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Objective: To compare the relative efficacy of the green pit viper antivenom from Thailand and Agkistrodon halys antivenom from China. DESIGN. In-vivo experimental study., Setting: A wildlife conservation organisation, a university, a poison information centre, and a regional hospital in Hong Kong., Main Outcome Measures: Pre- and post-antivenom lethal dose 50 (LD50) of the Cryptelytrops albolabris venom, median effective dose (ED50) of green pit viper antivenom and Agkistrodon halys antivenom against a lethal dose of the venom. SUBJECTS. Adult mice., Results: The intraperitoneal LD50 of the venom from locally caught Cryptelytrops albolabris was 0.14 microL. After post-exposure treatment with 10 microL of antivenom, it was elevated to 0.36 microL and 0.52 microL by the green pit viper antivenom and the Agkistrodon halys antivenom, respectively. The ED50 was 32.02 microL for green pit viper antivenom and 6.98 microL for Agkistrodon halys antivenom. Both green pit viper antivenom and Agkistrodon halys antivenom ameliorated the lethality of Cryptelytrops albolabris venom in mice., Conclusion: The overall superior neutralisation capacity of Agkistrodon halys antivenom over green pit viper antivenom may be related to the geographic proximity of the venoms used for antivenom preparation. The results point towards the need for further comparison of the two antivenoms on protein or immunoglobulin weight basis, and with respect to non-lethal clinically significant toxicities.

To provide exposure information for epidemiology studies conducted in Shanghai from 2001 to 2008, we completed retrospective exposure assessments (EA) of benzene and other hazards. Interviewers administered questionnaires to subjects from Shanghai area hospitals. An initial exposure screening by EA staff members, blinded as to case-control status, stratified jobs into exposed, unexposed, or uncertain categories prior to review by a separate expert panel (EP). Resources for the EA included job/industry-specific questionnaire responses by subjects, short-term benzene area concentration measurements from a Shanghai regulatory agency database, Chinese literature for qualitative and short-term quantitative measurements, on-site investigations, summaries of technology changes, and selected task simulations with concurrent benzene concentration measurements. An EP in Shanghai completed semi-quantitative benzene exposure assignments, with categories of 0 to 4 corresponding to intensity ranges of none, <1, 1 to 10, >10 to 100, and >100 mg/m(3). For other hazards, sources included the EP's knowledge of the industries and Chinese and Western literature. For benzene, 20% of the EAs selected by a stratified random process were evaluated by two alternate methods. The study database of potential cases and controls included 18,857 jobs from the subjects' work histories. From 818 individuals initially screened as probably benzene exposed, 964 jobs underwent further review. From subjects with final diagnoses, 755 jobs qualified for inclusion in the final database for any study. For other exposures, the EA considered 17,893 jobs from 7654 subjects for possible exposures and were in the final study database. Of these, 2565 individuals had exposures of study interest from their 4909 exposed jobs. The prevalent exposures included agricultural chemicals, petroleum products, and metals. The EA involved extensive information assembly and exposure assignment by an EP and periodic reviews. The methods described went beyond those typically applied in past general population studies and may have provided improved information for the epidemiologic analyses. However, sufficient, reliable measured historical data are lacking to evaluate this conclusion.

The objectives were (1) to investigate potential environmental and occupational risk factors of non-Hodgkin lymphoid neoplasms (NHLN), and (2) to explore the relationships between risk factors and NHLN subtypes according to the World Health Organization (WHO) classification. The investigation was a hospital-based case-control study consisting of 649 newly diagnosed NHLN cases (August 2003 through January 2008) and 1298 individually gender-age-matched patient controls at 25 hospitals in Shanghai. A 17-page questionnaire was used to obtain information on demographics, medical history, family history, lifestyle risk factors, employment history, residential history, and occupational and non-occupational exposures. Certain occupations of interest triggered a second questionnaire, which was occupation-specific and asked for more details about jobs, tasks, materials used and work environment. Exposure assessments were based on the questionnaires, on-site workplace investigations, data published in the Chinese literature, historical exposure measurements maintained by government health agencies, and expert opinions of a panel of local scientists who were familiar with workplaces in Shanghai. Risk estimates (odds ratios and 95% confidence intervals) of individual risk factors were calculated using conditional logistic regression models. A number of potential environmental and occupational risk factors were associated with an increased risk of NHLN (all subtypes combined) and/or individual subtypes; including home/workplace renovation, living on a farm, planting crops, raising livestock or animals, farm workers, fabric sewing and cutting workers, welders and sheet metal workers, masonry and plastering workers, product and chemical testing workers, toy manufacturing, agriculture industry, and beauty salon. Exposures associated with an increased risk of NHLN (all subtypes combined) and/or individual subtypes included benzene, solvents, petroleum fuels, metals, insecticides, herbicides, fertilizers, and glues and adhesives. Multivariate models were used to adjust for potential confounding exposures, and several potential risk factors were subsequently eliminated. The results of the investigation indicated that some risk factors applied to all or most subtypes (e.g., insecticides and overall NHLN and subtypes of B-cell lymphoid neoplasms), while others to specific subtypes only (e.g., benzene and follicular lymphoma). Thus, some risk factors were subtype-specific. The difference in risk by subtype underscores the importance of the etiologic commonality and heterogeneity of NHLN subtypes., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

