Ethylene Oxide: Cancer Evidence Integration and Dose-Response Implications

Association between ethylene oxide exposure and serum sex hormone levels measured in a reference sample of the US general population

Ethylene oxide (EO) is a crucial organic compound commonly utilized in industrial and medical products. Food and Drug Administration (FDA)-approved EO sterilization sterilizes about 50% of sterile medical devices in the U.S. Animal and human studies have suggested that EO exposure may result in severe health problem. However, studies evaluating the relationship between EO exposure and sex hormones in human populations are still lacking. Therefore, further investigation into EO's effects on humans is essential. This cross-sectional study within the U.S. National Health and Nutrition Examination Survey (NHANES),2013-2016 examined the relationship between EO-hemoglobin adducts (HbEO) and sex hormones. HbEO was found to be inversely associated with estradiol (E2) and positively associated with the ratio of total testosterone (TT) to E2 and sex hormone-binding globulin (SHBG) levels in adult males. Such associations HbEO and E2 and SHBG were non-linear in male adults. However, no significant associations were found between HbEO and sex steroids across various age groups of females and all male age groups except for adults. Thus, our study provides evidence that EO may potentially serve as an endocrine disruptor in the environment, affecting the levels of sex hormones in adult males.

Evaluating the Justice and Risk Dimensions of Ethylene Oxide Governance in the US

We investigate the governance and environmental justice (EJ) outcomes from the hazard reclassification of ethylene oxide (EtO) by the Environmental Protection Agency in 2016. In response to EtO pollution after 2018, federal and state regulators engaged constituents to respond to complaints about EtO but adhered to a cost-benefit governance approach that ultimately inhibited risk mitigation. We argue risk mitigation was constrained by path dependent approaches that simultaneously enabled recognition of constituent concerns about EtO pollution while minimizing the costs of institutional change. Drawing on data from government documents and interviews, we analyze governance responses in Illinois and Georgia, selected due to their cross-cutting exposures to EtO and public mobilization in response to EtO risk. Our research reveals how structural and political factors limit risk mitigation and create a mismatch between environmental outcomes and public expectations. Drawing from theories of environmental justice and risk society, we show how this acceptance of EtO risk aligns with Ulrich Beck's theory of a risk society while generating significant justice concerns for its inability to consider how risk experiences vary according to social class.

Association between ethylene oxide exposure and cognitive function in older adults from NHANES data

Ethylene Oxide (EO), a volatile organic compound, has garnered considerable attention for its potential impact on human health. Yet, the ramifications of EO exposure on the cognitive functionality of the elderly remain unclear. The aim of this study is to determine whether EO exposure in the elderly correlates with cognitive function. In this cross-sectional study, an analysis was conducted on 471 participants from the 2013 to 2014 United States National Health and Nutrition Examination Survey (NHANES). T1, T2, and T3 was used to represent the low, moderate, and high tertiles of log10-transformed HbEO levels, respectively. Weighted linear regression analysis, weighted logistic regression analysis, and restricted cubic spline models were employed to assess the association between HbEO and standardized z-scores of four cognitive tests. Firstly, analysis of variable characteristics across the different log10-transformed HbEO groups revealed that HbEO was higher in males, non-Hispanic whites, and smokers and that Z scores for Delayed Recall Test (DRT), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST) decreased as HbEO increased (p < 0.05). After adjusting for confounding factors, the log10-transformed HbEO levels were found to be negatively correlated with DRT-Z scores (T3 vs. T1 in Model 3: β (95% CI) = - 0.35 (- 0.54, - 0.15), p = 0.002, p for trend = 0.002). In addition, Stratified analyses showed that the four cognitive scores were negatively correlated with HbEO levels in those under 80 years of age. And men had worse AFT scores compared to women. Overall, the four Z-scores roughly trended downward as log10-transformed HbEO rose. Based on the findings of this research, EO exposure may be associated with adverse performance in the DRT among elderly individuals in the United States.

Association of ethylene oxide exposure and obstructive sleep apnea

BACKGROUND

Ethylene oxide (EO) is a widely utilized industrial compound known to pose health hazards. Although its carcinogenic characteristics have been thoroughly investigated, recent findings indicate possible links to respiratory disease. The correlation between EO exposure and the likelihood of developing obstructive sleep apnea (OSA) in individuals remains unclear. The study aimed to explore the association between EO exposure and OSA within the broader US population.

METHODS

From 2015 to 2020, 4355 participants were analyzed cross-sectionally in the National Health and Nutrition Examination Survey (NHANES). As the primary indicator of EO exposure, hemoglobin adducts of EO (HbEO) were used in this study. The relationship between EO exposure and OSA prevalence was assessed using weighted multivariable regression analysis and smoothing curve fitting. Using subgroup analysis and interaction tests, we investigated whether this association remained consistent across populations.

RESULTS

According to the study, higher HbEO level was positively correlated with a higher prevalence of OSA. Compared to the first HbEO quartile (Q1), participants within the highest quartile (Q4) presented a higher OSA prevalence in the fully model (OR = 1.32, 95% CI: 1.08-1.62, P = 0.01, P for trend = 0.001). This correlation was particularly evident among females and individuals who are insufficiently physically active.

