0.556, 95%CI: 0.332-0.929; trend P=0.024). Conclusion: Cognition-related healthy lifestyles are associated with significantly lower risk for early cognitive decline in the elderly, especially in women.

[Association analysis between sex hormone levels and all-cause mortality in Hainan female centenarians].

Objective: To investigate the distribution characteristics of sex hormones and their relationship with all-cause mortality in Hainan female centenarians. Methods: All the subjects were from China Hainan Centenarian Cohort Study. A total of 717 female centenarians were included in the final analysis. Kaplan-Meier method was used to draw the survival curve, and Cox proportional hazard regression was used to analyze the relationship between sex hormones and survival time. Results: The M(Q1, Q3) of estradiol and progesterone among female centenarians was 32.60 (18.40, 58.70) pmol/L and 0.62 (0.32, 1.01) nmol/L. The estradiol (pmol/L) and progesterone (nmol/L) in the survival and death groups were 26.65 vs.37.80, 0.54 vs.0.69, respectively, with statistical differences (P<0.05). Cox multivariate analysis showed that estradiol and progesterone were significantly associated with death (P<0.05), the hazard ratio (HR) of estradiol Q4 was 1.58 (95%CI: 1.17-2.15), and the HR of progesterone Q3 was 1.53 (95%CI: 1.10-2.12), HR for Q4 was 1.63 (95%CI: 1.15-2.32). Subgroup and cross-analysis showed that estradiol was statistically significant with hypertension, diabetes, and low high-density lipoprotein cholesterol (P<0.05), and progesterone interacted with diabetes (P=0.016), while testosterone interacted with low high-density lipoprotein cholesterol (P=0.034). Conclusion: It is suggested that the estrogen levels of female centenarians in Hainan were associated with a higher mortality risk and an increased risk of cardiovascular metabolic disease (such as diabetes, hypertension, and abnormal lipid metabolism).

[Association between smoking status and mortality risk among elderly people aged 60 and above in Beijing City].

Objective: To examine the association between smoking status and related mortality among elderly people aged 60 and above in urban and rural areas of Beijing City. Methods: Based on Beijing City Elderly Comprehensive Health Cohort Study from 2009 to 2014, a total of 4 499 eligible older adults included in the baseline survey were followed up and investigated to collect information on survival and death. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs), and the dose-response relationship was estimated between the smoking index, the years of quitting and mortality. Results: The median (IQR) age of 4 499 subjects was 70.00 (10.00) years old, including 1 814 (40.32%) males. The proportion of non-smokers, former smokers and current smokers was 69.50% (3 127/4 499), 13.20% (594/4 499) and 17.30% (778/4 499), respectively. After adjusting for confounding factors such as demographic and sociological characteristics, lifestyle, etc., the results of multivariate Cox regression analysis showed that, compared to non-smokers, former smokers had a 30.6% increased risk of all-cause mortality [HR (95%CI): 1.306 (1.043-1.636)] and the HR (95%CI) of all-cause, malignant tumor and lung cancer mortality among current smokers has increased by 50.0% [HR (95%CI): 1.500 (1.199-1.877)], 80.3% [HR (95%CI): 1.803 (1.226-2.652)] and 212.6% [HR (95%CI): 3.126 (1.626-6.012)], respectively. The smoking index was positively associated with the increased risk of all-cause, malignant tumor and lung cancer mortality, while the years of smoking cessation were negatively associated with that risk (P<0.05). Conclusion: Smoking is associated with tobacco-related mortality among elderly people in Beijing City.

Genetic analysis of longevity and their associations with fertility traits in Holstein cattle.