The objectives were: (1) to investigate potential environmental and occupational risk factors of acute myeloid leukemia (AML), and (2) to explore the relationships between risk factors and AML subtypes according to the World Health Organization (WHO) classification. The investigation was a hospital-based case-control study consisting of 722 newly diagnosed AML cases (August 2003 through June 2007) and 1444 individually gender-age-matched patient controls at 29 hospitals in Shanghai. A 17-page questionnaire was used to obtain information on demographics, medical history, family history, lifestyle risk factors, employment history, residential history, and occupational and non-occupational exposures. Certain occupations of interest triggered a second questionnaire, which was occupation-specific and asked for more details about jobs, tasks, materials used and work environment. Exposure assessments were based on the questionnaires, on-site workplace investigations, data published in the Chinese literature, historical exposure measurements maintained by government health agencies, and expert opinions of a panel of local scientists who were familiar with workplaces in Shanghai. Risk estimates (odds ratios and 95% confidence intervals) of individual risk factors were calculated using conditional logistic regression models. A number of potential environmental and occupational risk factors were associated with an increased risk of AML (all subtypes combined) and/or individual subtypes; including home or workplace renovation, living on a farm, planting crops, raising livestock or animals, farm workers, metal workers, rubber and plastic workers, wood and furniture workers, printers, loading and unloading workers, automobile manufacturing, general construction, and food and beverage industry (restaurants and other eateries). Exposures associated with an increased risk of AML (all subtypes combined) and/or individual subtypes included benzene, diesel fuel, metals, insecticides, fertilizers, glues and adhesives, paints and other coatings, and inks and pigments. Multivariate models were used to adjust for potential confounding exposures, and several potential risk factors were subsequently eliminated. The results of the investigation indicated that some risk factors applied to all or most subtypes (e.g., living on a farm and overall AML and several subtypes), while others to specific subtypes only (e.g., raising livestock and AML with multilineage dysplasia). Thus, some risk factors were subtype-specific. The difference in risk by subtype underscores the importance of the etiologic commonality and heterogeneity of AML subtypes., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To investigate potential risk factors (personal characteristics, lifestyle, and environmental factors) of non-Hodgkin lymphoid neoplasms (NHLN), including lymphomas and lymphocytic leukemia, according to the World Health Organization classification., Materials and Methods: The investigation was a hospital-based case-control study consisting of 649 confirmed NHLN cases and 1298 individually gender-age-matched patient controls at 25 hospitals in Shanghai. A 17-page questionnaire was used to obtain information on demographics, medical history, family history, lifestyle risk factors, employment history, residential history, and occupational and non-occupational exposures. Risk estimates were calculated using conditional logistic regression models., Results: Potential risk factors of NHLN (all subtypes combined) or individual subtypes included low-level education, home or workplace renovation, living on a farm, planting crops, and raising livestock or animals. Some risk factors applied to all or most subtypes (such as lowlevel education, living on a farm, and raising livestock or animals), whereas others did not (such as the use of traditional Chinese medicines, which was associated with a reduced risk). Blood transfusions, hair dyes, or living near high-voltage power lines were not associated with an increased risk., Conclusions: The study identified a number of risk factors for NHLN overall and specific subtypes. Some risk factors were subtype-specific. The difference in risk by subtype underscores the etiologic commonality and heterogeneity of NHLN subtypes.