CONCLUSIONS

This research found a positive relationship between the extent of exposure to EO and OSA prevalence among a representative sample of Americans.

Associations between ethylene oxide exposure and chronic bronchitis: results from the NHANES 2013-2018

Introduction

Ethylene oxide (EtO) is a reactive gas commonly used in the production of various chemical compounds. Research has linked EtO exposure to respiratory conditions, including chronic obstructive pulmonary disease (COPD) and asthma. However, its potential effects on chronic bronchitis (CB) remain unclear, highlighting the need for further study to understand its role in respiratory health.

Methods

Our study investigated data from 5,044 NHANES participants between 2013 and 2018 across three 2-year survey cycles. The relationship between HbEtO and CB was examined using weighted logistic regression, with HbEtO quartiles analyzed to assess the trend. A smoothed curve was fitted to verify the relationship between HbEtO and CB. Additionally, sensitivity analyses were conducted to assess the robustness of our results, while subgroup analyses explored potential effect modifiers of the HbEtO-CB association.

Results

Compared with patients without CB, patients with CB had elevated HbEtO levels. Specifically, natural Log2HbEtO levels were linked to a greater prevalence of CB in a fully adjusted model (OR = 1.243, 95% CI: 1.143-1.352). Analysis of Log2HbEtO quartiles showed a significant trend in Q4 compared with Q1 (p for trend < 0.001). The fitted smoothed curve indicated a U-shaped nonlinear association, with saturation and threshold analysis revealing an inflection point at Log2HbEtO = 4.87. Sensitivity analyses confirmed the robustness of these findings, and subgroup analyses identified consistent associations across various groups.

Conclusion

Our study found a significant association between EtO exposure and the occurrence of CB. Given the health risks linked to EtO exposure, implementing effective control measures is essential. Such actions could help lower CB prevalence and enhance respiratory health in vulnerable populations.

Associations between Ethylene Oxide Exposure and Liver Function in the US Adult Population

BACKGROUND

Ethylene oxide, a reactive epoxy compound, has been widely used in various industries for many years. However, evidence of the combined toxic effects of ethylene oxide exposure on the liver is still lacking.

METHODS

We analyzed the merged data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016. Ultimately, 4141 adults aged 18 and over were selected as the sample. We used linear regression to explore the association between blood ethylene oxide and LFT indicators.

RESULTS

The weighted linear regression model showed that HbEO is positively correlated with ALP (β = 2.61, 95% CI 1.97, 3.24, p < 0.0001), GGT (β = 5.75, 95% CI 4.46, 7/05, p < 0.0001), ALT (β = 0.50, 95% CI 0.09, 0.90, p = 0.0158), and AST (β = 0.71, 95% CI 0.44, 0.98, p < 0.0001) and negatively correlated with TBIL (β = -0.30, 95% CI -0.43, -0.16, p < 0.0001).

CONCLUSIONS

Ethylene oxide exposure is significantly associated with changes in liver function indicators among adults in the United States. Future work should further examine these relationships.

Antinociceptive and anti-inflammatory activities of Ayapana triplinervis essential oil rich in thymohydroquinone dimethyl ether from Brazil

Ayapana triplinervis (M.Vahl) R.M.King & H.Rob. (Asteraceae), popularly known as japana, is a tropical, aromatic subshrub widely used as tea to combat some diseases. The essential oil was obtained from the leaves by hydrodistillation (3 h), and the chemical composition was analyzed by gas chromatography coupled to mass spectrometry. For in vivo assays, Mus musculus/Swiss mice were used to evaluate oral acute toxicological (at dose of 2000 mg/kg); peripheral and central analgesic for abdominal contortion (doses of 6.25, 12.5, 25, 50 and 100 mg/kg), hot plate test (12.5, 25, 50, and 100 mg/kg) and formalin (25, 50 and 100 mg/kg); open field test (100 mg/kg); and anti-inflammatory by ear swelling induced by xylene (6.25,12.5, 25, 50, and 100 mg/kg). The yield of A. triplinervis essential oil (AtEO) was 4.6%, and the oxygenated monoterpene 2,5-dimethoxy-p-cymene was the major compound in this study (63.6%). AtEO at a dose of 2,000 mg/kg orally did not change the behavior patterns or mortality of the animals; liver and kidney biochemical levels were similar to the control group, indicating no liver and kidney toxicity. Moreover, AtEO, at doses of 6.25, 12.5, 25, 50, and 100 mg/kg, reduced abdominal contortions by 21%, 54%, 91%, 58%, and 55%, respectively. In the hot plate test, AtEO showed a significant increase in latency time in the 60-min interval at doses of 25 mg/kg (11.3 ± 3.3 s) and 100 mg/kg (11.9 ± 0.9 s). In the first phase of the formalin test, AtEO decreased paw licking time at doses of 25, 50, and 100 mg/kg, with inhibition of 22%, 38%, and 83%; in the second phase, the same doses, decreased licking time with inhibition of 24%, 34%, and 76%. AtEO did not present a significant change in the spontaneous locomotor activity of the animals. Doses of 6.25, 12.5, 25, 50, and 100 mg/kg significantly reduced ear edema induced by topical application of xylene with percentages of 40%, 39%, 54%, 45%, and 45%, respectively. So, AtEO demonstrated low acute oral toxicity and exhibited significant antinociceptive and anti-inflammatory actions, consistent with the use of A. triplinervis in traditional medicine.