The increase of longevity is intended to reduce involuntary culling rates, not extend the life span, and it reflects the ability of animals to successfully cope with the environment and disease during production. Sire model, animal model and repeatability animal models were used to estimate the (co) variance components of longevity and fertility traits. Six longevity and thirteen fertility traits were analysed, including herd life (HL), productive life (PL), number of days between first calving and the end of first lactation or culling (L1); number of days between first calving and the end of the second lactation or culling (L2); number of days between first calving and the end of the third lactation or culling (L3); number of days between first calving and the end of the fourth lactation or culling (L4); age at first service, age at first calving (AFC), the interval from first to last inseminations in heifer (IFLh), conception rate of first insemination in heifer, days open (DO), calving interval, gestation length, interval from calving to first insemination (ICF), interval from first to last inseminations in cow (IFLc), conception rate of first insemination in cow, calving ease (CE), birth weight, and calf survival. The estimated heritabilities (±SE) were 0.018 (±0.003), 0.015 (±0.003), 0.049 (±0.004), 0.025 (±0.003), 0.009 (±0.002) and 0.011 (±0.002) for HL, PL, L1, L2, L3 and L4, respectively. Strong correlations were appeared in HL and PL; the genetic and phenotypic correlation coefficients were 0.998 and 0.985, respectively. There were high genetic and phenotypic correlations which were observed in L1 and L2, L2 and L3, L3 and L4, respectively. All fertility traits of heifer showed medium to high heritability, while the cow showed low heritability. All heifer fertility traits had low genetic associations with longevity traits, ranging from -0.018 (L2 and IFLh) to 0.257 (L3 and AFC). Most of the fertility traits showed negative correlations with longevity traits in different parities, and we recommend DO, ICF, IFLc and CE as indirect indicators of longevity traits in dairy cows, but we also need to take into account the differences between parities.

[Comparative analysis of clinical diagnosis and treatment guidelines for drug-induced liver injury at home and abroad].

Drug-induced liver injury influencing factors are complex and have diverse clinical manifestations. Simple and reliable diagnostic methods are still deficient, and further classification of toxicological mechanisms is required. There are numerous pertinent discrepancies between domestic and international guidelines aimed at drug-induced liver injury diagnosis and treatment, with partial to no consensus on the content. The American Gastroenterological Association's 2021 Clinical Guidelines, the Asia-Pacific Association for the Study of the Liver's 2021 Consensus Guidelines, the Council for International Organizations of Medical Sciences' 2020 International Consensus, the European Society's Hepatology Committee's 2019 Clinical Practice Guidelines, and the 2015 Chinese Medical Association Guidelines are five influential clinical guidelines on drug-induced liver injury at home and abroad. The epidemiology, risk factors, diagnosis and evaluation, treatment management, and other contents, particularly traditional Chinese medicine, were compared and analyzed using other relevant consensus opinions or guidelines in order to improve understanding and provide a reference for clinical diagnosis and treatment of drug-induced liver injury.

[An investigation on the nutritional status and support of in-patients with common variable immunodeficiency].

The study aimed to reveal for the first time the clinical characteristics, nutritional and metabolic status and support of hospitalized patients with common variant immunodeficiency disease (CVID), and provide reference to improve the long-term nutritional management for such patients. This is a retrospective cross-sectional study. Through searching the electronic medical record system of Peking Union Medical College Hospital, the study included 33 consecutive in-patients with CVID diagnosed in Jan 2016 to Jun 2021, with the male to female ratio of 16∶17. All their medical data, nutritional assessment and intervention retrospectively summarized and analyzed. Data with normal distribution were described using (x¯±s), and analyzed with independent sample t-test. Data with non-normal distribution were compared with non-parametric test. The results showed that the median onset-age of the included patients was 22 (10.0,36.5) years old, and the median duration was 9.0 (2.0,16.0) years. All patients had recurrent infections involving various systems (33/33), with development of autoimmune diseases (8/33) and lymphoproliferative disease or malignancy (9/33) in some cases among them. The nutritional risk screening 2002 (NRS 2002) scores revealed that 85.19% of adults had an NRS 2002≥3 points, and 33.33% of children had a BMI-for-age z score<-2. Weight loss occurred in 66.67% of patients (22/33), while 87.88% (29/33), 69.70% (23/33) and 81.82% (27/33) of patients respectively had anemia, hypoalbuminemia and decreased prealbumin. Among 22 patients with micronutrients status evaluated, 77.27% (17/22), 22.73% (5/22) and 31.82% (7/22) of patients respectively had lowered serum iron, folate deficiency and vitamin B12 insufficiency. Six patients underwent 25-OH-VD3 measurement, and were all testified to have vitamin D deficiency. Among all patients with nutritional risk, 56.00% of them underwent nutritional support: oral nutritional supplements (14 cases), enteral feeding (4 cases) and parenteral nutrition (5 cases). In conclusion, the condition of malnutrition was prevalent in patients with CVID, but was under-recognized and undertreated to some degree.