Objectives: The objectives are (1) to investigate and identify potential risk factors (personal characteristics, lifestyle and environmental factors) of acute myeloid leukemia (AML), and (2) to explore the relationships between potential risk factors and AML subtypes according to the World Health Organization (WHO) classification of myeloid neoplasms., Materials and Methods: The investigation was a hospital-based case-control study consisting of 722 confirmed AML cases and 1444 individually gender-age-matched patient controls at 29 hospitals in Shanghai. A 17-page questionnaire was used to obtain information on: demographics, medical history, family history, lifestyle risk factors, employment history, residential history, and environmental and occupational exposures. Certain occupations of interest triggered a second questionnaire, which was occupation-specific and asked for more details about jobs, tasks, materials used and work environment. Risk estimates (odds ratios and 95% confidence intervals) were calculated using conditional logistic regression models., Results: Several potential risk factors of AML (all subtypes combined) and individual subtypes were identified; including low-level education, body mass index (BMI), blood transfusion, smoking, alcohol consumption, home or workplace renovation, living on a farm, planting crops, raising livestock or animals, employment as farm workers or in the agricultural industry, and exposures to insecticides or fertilizers. Some risk factors applied to all or several subtypes (such as low-level education and living on a farm), while others were limited to one or two specific subtypes (such as home/office renovation and acute promyelocytic leukemia). An inverse association was found between BMI and overall AML or the sub-category "AML not otherwise categorized", whereas a positive association between BMI and the subtype acute promyelocytic leukemia was detected. An unexpected finding was the association between the use of traditional Chinese medicines and a reduced risk of AML in general as well as several major subtypes., Conclusions: The study identified a number of risk factors for AML in general as well as for some specific subtypes. Some of the risk factors were subtype-specific. The difference in risk by subtype underscores the importance of investigating the etiologic commonality and heterogeneity of AML by subtype in epidemiologic research.

Of the 700 million workers in China, approximately 200 million workers are potentially exposed to industrial hazards. Although the promulgation and implementation of occupational exposure limits (OELs) in China began in the mid-1950, a systematic approach was not formalized until the formation of the Subcommittee of Occupational Health Standards Setting (SOHSS) in 1981. More recently, the 2002 Occupational Disease Prevention and Control Act of the People's Republic of China created the legislative framework for the development and enforcement of OELs. The SOHSS, whose members are primarily health professionals, is the organization responsible for the development of recommended standards, under the auspices of the Ministry of Health. The philosophy of OEL development of the SOHSS consists of a two-step approach: (1) an initial health-based recommended standard is established based on scientific data, and (2) a final law-based standard takes into consideration both socioeconomic and technological feasibility. Governmental agencies such as the Centers for Diseases Control and Prevention and the Institutes of Public Health Supervision at the state, provincial or municipal levels are charged with the responsibilities of the enforcement of OELs. The process and challenges in the enforcement of OELs are discussed. A comparison is made between selected Chinese OELs and those in other countries. The OELs for benzene and industrial dusts (including silica) are discussed in some detail.

This article presents a summary of benzene exposure levels in the shoemaking industry in China reported in the Chinese medical literature between 1978 and 2004. A comprehensive search identified 182 papers reporting such exposure data. These papers could be classified into two categories: benzene poisoning case reports and industrial hygiene surveys. From each paper, the following information was abstracted whenever available: location and year of occurrence, occupation and/or task involved, benzene content in adhesives/solvents, work environment, working conditions, working hours, diagnosis, and air monitoring data of benzene. A total of 333 benzene measurements (88 averages, 116 minimums, 129 maximums) in the shoemaking industry were reported in the 182 papers identified. The data were analyzed in terms of geographical location, time period, type of ownership (state, township, or foreign), type of report (benzene poisoning reports vs. industrial hygiene surveys), and job title (work activity) or process. The reported data covered a wide range; some measurements were in excess of 4500 mg/m(3). Thirty-five percent of the reported benzene concentrations were below 40 mg/m(3), which was the national occupational exposure limit (OEL) for benzene between 1979 and 2001. The remaining 65% measurements, which exceeded the national OEL in effect at the time, and were distributed as follows: 40-100 mg/m(3), 11%; 100-300 mg/m(3), 21%; 300-500 mg/m(3), 13%; and 500+ mg/m(3), 20%. However, only 24% of the reported measurements after 2002 were below 6 mg/m(3), i.e., Permissible Concentration-Time Weighted Average (PC-TWA) and 10 mg/m(3), i.e., Permissible Concentration-Short Term Exposure Limit (PC-STEL), the newly amended benzene OELs in effect after May 2002. The data demonstrated that the majority of the facilities in the shoemaking industry reported in the literature were not in compliance of the OEL for benzene in effect at the time. Overall, the data show a clear downward trend of benzene exposure levels over the years, particularly after the introduction of the new lower OEL in 2002. Even though substantially lower when compared to levels in the past, current benzene exposure measurements from the literature review suggest that many facilities in the shoemaking industry in China have benzene concentrations that are still above the new OEL. The reported data, stratified by job, year and survey reason, can be used as part of the information and analysis for developing a job-exposure matrix in retrospective exposure assessment and thus may be part of the information used in developing historical exposure estimates in epidemiologic studies of shoe workers.