Positive association of ethylene oxide levels with young stroke: a population-based study

Background

Ethylene oxide (EtO), a highly reactive organic compound with extensive industrial applications, poses significant health risks. The association between EtO exposure and stroke was not well established. This study examined the association between EtO exposure and stroke among US adults using data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES).

Methods

We used appropriately weighted multifactorial logistic regression models to analyze the data and validated the findings with smoothed curve fitting. Stratified analysis and interaction assessments were performed to evaluate the robustness of the findings.

Results

The study included 5,071 participants, balanced between men and women, with a stroke prevalence of 4.1%. Higher EtO levels were associated with rising rates of stroke (OR = 1.23, 95% CI: 1.06-1.42). Individuals in the top 25% group displayed a stroke prevalence 1.6 times higher than those in the bottom 25% group (OR = 1.60, 95%CI: 1.03-2.48). Stratified analysis demonstrated a significant positive association between EtO and stroke in individuals under 50 years (OR = 1.94, 95%CI: 1.38-2.72), while no significant association was found in those aged 50 and above (OR = 0.97, 95%CI: 0.83-1.14).

Conclusion

This study identified a significant association between EtO exposure and stroke occurrence in young adults in the United States.

Associations of ethylene oxide exposure with depression in American adults

Ethylene oxide (EO) is an organic compound known for its high reactivity and negative impact on human health, but its adverse effects on depression remain poorly understood. A cross-sectional study was conducted among 2884 participants from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2016. Participants were classified into four groups according to quartiles of log10-transformed hemoglobin adducts of EO (HbEO) levels. A logistic regression model was used to estimate the association between EO exposure and the risk of depression. Finally, we evaluated whether the association was mediated by inflammatory factors. Individuals with depression exhibited higher levels of hemoglobin adducts of ethylene oxide (HbEO) compared to those without depression. After adjusting for all covariates, patients in the highest quartile of HbEO (Q4 group) had a higher risk of depression, using the lowest quartile (Q1 group) as the reference group [odds ratio (OR) = 2.21, 95% confidence interval (95% CI): (1.47, 3.40)]. Additionally, the relationship between EO levels and the prevalence of depression followed a non-linear U-shaped pattern. Furthermore, inflammatory cells showed a positive correlation with EO levels. Moreover, white blood cells and neutrophils significantly mediated the relationship between HbEO and the risk of depression with mediated proportions of 14.70 and 12.55%, respectively. Exposure to ethylene oxide increases the risk of depression. Inflammatory factors partially mediated the observed association between EO exposure and depression.

The Effects of Ozone Sterilization on the Chemical and Mechanical Properties of 3D-Printed Biocompatible PMMA

Since ozone is highly corrosive, it can substantially affect the mechanical and chemical properties of the materials; consequently, it could affect the applicability of those materials in medical applications. The effect of ozone sterilization on the chemical and mechanical properties of additively manufactured specimens of biocompatible poly(methyl-methacrylate) was observed. FDM 3D-printed specimens of biocompatible PMMA in groups of five were exposed to high concentrations of ozone generated by corona discharge for different durations and at different ozone concentrations inside an enclosed chamber with embedded and calibrated ozone, temperature, and humidity sensors. A novel approach using laser-induced fluorescence (LIF) and spark-discharge optical emission spectrometry (SD-OES) was used to determine an eventual change in the chemical composition of specimens. Mechanical properties were determined by testing the tensile strength and Young's modulus. A calibrated digital microscope was used to observe the eventual degradation of material on the surface of the specimens. SD-OES and LIF analysis results do not show any detectable sterilization-caused chemical degradation, and no substantial difference in mechanical properties was detected. There was no detectable surface degradation observed under the digital microscope. The results obtained suggest that ozone sterilization appears to be a suitable technique for sterilizing PMMA medical devices.

Association between ethylene oxide levels and depressive symptoms: A cross-sectional study based on NHANES 2013-2018 database

BACKGROUND AND AIM

Ethylene oxide (EO) is a commonly used compound with known health risks. However, the specific association between EO exposure and the development of depressive symptoms has not been well established. Therefore, this study aimed to examine the potential association between EO exposure, as indicated by hemoglobin adduct of ethylene oxide (HbEO) levels, and the occurrence of depressive symptoms.

METHODS

We employed logistic regression, restricted cubic spline, and subgroup analysis to investigate the association between EO exposure and the occurrence of depressive symptoms. Additionally, we conducted a mediating effect analysis to explore the potential factors influencing the association between EO exposure and depressive symptoms.

RESULTS

Elevated HbEO levels were associated with the development of depressive symptoms. After adjusting for potential confounders, the highest quartile of HbEO levels showed an odds ratio (OR) of 3.37 [95 % confidence interval (CI): 1.87-6.10, P = 0.002] compared with the lowest quartile. Additionally, a linear association was observed between HbEO levels and the risk of depressive symptoms. We also revealed that the levels of several inflammatory factors and triglycerides mediated the association between EO exposure and the occurrence of depressive symptoms.