[The nutritional management in the early rehabilitation for critically ill patients].

The early rehabilitation is one of the important measures for the prevention or management of the post-intensive care syndrome. The nutritional intervention, as another essential supportive treatment for critically ill patients, is closely linked to rehabilitation management. However, the nutritional management in relation to early rehabilitation for critically ill patients has been rarely studied up to now. This paper sorts out the link between nutrition support and early rehabilitation for patients with critical illness, and looks forward to providing evidence for the combination of critical care rehabilitation management and nutritional intervention.

[Clinical significance of autoantibodies against ubiquitin carboxyl hydrolase L1 epitopes in the screening and diagnosis of Sjögren syndrome].

Objective: To study the clinical significance of autoantibodies against different ubiquitin carboxyl hydrolase L1 (UCH-L1) epitopes in Sjogren syndrome (SS). Methods: The serum levels of different UCH-L1 epitope autoantibodies in 98 SS patients [SS group, 17 males and 81 females, aged (49.1±12.3) years] in the Fifth Affiliated Hospital of Zhengzhou University and Peking University People's Hospital from January 2017 to January 2020 and 37 healthy controls [control group, 6 males and 31 females, aged (46.3±5.8) years] were determined by enzyme-linked immunosorbent assay (ELISA). Three potential epitopes of UCH-L1 protein were analyzed and synthesized and anti-UCH-L1203-214 and anti-UCH-L158-69 antibodies were studied between the two groups. The levels of the two anti-UCH-L1 antibodies in the two groups were compared. The correlation between the levels of UCH-L1 antibodies and clinical data of SS patients were analyzed by Pearson correlation analysis. Results: The serum levels of anti-UCH-L1203-214 and anti-UCH-L158-69 antibody in SS patients were significantly higher than those in healthy controls (HCs) (anti-UCH-L1203-214: 108.2±54.3 vs 78.9±25.8, P<0.001, anti-UCH-L158-69: 86.8±33.3 vs 60.4±21.5, P<0.001). The positive rates of anti-UCH-L1203-214 and anti-UCH-L158-69 antibodies in serums of SS patients were 27.6 % (27/98) and 25.5% (25/98), and those in HCs were 2.7%(1/37) and 5.4 %(2/37), respectively. In SS patients with positive serum anti-UCH-L158-69 antibody, the levels of IgG, γ globulin and rheumatoid factor (RF) and anti-SS-related antigen B (anti-SSB) antibody positive rate were all significantly higher than those in patients with negative antibody (all P<0.05). In SS patients with negative antinuclear antibody (ANA), anti-RNA binding protein (anti-RNP) antibody, anti-SS-related antigen A (anti-SSA) antibody and anti-SSB antibody, the positive rates of anti-UCH-L1203-214 antibody was 32.1%(9/28), 27.2%(25/92), 36.4%(12/33), 28.6%(18/63), respectively; and the positive rates of anti-UCH-L158-69 antibody was 21.4%(6/28), 30.4%(28/92), 30.3%(10/33), 20.6%(13/63), respectively. The level of serum anti-UCH-L1203-214 antibody in SS patients was positively correlated with the IgA level (r=0.21, P=0.024). The level of anti-UCH-L158-69 antibody in SS patients was positively correlated with the levels of γ-globulin, IgG and RF (r=0.35, 0.33, 0.32, all P<0.01). Conclusion: Autoantibodies against UCH-L1 epitopes are correlated with some clinical parameters of SS patients, which is of promising significance in the screening and diagnosis of SS.

[Influential factors related to osteoradionecrosis of the mandible in oral and maxillofacial cancer patients following radiotherapy].