This article presents a summary of lead exposure levels and lead poisoning at workplaces in China reported in the Chinese medical literature between 1990 and 2005. A comprehensive literature search identified 618 papers reporting lead exposure and lead poisoning data. The data were analyzed in terms of time period, type of industry, size of factory, and task or process. In 2002 the new Occupational Diseases Prevention and Control Act was passed in China, with new provisions specifically for regulatory enforcement. Therefore, a comparison of lead exposure levels and lead poisoning rates before and after the 2002 Act will shed some light on the effectiveness of the new regulation. The reported lead exposure levels covered a wide range; some measurements were in excess of 250 mg/m(3), which was orders-of-magnitude higher than the occupational exposure levels (OELs) for lead in China. The overall arithmetic mean, median, and geometric mean were 0.92, 0.25, and 0.24 mg/m(3), respectively. Approximately 53.7% of the averages reported in the papers were above the national OELs. The data demonstrated that many facilities in the lead industries reported in the literature were not in compliance with the OELs. Similarly, there appeared to be only a minor impact of the 2002 Act on the reduction of occupational lead poisoning in China. The lead poisoning rates reported in the literature were well above 30%. Judging by the lead exposure levels and the lead poisoning rates, the current overall occupational health monitoring system appears inadequate, lacking the necessary enforcement. The 2002 Act, without the necessary enforcement, did not appear to have a major impact on either lead exposures or lead poisoning in China. Much work in enforcing the 2002 Act remains to be done.

The interest in the relationship between benzene exposure and non-Hodgkin lymphoma (NHL) appears to have been generated from a 1979 publication, which reported an increased risk of NHL among persons potentially exposed to benzene and/or coal tar fractions. More recently (1997), an increased risk of NHL was reported among 74,828 workers exposed to benzene and other chemicals in a variety of industries in China. On the contrary, no increased risk of NHL was reported in a cohort of 1,165 workers at two rubber hydrochloride plants in Ohio (US), who were exposed to extremely high levels of benzene and were found to have an increased risk of acute myeloid leukemia. In another large cohort of some 7,676 US workers exposed to benzene, no increased risk of NHL was reported. Similarly, no increased risk of NHL was reported in a combined cohort of 308,199 petroleum workers in the US, the UK, Canada, Australia, Italy and Finland, who were exposed to benzene or benzene-containing petroleum products. The lack of an association between benzene exposure and NHL in cohort studies is supported by case-control studies from the US, Canada, Italy and the UK. To further investigate the relationship between benzene exposure and NHL, we are conducting a hospital-based case-control study in Shanghai, China. Cases are newly diagnosed NHL patients at 29 hospitals in Shanghai. For each case, two matched controls are selected among patients without any lymphatic or hematopoietic diseases at the same hospital. Demographic, employment, medical and lifestyle information is obtained through questionnaires (primary and secondary). Sources for benzene exposure information include a database of 50,000+ benzene measurements maintained by the Shanghai Municipal Institute of Public Health Supervision (IPHS), Shanghai District IPHS, walk-through surveys at factories, additional measurements at factories and reports in Chinese medical journals. Patient enrollment started in 2003 and it is estimated that the study will have 400-450 NHL cases by December 2006. Some of the occupations or industries reported among enrolled study subjects (cases and controls) with potential exposure to benzene include shoe workers, painters, mechanics or machinists, and printers. Some of the unique features of the study are discussed.

This article presents an overview of occupational benzene exposures in China based on data published in Chinese medical journals. The data were derived from 384 reports of benzene poisoning or industrial hygiene surveys published in Chinese medical journals between 1960 and 2003. The following information was extracted whenever available: industry, occupation, task, date, benzene levels, sampling location, workplace descriptions and, for case reports, medical diagnosis. Each paper provided one or more sets of benzene data, each set representing a sampling location or job title with one to several measurements including, mainly, breathing zone area concentration measurements, and much less frequently personal monitoring. Two criteria based on data quality were applied to select suitable data for analyses. The selected exposure data were analyzed by industry and time period. Nine hundred five sets of benzene measurements from 72 industries were reported in the 384 papers selected for this review, and 621 sets (68.6%) presented average benzene concentrations, which covered 55 industries. The distribution of the reported average benzene exposures was skewed with a median of 51.5 mg/m3. The average benzene concentrations were below 100 mg/m3 for 406 (65%) of the 621 reported average concentrations. The medians of the reported averages in mg/m3 for the five industries with the highest exposures were: 124.8 for leather products, 98.7 for electronic devices, 75.4 for machinery, 50.4 for shoes, and 50.3 for office supplies and sports equipment manufacturing. These data describe the concentrations and changing patterns of occupational benzene exposure by industry and time period in China.