CONCLUSIONS

Higher levels of EO exposure were related to an increased risk of developing depressive symptoms. The analysis also suggested that the inflammatory response might play a mediating role in the pathway from EO exposure to depressive symptoms.

Association between blood ethylene oxide levels and periodontitis risk: a population-based study

Background

The etiopathogenesis of periodontitis is closely associated with environmental conditions. However, the relationship between ethylene oxide exposure and periodontitis risk remains unclear.

Methods

We selected qualified participants from National Health and Nutrition Examination Survey (NHANES) 2013-2014. Periodontitis was identified according to the criteria of the Community Periodontal Index (CPI), Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition. Ethylene oxide exposure was quantified by hemoglobin adducts of ethylene oxide (HbEO) levels. Log2-transformation was used to normalize HbEO levels. We designed three logistic regression models to explore potential relationship between HbEO and periodontitis. Restricted cubic spline (RCS) and subgroup analysis were also conducted with all covariates adjusted. We performed multivariable linear regression to appraise the association between the risk of periodontitis and different indicators of inflammation, including white blood cells, neutrophils, lymphocytes, and monocytes. Mediation analysis was subsequently performed to examine whether ethylene oxide exposure contributed to periodontitis development through systemic body inflammation.

Results

A total of 1,065 participants aged more than 30 were incorporated in this study. We identified that participants with higher HbEO levels showed increased risk of periodontitis after adjusting for all covariates (OR = 1.49, 95% CI: 1.14, 1.95, p = 0.0014). The results of subgroup analysis remained stable. The restricted cubic spline (RCS) curve also revealed a non-linear correlation between log2-transformed HbEO levels with the risk of periodontitis (p for nonlinear < 0.001). Mediation analysis indicated that HbEO level was significantly associated with four inflammatory mediators, with the mediated proportions of 14.44% (p < 0.001) for white blood cell, 9.62% (p < 0.001) for neutrophil, 6.17% (p = 0.006) for lymphocyte, and 6.72% (p < 0.001) for monocyte.

Conclusion

Participants with higher ethylene oxide exposure showed higher risk of periodontitis, which was partially mediated by systemic body inflammation. More well-designed longitudinal studies should be carried out to validate this relationship.

Automated, cryogen-free headspace-trap with gas chromatography-mass spectrometry analysis of ethylene oxide and 2-chloroethanol as residual fumigants in foods

Ethylene oxide (EtO), although banned for use, is still being detected in foodstuffs that have been fumigated to eradicate pests during storage and transport. Residual levels over the European Union's (EU) maximum residue limit (MRL) pose severe health concerns. Recent detection of EtO and its by-product 2-chloroethanol (2-CE) at alarming levels have led to product recalls throughout the EU. Here, a simple, automated headspace (HS)-trap method for the simultaneous determination of EtO and its derivative 2-CE by gas chromatography-mass spectrometry (GC-MS) at the required MRL of ≤ 0.05 mg/kg has been implemented. Syringe-based HS combined with backflushed trapping technology provided enrichment of multiple extractions from the same sample vial (known as multi-step enrichment or MSE®) to increase sensitivity for EtO and 2-CE analysis by GC-MS using single-ion-monitoring (SIM) mode. Method detection limits (MDLs) of 0.00059 mg/kg and 0.00219 mg/kg for EtO and 2-CE, respectively, were obtained without the need for manual handling, solvent extraction or derivatization methods. Recoveries were shown to average (n = 5) at 98% and 107% for EtO and 2-CE, respectively, and the reproducibility was <10% for both compounds.

The association of hemoglobin ethylene oxide levels with albuminuria in US adults: analysis of NHANES 2013-2016

Ethylene oxide (EO) is a common chemical contaminant in the environment and associated with the occurrence of multiple clinical diseases. This study aimed to explore the association of hemoglobin ethylene oxide (HbEO) levels with the risk of albuminuria in a representative sample of US adults. In total, 3523 participants from National Health and Nutrition Examination Survey (NHANES) 2013-2016 were enrolled and classified into four groups based on HbEO. Restricted cubic spline plots and multiple logistic regression were performed to investigate the connection between HbEO levels and albuminuria, and mediation analysis was applied to elucidate the potential mechanism for the effect of HbEO concentrations on albuminuria. In the results, compared with the extreme quartile of HbEO levels, the weighted prevalence of albuminuria was significantly increased in participants with highest quartile (Q4 vs Q1, 11.2% vs 8.1%). Restricted cubic spline plots revealed that the risk of albuminuria raised non-linearly and positively with elevated HbEO level. After adjusting for confounders, the logistic regression suggested that the risk of albuminuria was enhanced by 12% for each one-unit increase in log-2-transformed HbEO (OR = 1.12, 95% CI, 1.03-1.22, P = 0.007). Moreover, the multivariate ORs (95% CIs) on albuminuria was increased across the increasing HbEO quartiles (Q4 vs Q1, OR = 1.54, 95% CI, 1.09-2.17; P for trend = 0.029). Furthermore, the impact of high HbEO level on albuminuria was partially related to inflammation markers, including white blood cells (17.2%), neutrophils (22.1%), and lymphocytes (19.5%). To sum up, our study identified that high HbEO levels increased the risk of albuminuria in representative population of US adults, and several inflammatory mediators might be potentially involved in EO-associated albuminuria.