Objective: To identify risk factors associated with mandibular osteoradionecrosis (ORN) in oral and maxillofacial cancer patients following radiotherapty and to provide scientific basis for the etiological research and clinical prevention of mandibular ORN. Methods: A retrospective study was conducted in patients with oral and maxillofacial-head and neck cancer during the period from January 2013 to December 2015. Influential factors related to mandibular ORN were screened by single factor analysis, Lasso and Logistic regression analysis. Results: A total of 757 patients were analyzed, and the total incidence of mandibular ORN was 12.0%(91/757). There were 443 males and 314 females, aged (51.8±13.7) years. Thirty-five related factors were screened to 28 by single factor analysis. It was determined by Lasso regression analysis that, radiation doses (OR=1.135, P=0.034, 95%CI: 1.089-1.232), T classification (OR=2.586, P=0.001, 95%CI: 1.482-4.512), mandibular surgery (OR=9.101, P<0.001, 95%CI: 2.796-29.630), periodontitis (OR=6.089, P<0.001, 95%CI: 2.708-13.693), diabetes (OR=4.467, P=0.002, 95%CI: 1.705-11.704), tooth extraction after radiotherapy (OR=3.228, P=0.001, 95%CI: 1.640-6.350), dental caries (OR=2.911, P=0.009, 95%CI: 1.300-6.516), periapical periodontitis (OR=2.726, P=0.016, 95%CI: 1.209-6.145), smoking (OR=4.438, P=0.002, 95%CI: 1.702-11.571) and unilateral/bilateral radiotherapy (OR=2.225, P=0.028, 95%CI: 1.090-4.545) were significantly associated with developing mandibular ORN. Conclusions: Ten main risk factors for mandibular ORN were identified through the single center, large sample, retrospective analysis, which has a certain value for clinical prevention of mandibular ORN. Prospective, randomized controlled trials and long-term follow-up are still needed.

Maternal cardiac arrest: a retrospective analysis.

OBJECTIVES: To describe the characteristics and factors which may influence the maternal outcomes of maternal cardiac arrest (MCA). DESIGN: Retrospective analysis of cases. SETTING: China. POPULATION OR SAMPLE: A total of 61 MCA patients admitted or transferred to The Third Affiliated Hospital of Guangzhou Medical University from January 2000 to December 2019. METHODS: Clinical data for MCA were analysed retrospectively. The indicators included maternal age; BMI; gestational age; antenatal examination; income; MCA cause and place; cardiopulmonary resuscitation (CPR); mode of delivery; maternal prognosis; and neonatal outcome. MAIN OUTCOME MEASURES: The impact of case characteristics on maternal prognosis of MCA. RESULTS: The hospital received 61 patients with MCA, 36 of whom died (mortality 59.0%, 95% CI 46.3-71.7%). MCA was predominantly caused by treatable complications. Those who died were more likely to have collapsed in the ICU. CONCLUSIONS: Regular antenatal examination and early intervention can reduce the incidence of adverse pregnancy outcomes. The location of MCA occurred may be related to maternal prognosis. The leading causes of MCA were postpartum haemorrhage and amniotic fluid embolism. TWEETABLE ABSTRACT: A retrospective analysis describes the correlation between case characteristics of MCA and maternal outcomes.

[Incidence of deeply infiltrating endometriosis among 240 cases of pelvic endometriosis and analysis of its clinical and pathological characteristics].

Objective: To evaluate the incidence of deeply infiltrating endometriosis (DIE) among patients of pelvic endometriosis confirmed by pathology and to make analysis of its clinical and pathological characteristics. Methods: From January 1, 2018 to December 31, 2018, clinical data of 240 cases of pelvic endometriosis diagnosed by laparoscopy and pathology hospitalized in Peking University First Hospital were analyzed retrospectively for the characteristics of symptoms, pelvic examination and anatomic distribution of endometriosis foci. Results: (1) Among 240 cases of pelvic endometriosis, 94 were diagnosed with DIE with an incidence of 39.2% (94/240); of them the diagnosis were made preoperatively in 44 cases (46.8%, 44/94). (2) Compared with those without DIE, patients with DIE had higher rates of secondary dysmenorrhea [53.2% (50/94) versus 38.4% (56/146), P=0.033], anal pain [43.6% (41/94) versus 28.1% (41/146), P=0.013], dyspareunea [39.4% (37/94) versus 18.5% (27/146), P=0.001] and frequent bowel movement [33.0% (31/94) versus 15.8%(23/146), P=0.002]. (3) Patients with DIE had higher rates of bad movement of uterus [21.3% (20/94) versus 6.8% (10/146), P=0.001], painful nodularity on uterosacral ligaments [26.6% (25/94) versus 6.2% (9/146), P<0.01], painful nodularity of posterior fornix [19.1% (18/94) versus 4.8% (7/146), P<0.01], blue nodule in vaginal wall [6.4% (6/94) versus 0 (0/146), P=0.003] by pelvic examination compared with those without DIE. (4) Ninety-four patients with DIE had a total of 162 nodules, of those 88 (54.3%, 88/162) located in uterosacral ligaments, 14 (8.6%, 14/162) in the rectum, 7 (4.3%, 7/162) in vaginal wall, 6 (3.7%, 6/162) in ureter, 4 in bladder (2.5%, 4/162), 2 (1.2%, 2/162) in Douglas pouch. Forty-three DIE patients (45.7%, 43/94) had more than one nodules. Patients with DIE had concomitant ovarian endometriosis in 69 cases (73.4%, 69/94), with a total of 103 endometrial cysts. (5) Patients with DIE had a higher rate of obliterated Douglas pouch [76.6% (72/94) versus 19.2% (28/146), P<0.01]. Conclusions: More than one third of patients with pelvic endometriosis have concomitant DIE with a lower rate of preoperative diagnosis. Pelvic pains, bad movement of uterus and painful nodulirity around cervix suggest the presence of DIE.