The recent passage of the Occupational Diseases Prevention and Control Act of 2002 (ODPCAct) in China and the new occupational exposure limits signify the Chinese government's commitment to improve the environment of the workplace and to eradicate preventable occupational diseases. The effectiveness of the ODPCAct, however, will depend on not only implementation and enforcement but also education and communication. For large industrial facilities, implementation of the new regulations can be enforced with periodic monitoring and inspections. The difficulty will come from small makeshift or crudely converted workshops in villages and small towns in rural areas. The challenge will be to reach out to these small workshop owners and workers, i.e., to communicate and inform them about the newly promulgated regulations, the business owners' legal responsibility and liability, and the workers' right to a safe workplace. Attention and resources should be focused on educating both shop owners and workers about the hazards of the chemicals that they use, basic requirements for a safe workplace, preventive measures, and controls to reduce exposures.

Phonological awareness, the ability to analyze spoken language into small sound units, has been shown to be affected by the individual's early orthographic experience (alphabetic vs. non-alphabetic). Past studies, however, have not differentiated the effect of script alphabeticity from that of spoken language experience, which covaries strongly with the phonological properties of the language. The present study compares younger, pre-reading to older, literate children from different linguistic backgrounds on their phonological awareness. Hong Kong and Guangzhou subjects both spoke Cantonese. The latter subjects had early experience with Pinyin (alphabetic) in addition to their logographic Chinese reading; the former read only logographic Chinese. New Zealand subjects spoke English and read the Roman alphabet. Results showed that: (1) the Hong Kong and Guangzhou pre-readers performed very similarly at all levels of phonological awareness; (2) the New Zealand pre-readers outperformed their Hong Kong and Guangzhou counterparts on onset, rime, and coda analyses; (3) the Guangzhou reading children outperformed their Hong Kong counterparts on onset and coda analyses. Whereas finding (3) reflects an effect of alphabeticity in the first learned script, finding (2) in combination with finding (1) indicates an effect of early spoken language experience independent of orthography. The fact that orthographic and spoken language experience both impact on the development of phonological skills implies a mediating function of phonological awareness in integrating sound information derived from reading and perceiving speech.

As reviewed in some detail in the present paper, workers employed in a wide variety of industries were included in the Chinese benzene study, and were exposed to not only benzene but also a wide range of other industrial chemicals. To attribute any or all health effects observed in the exposed cohort to benzene without examining other concomitant exposures is not appropriate. Although it was stated that one of the major objectives of the expanded study was to examine the effects of other risk factors, no such examination was made in any of the analyses in the expanded CAPM-NCI study. The CAPM-NCI study suffered from a number of limitations. One of the most serious limitations of the study involved the exposure estimates developed by the US NCI team. Comparing the assumptions used in the development of estimates and the exposure estimates themselves to actual data reported previously by the Chinese investigators revealed numerous inconsistencies and, in many cases, large discrepancies. It appeared that the exposure estimates were consistently lower than the actual exposure data. The so-called indirect validation conducted by the NCI team served no useful purpose, since by definition it could not validate the absolute values of the estimates. NCI was fully aware of some of the inadequacies of its exposure estimates. Although in a 1994 paper, the NCI team recognized that little confidence could be attached to the estimated (e.g., only 2% of the estimates for the time interval 1949-1959 and only 6% of the estimates prior to 1975 were rated in the high confidence category), the inadequacy of the estimates was never mentioned or discussed in any subsequent analyses or in the latest report (Hayes et al., 1998). Instead, the exposure of the workers was hailed as "well characterized" (Hayes et al., 1998). In conclusion both CAPM and NCI have made substantial efforts in studying the relationship between benzene exposure and various malignancies. Unfortunately, there were many inherent problems in the data as well as serious limitations in the exposure estimates. Because of these unresolved problems and limitations, many of the results in the CAPM-NCI study are unreliable. Therefore, the conclusions of the study, particularly those involving exposure estimates, are not justified.