Association Between Ethylene Oxide Exposure and Cognitive Function in US Older Adults: NHANES 2013-2014

Background

Ethylene oxide (EO) is a common organic compound associated with many adverse health outcomes. However, studies exploring the association between EO exposure and cognitive function are limited.

Objective

This study aims to examine this relationship between EO exposure and cognition in older adults.

Methods

This study enrolled 438 older adults from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle. EO exposure was quantified by the measurements of blood hemoglobin adducts of ethylene oxide (HbEO) concentrations. Cognitive function was measured by the Consortium to Establish a Registry for Alzheimer's Disease battery (CREAD), the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Linear regression model, generalized additive model, and smooth curve fitting were applied to examine the linear and nonlinear relationship between EO exposure and cognitive function. We used a two-piecewise linear regression model to detect the threshold effect of EO exposure on cognitive function.

Results

Participants with higher HbEO levels had lower AFT and DSST scores than those with lower HbEO levels. After adjusting for all confounding factors, log2-transformed HbEO levels were negatively associated with AFT score. The smooth curve fitting demonstrated the nonlinear relationship between EO exposure and DSST scores. When log-2 transformed HbEO levels >4.34 pmol/g Hb, EO exposure was negatively associated with DSST score.

Conclusions

This study indicated that high levels of HbEO were associated with cognitive decline in US older adults. Future cohort studies are needed to verify our findings.

Assessment of Chemical Facility Ethylene Oxide Emissions Using Mobile and Multipoint Monitoring

Ethylene oxide (EtO) is a hazardous air pollutant that can be emitted from a variety of difficult to measure industrial sources, such as fugitive leaks, wastewater handling, and episodic releases. Emerging next generation emission measurement (NGEM) approaches capable of time-resolved, low parts per billion by volume (ppbv) method detection limits (MDLs) can help facilities understand and reduce EtO and other air pollutant emissions from these sources yielding a range of environmental and public health benefits. In October 2021, a first of its kind 4-day observational study was conducted at an EtO chemical facility in the midwestern United States. The study had dual objectives to both improve understanding of EtO emission sources within the facility and advance NGEM methods. Using cavity ring-down spectroscopy (CRDS) instruments, a combination of mobile surveys and stationary multipoint process unit monitoring assessed EtO concentrations in and near facility operations, while testing and comparing measurement methods. The study concluded that four main areas of EtO source emissions existed within the facility, each possessing unique emission characteristics. Episodic EtO emissions from supply railcar switchovers and batch reactor washouts, lasting seconds to minutes in duration, produced EtO concentrations exceeding 500 ppbv inside the process unit in some cases. In one instance, EtO at ~30 ppbv was briefly observed hundreds of meters from the process unit. Lower level but more sustained EtO concentrations were observed near an EtO transfer pump and wastewater tank outfall and drain system. Overall, 4.6% of mobile survey data were above the 1.2 ppbv mobile test MDL while the nine stationary sampling locations ranged from 17.7% to 82.8% of data above the 1.0 ppbv multipoint test MDL. This paper describes the EtO emissions observed in and near the four defined source areas within the facility and provides details of the NGEM method development advances accomplished as part of the study.

Potential Carcinogens in Makeup Cosmetics

Facial makeup cosmetics are commonly used products that are applied to the skin, and their ingredients come into contact with it for many years. Consequently, they should only contain substances that are considered safe or used within an allowable range of established concentrations. According to current European laws, all cosmetics approved for use should be entirely safe for their users, and the responsibility for this lies with manufacturers, distributors, and importers. However, the use of cosmetics can be associated with undesirable effects due to the presence of certain chemical substances. An analysis of 50 random facial makeup cosmetics commercially available on the European Union market and manufactured in six European countries was carried out, concerning the presence of substances with potential carcinogenic properties, as described in recent years in the literature. Nine types of facial makeup cosmetics were selected, and their compositions, as declared on the labels, were analyzed. The carcinogens were identified with information present in the European CosIng database and according to the Insecticide Resistance Action Committee's (IRAC) classification. As a result, the following potential carcinogens were identified: parabens (methylparaben, propylparaben, butylparaben, and ethylparaben), ethoxylated compounds (laureth-4, lautreth-7, or ethylene glycol polymers known as PEG), formaldehyde donors (imidazolidinyl urea, quaternium 15, and DMDM hydantoin), and ethanolamine and their derivatives (triethanolamine and diazolidinyl urea), as well as carbon and silica. In conclusion, all of the analyzed face makeup cosmetics contain potential carcinogenic substances. The literature review confirmed the suppositions regarding the potential carcinogenic effects of selected cosmetic ingredients. Therefore, it seems necessary to carry out studies on the long-term exposure of compounds present in cosmetics and perhaps introduce stricter standards and laws regulating the potential presence of carcinogens and their activity in cosmetics.