Effects of steam explosion pretreatment and Lactobacillus buchneri inoculation on fungal community of unensiled and ensiled total mixed ration containing wheat straw during air exposure.

AIM: To compare the effects of steam explosion and Lactobacillus buchneri inoculation on fungal community in ensiled total mixed ration (TMR) during aerobic exposure. METHODS AND RESULTS: The TMRs were prepared using wheat straw with or without steam explosion, sweet potato residue, lucerne hay, maize meal and soybean meal, and ensiled with or without L. buchneri inoculation. Fungal communities were detected by high-throughput sequencing. All ensiled TMRs were well ensiled and steam explosion has a major effect on improving aerobic stability. The fungal species, such as Xeromyces bisporus and Cryptococcus victoriae, that dominated in the TMR decreased after ensiling, with a concomitant increase in Candida humilis, Pichia kudriavzevii, Aspergillus flavus and Phanerochaete chrysosporium. Most mould species decreased, with C. humilis and P. kudriavzevii dominating during aerobic exposure. CONCLUSION: Steam explosion could improve the aerobic stability in ensiled TMR by inhibition of C. humilis. SIGNIFICANCE AND IMPACT OF THE STUDY: High-throughput sequencing used in this study provides insight into the fungal community in ensiled TMR during aerobic exposure, which could contribute towards elucidating the mechanism by which aerobic deterioration develops.

[Risk factors of human cystic echinococcosis in Shiqu County Sichuan Province: a case-control study].

OBJECTIVE: To identify the main risk factors of human cystic echinococcosis in Shiqu County, Sichuan Province, so as to provide the reference for the formulation of echinococcosis control strategies in Shiqu County. METHODS: During the period from November 2015 through June 2017, the patients with cystic echinococcosis (case group) and healthy controls (control group) were randomly sampled from Shiqu County as the study subjects. A questionnaire survey was conducted to capture the study subjects'age, gender, ethnicity, occupation, religion, lifestyle, education level, number of household dogs, bovine and sheep, and density of dog feces in the courtyard. The major risk factors of human cystic echinococcosis were identified using a logistic regression model. RESULTS: Univariate logistic regression analysis showed 7 risk factors with statistical significance between the case and control groups, and age, lifestyle, number of household bovine, number of household sheep, number of house-hold dogs, and the density of dog feces in the courtyard were included in the multivariate logistic regression model (OR = 1.026, 4.792, 1.067, 1.022, 1.709 and 1.095, respectively). CONCLUSIONS: High age, pastoral nomadic lifestyle, high number of house-hold bovine, high number of household sheep, high number of household dogs and high density of dog feces in the courtyard are strongly associated with the riks of human cystic echinococcosis in Shiqu County.

[A novel HAND1 mutation associated with sporadic dilated cardiomyopathy].