The relationship between ethylene oxide levels in hemoglobin and the prevalence of kidney stones in US adults: an exposure-response analysis from NHANES 2013-2016

Exposure to ethylene oxide may cause a number of diseases. The purpose of this study was to investigate whether there is an association between hemoglobin ethylene oxide (HbEO) and the risk of developing kidney stones in US adults. We analyzed 3348 patients from the National Health and Nutrition Survey (NHANES) 2013-2016 and conducted a cross-sectional study. Dose-response analysis curves of restricted cubic spline function, multiple logistic regression, and subgroup analysis were used to investigate the association between HbEO and the risk of kidney stones. Logistic regression models were used to analyze the correlation between HbEO and kidney stones. Among the 3348 participants, 3016 people self-reported having a kidney stone. After adjusting for age, sex, race, marital status, education level, diabetes, vigorous recreational activity, moderate recreational activity, body mass index, blood urea nitrogen, creatinine, eGFR, and uric acid, we found a positive association between HbEO and the risk of kidney stones. We divided patients into four groups based on quartiles of HbEO levels and performed multifactorial logistic regression after adjusting for confounders, which showed that the incidence of kidney stones increased with increasing HbEO concentrations compared with Q1 (Q2, OR = 0.922, 95% CI, 0. 657-1.295, P = 0.639; Q3, OR = 1.004, 95% CI, 0.713-1.414, P = 0.983; Q4, OR = 1.535, 95% CI, 1.114-2.114, P = 0.009). High levels of HbEO were positively correlated with the risk of kidney stone development and could be used as an indicator of kidney stone prevention.

The association between ethylene oxide exposure and asthma risk: a population-based study

Ethylene oxide (EO) is a reactive epoxide. However, the association between EO exposure and the risk of developing asthma in humans is unknown. The aim of this study was to investigate the relationship between EO exposure and the risk of developing asthma in the general US population. In this cross-sectional study, data of 2542 patients from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2016 were obtained and analyzed. Hemoglobin adducts of EO (HbEO) level be used as the main factor for predicting EO exposure. The association between the level of EO exposure and the risk of developing asthma was evaluated with logistic regression models and dose-response analysis curves of restricted cubic spline function. Mediation analysis and linear regression analysis were utilized to evaluate the association between EO exposure and inflammation indicators. According to the quartiles of HbEO level, the patients were divided into four groups. The results indicated that an increased HbEO level was associated with a higher risk of asthma onset. Compared with the lowest quartile, the odds ratio (OR) with the 95% confidence interval (CI) for the highest quartile was 1.960 (95% CI: 1.348-2.849, P = 0.003). After being adjusted for numerous potential confounders, the OR of quartile 4 relative to quartile 1 was 1.991 (95% CI: 1.359-2.916, P = 0.001). Consistent results were also obtained in most subgroup analyses and dose-response analysis curves. In addition, EO levels were positively correlated with the inflammatory indicators (P = 0.006 for WBC, P = 0.015 for lymphocyte, and P = 0.015 for neutrophil). This study revealed a positive correlation between the level of EO exposure and the risk of asthma in a representative US population. In addition, inflammatory response may prove to be a potential biological mechanism underlying EO-induced asthma.

Food-Borne Chemical Carcinogens and the Evidence for Human Cancer Risk

Commonly consumed foods and beverages can contain chemicals with reported carcinogenic activity in rodent models. Moreover, exposures to some of these substances have been associated with increased cancer risks in humans. Food-borne carcinogens span a range of chemical classes and can arise from natural or anthropogenic sources, as well as form endogenously. Important considerations include the mechanism(s) of action (MoA), their relevance to human biology, and the level of exposure in diet. The MoAs of carcinogens have been classified as either DNA-reactive (genotoxic), involving covalent reaction with nuclear DNA, or epigenetic, involving molecular and cellular effects other than DNA reactivity. Carcinogens are generally present in food at low levels, resulting in low daily intakes, although there are some exceptions. Carcinogens of the DNA-reactive type produce effects at lower dosages than epigenetic carcinogens. Several food-related DNA-reactive carcinogens, including aflatoxins, aristolochic acid, benzene, benzo[a]pyrene and ethylene oxide, are recognized by the International Agency for Research on Cancer (IARC) as causes of human cancer. Of the epigenetic type, the only carcinogen considered to be associated with increased cancer in humans, although not from low-level food exposure, is dioxin (TCDD). Thus, DNA-reactive carcinogens in food represent a much greater risk than epigenetic carcinogens.

Systematic review of the scientific evidence on ethylene oxide as a human carcinogen

Ethylene oxide is a highly reactive chemical primarily used as an intermediate in chemical production and as a sterilant of medical equipment and food products; it also is produced endogenously as a result of physiological processes. We conducted a systematic review of the potential carcinogenicity of inhaled ethylene oxide in humans using methods that adhere to PRIMSA guidelines and that incorporate aspects from the Institute of Medicine (IOM) (now the National Academy of Medicine) as well as several US Environmental Protection Agency (EPA) frameworks for systematic reviews. After a comprehensive literature search and selection process, study quality was evaluated following a method adapted from the EPA Toxic Substances Control Act (TSCA) framework. The literature screening and selection process identified 24 primary studies in animals or humans and more than 50 mechanistic studies. Integrating epidemiological, animal, and mechanistic literature on ethylene oxide and cancer according to the IOM framework yielded classifications of suggestive evidence of no association between ethylene oxide and stomach cancer, breast cancer and lymphohematopoietic malignancies at human relevant exposures. However, we acknowledge that there is additional uncertainty in the classification for lymphohematopoietic malignancies owing to a paucity of evidence for specific types of these tumors, each of which is a distinct disease entity of possibly unique etiology.

Blood ethylene oxide, systemic inflammation, and serum lipid profiles: Results from NHANES 2013-2016

BACKGROUND

Using data from the National Health and Nutrition Examination Survey (NHANES), this study aimed to explore the relationship between ethylene oxide (EO) exposure and serum lipid profiles as well as the mediation effect of systemic inflammation among the general adult population.

METHODS

This cross-sectional study analyzed NHANES data from 2013 to 2016, examining a total of 2721 participants. The EO biomarker (hemoglobin adduct of EO [HbEO]) was quantified in blood using a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method. The association among HbEO levels, inflammatory biomarkers, and four serum lipids was evaluated using a multivariable linear regression model. Mediating analysis was performed to examine the effect of inflammatory biomarkers on the relationship between HbEO levels and serum lipid profiles.

RESULTS

As the quartiles of HbEO increased, high-density lipoprotein cholesterol (HDL-C) monotonically decreased (p for trend <0.001). Using the lowest quartile of HbEO as a reference, the percent change for HDL-C was 6.30% (95% CI: 3.89%, 8.71%) in the highest quartile of HbEO. HbEO levels were dose-dependently associated with triglycerides (TG) (p for trend = 0.001). The percent change in TG in the fourth quartile of HbEO was 17.24% (95% CI: 2.01%, 32.48%) compared to the first quartile. Overall, inflammatory biomarkers (hs-CRP, alkaline phosphatase, white blood cell count, neutrophil count, and lymphocyte count) increased monotonically in correlation with increasing HbEO levels (all p for trend <0.01); were positively correlated with total cholesterol (TC), TG, and low-density lipoprotein cholesterol (LDL-C); and were negatively associated with HDL-C. Additionally, inflammatory biomarkers strongly mediated the relationships between HbEO and HDL-C and TG with maximum mediated proportions of 21.40% and 33.40%, respectively.

CONCLUSIONS

These findings suggest that HbEO is closely linked to serum lipid profiles and that systemic inflammation may be a key mediator of this association.

The role of endogenous versus exogenous sources in the exposome of putative genotoxins and consequences for risk assessment

The "totality" of the human exposure is conceived to encompass life-associated endogenous and exogenous aggregate exposures. Process-related contaminants (PRCs) are not only formed in foods by heat processing, but also occur endogenously in the organism as physiological components of energy metabolism, potentially also generated by the human microbiome. To arrive at a comprehensive risk assessment, it is necessary to understand the contribution of in vivo background occurrence as compared to the ingestion from exogenous sources. Hence, this review provides an overview of the knowledge on the contribution of endogenous exposure to the overall exposure to putative genotoxic food contaminants, namely ethanol, acetaldehyde, formaldehyde, acrylamide, acrolein, α,β-unsaturated alkenals, glycation compounds, N-nitroso compounds, ethylene oxide, furans, 2- and 3-MCPD, and glycidyl esters. The evidence discussed herein allows to conclude that endogenous formation of some contaminants appears to contribute substantially to the exposome. This is of critical importance for risk assessment in the cases where endogenous exposure is suspected to outweigh the exogenous one (e.g. formaldehyde and acrolein).

IoT-Based Fumigation for Insect Repellent in Food Storages: Breaking the Trade-Off between Efficiency and Safety

Insect infestation in food can cause various health risks when ingested by humans, as well as damage to food itself. To tackle this, food safety can be secured by fumigating the food storage, using specific materials containing pesticides. However, because most fumigation is toxic to human health, there is a trade-off relationship between insect repellency and safety assurance. In this paper, to overcome this problem, first, organic fumigation is proposed, in which a relatively low-risk pyrethrin oil is developed. Second, a novel system which can remotely monitor and control fumigation using IoT is proposed for mitigating the fact that pyrethrin can also be dangerous when inhaled directly. Third, an insect repellent LED lamp system, which can replace insecticide through direct fumigation and ensure safety, has been proposed. Fourth, a camera-based human access detection system is developed for more efficient and safe controls during the fumigation. The performance of the proposed system has been verified through implemented test-bed, and it is revealed that the trade-off relationship between efficiency and safety can be overcome.