Objective: To investigate a novel mutation in the HAND1 gene associated with sporadic dilated cardiomyopathy (DCM). Methods: From February 2013 to February 2017, the clinical data and peripheral venous blood samples were collected from 120 patients with sporadic DCM and 200 healthy controls, who were both from the Fifth People's Hospital of Shanghai, Fudan University and Shanghai Chest Hospital, Shanghai Jiaotong University.The genomic DNA was extracted from the study participants.The coding exons of HAND1 were amplified from the study subjects by polymerase chain reaction, and were sequenced for a potential HAND1 mutation.The online computer programs MUSCLE and Mutation Taster were used to analyze the conversation of an altered amino acid and to predict the disease-causing potential of an identified mutation, respectively.The wild-type HAND1 was cloned and the mutant was generated by site-directed mutagenesis.The Dual-luciferase reporter assay kits were used to explore the functional characteristics of the mutant HAND1. Results: A novel heterozygous mutation, a substitution of thymine for guanine at nucleotide 346 (c.346G>T), predicting the conversion of a glutamic acid-encoding codon into a stop codon at codon 116 (p.E116X), was detected in a patient with sporadic DCM.The nonsense mutation was absent in the 200 control individuals.The altered glutamic acid at amino acid position 116 was highly conserved evolutionarily, and the mutation was predicted to be pathogenic.Biological analyses revealed that the mutant HAND1 lost the ability to transcriptionally activate a target gene. Conclusion: Loss-of-function mutation in HAND1 is likely to be an uncommon cause responsible for sporadic DCM.

A comparative study assessing a new tool for occluding parenchymal blood flow during liver resection for hepatocellular carcinoma.

BACKGROUND: The aim of this study was to compare the efficacy of a new tool (the hepatic section vascular blocker, HSVB) with hepatic pedicle clamping and hemihepatic vascular exclusion to control bleeding during liver resection for cancer. METHODS: Clinical data on 117 patients who underwent liver resection from 2004 to 2009 were analysed retrospectively. Forty-two patients had liver resection using the HSVB (group A), in 35 patients hemihepatic vascular exclusion was used (group B), and in 40 patients hepatic pedicle clamping with a Pringle manoeuvre was used (group C). Blood loss, operative time, postoperative hepatic function and complications were compared. RESULTS: Mean blood loss and operative time in group A were significantly less than in groups B (p=0.026 and p<0.001, respectively) and C (p<0.001 and p<0.001). There were significant differences between groups A and C in total bilirubin (TB) and alanine transaminase (ALT) levels on postoperative days 3 and 7, and group A had better hepatic function (TB p=0.014 and p=0.009; ALT p<0.001 and p<0.001). The rate of postoperative ascites was significantly higher in group C compared with group A (p<0.001). In group C, 2 patients had liver failure, 1 had a gastro-intestinal haemorrhage and 1 died. CONCLUSIONS: Using the HSVB during liver resection effectively controlled bleeding, saved operative time and preserved hepatic function. It proved to be a safe and feasible technique.

Seroprevalence of Helicobacter pylori infection in medical staff in Shanghai.

BACKGROUND: The epidemiology of Helicobacter pylori is still under investigation. It is postulated that the human stomach is the natural reservoir and that spread occurs by oral-oral or fecal-oral transmission. The aim of this study was to determine whether medical staff, especially endoscopy unit personnel, are at an increased risk of acquiring H. pylori infection. METHODS: An enzyme-linked immunosorbent assay technique was used to detect circulating H. pylori IgG antibodies in 1050 medical staff from 16 hospitals in Shanghai, including 125 GI endoscopists, 45 endoscopy unit nurses, 71 gastroenterologists not doing endoscopy, 105 nurses working in gastroenterology wards, 417 internists, and 287 general nurses. This group was compared with an age-matched population obtained from the same urban area of the city. RESULTS: The overall prevalence of H. pylori infection in total medical staff was 70.0%, compared to 44.6% in general population (P < 0.0001). Age-adjusted comparisons between subgroups of medical staff were made. The prevalence of H. pylori in GI endoscopists was 82.4%, which is significantly higher than 66.4% in internists and 65.8% in general nurses (all, P < 0.01) but not significantly different from 77.7% in endoscopy unit nurses or from 74.2% in nurses working in gastroenterology wards (all, P > 0.05). Further analysis did not show any significant difference in the prevalence of H. pylori between other subgroups. The prevalence of H. pylori infection in GI endoscopists increased with the number of years of practice. CONCLUSIONS: Medical staff, especially endoscopy unit personnel, are at increased risk of infection with H. pylori. These findings strongly suggest the medical practice and endoscopy procedures are risk factors for H. pylori infection and support person-to-person transmission in this setting, probably from patients to medical staff.