Genotoxicity evaluation of medical devices: A regulatory perspective

This review critically evaluates our current regulatory understanding of genotoxicity testing and risk assessment of medical devices. Genotoxicity risk assessment of these devices begins with the evaluation of materials of construction, manufacturing additives and all residual materials for potential to induce DNA damage. This is followed by extractable and/or leachable (E&L) studies to understand the worst case and/or clinical exposures, coupled with risk assessment of extractables or leachables. The TTC (Threshold of Toxicological Concern) approach is used to define acceptable levels of genotoxic chemicals, when identified. Where appropriate, in silico predictions may be used to evaluate the genotoxic potentials of identifiable chemicals with limited toxicological data and above the levels defined by TTC. Devices that could not be supported by E&L studies are evaluated by in vitro genotoxicity studies conducted in accordance with ISO10993-3 and 33. Certain endpoints such as 'site of contact genotoxicity' that are specific for certain classes of medical devices are currently not addressed in the current standards. The review also illustrates the potential uses of recent advances to achieve the goal of robust genotoxicity assessment of medical devices which are being increasingly used for health benefits. The review also highlights the gaps for genotoxicity risk assessment of medical devices and suggests possible approaches to address them taking into consideration the recent advances in genotoxicity testing including their potential uses in biocompatibility assessment.

Inverse association between blood ethylene oxide levels and obesity in the general population: NHANES 2013-2016

BACKGROUND

Ethylene oxide (EO) has been shown to associate with increased cardiovascular risk. This study aimed to explore the relationship and its meditating factors between EO exposure and the major cardiovascular risk factor of obesity among the general adult population.

METHODS

Cross-sectional data of 3,220 participants from National Health and Nutritional Examination Survey (NHANES) 2013-2016 were enrolled. Obesity was defined as body mass index (BMI) ≥30 kg/m², and abdominal obesity was defined as waist circumference (WC) ≥102 cm in men and ≥88 cm in women. The association among hemoglobin adduct of EO (HbEO), inflammatory biomarkers, and obesity was evaluated using restricted cubic splines and the multivariable linear regression model. Mediation analysis was used to further assess their association.

RESULTS

The increased quartiles of HbEO were inversely associated with BMI and WC [Q1 vs. Q4, BMI: β = -2.98 (-3.74, -2.22), WC: β = -6.50 (-8.60, -4.39); all p for trend < 0.05], and were inversely associated with obesity after full adjustment [obesity: OR = 0.43 (0.31, 0.58), abdominal obesity: OR = 0.42 (0.27, 0.65); all p for trend < 0.05]. The levels of alkaline phosphatase, white blood cells, lymphocytes, and neutrophils were also positively associated with BMI and WC (all p < 0.05). Mediation analysis showed that exposure of EO not only had a negative direct effect on BMI and WC, but also generated an inverse indirect effect.

CONCLUSIONS

Current findings showed an inverse association between HbEO and obesity, and suggested that systemic inflammation may not be their only mediator. Additional research is required to explore the underlying link of EO and system metabolism.

Association between blood ethylene oxide levels and the risk of cardiovascular diseases in the general population

Ethylene oxide (EtO) is a highly reactive organic compound that is mainly used as a sterilizing agent. However, to date, the effects of EtO on the cardiovascular system are not clear. We aimed to explore the association between blood EtO levels and the risk of cardiovascular disease (CVD) in the general US population. We obtained information on blood levels of EtO and CVD outcomes in 3,410 participants from the National Health and Nutritional Examination Survey (NHANES) 2013-2014 and 2015-2016. Logistic regression models were applied to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between EtO and risk of all CVD as well as subtypes of CVD. Linear regression analyses were used to estimate the associations of EtO with potential mechanistic parameters of CVD, including blood pressure, blood lipid levels and inflammatory parameters. Higher blood levels of EtO were associated with an increased risk of all CVD (p for trend = 0.003), with an adjusted OR (95% CI) in the highest quartile of 1.94 (1.24, 3.02) compared with the lowest quartile as a reference. Higher concentrations of EtO were positively associated with the risk of angina (p for trend = 0.04) and heart attack (p for trend = 0.011). In addition, the concentration of EtO was positively associated with the levels of triglycerides, white blood cells, lymphocytes, monocytes, neutrophils and eosinophils (p = 0.003 for eosinophils and p < 0.001 for the others) and negatively associated with the level of high-density lipoprotein cholesterol (p < 0.001). We found that exposure to EtO was associated with angina, heart attack and all CVD in a large representative US population. Furthermore, EtO may induce CVD through the inflammatory response and abnormal fatty acid metabolism.

Association of exposure to ethylene oxide with risk of diabetes mellitus: results from NHANES 2013-2016

Animal studies suggested that exposure to ethylene oxide (EO) might induce hepatic lipid peroxidation and inflammatory lesions in various organs. However, the association between EO exposure and diabetes risk in humans is unknown. This study aimed to examine the association of EO exposure with the prevalence of diabetes mellitus in a general population of US adults. This study consisted of 3448 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle and 2015-2016 cycle. Circulating levels of EO biomarker (hemoglobin adducts of EO (HbEO)) was measured by using high-performance liquid chromatography coupled with tandem mass spectrometry. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariate logistic regression. The weighted median level of HbEO was 29.9 (95% CI: 21.8, 56.0) pmol/g Hb. Elevated levels of HbEO were associated with higher HbA1c and lower high-density lipoprotein cholesterol (both P_trend <0.01). After multivariate adjustment including demographics, lifestyle factors, and body mass index (BMI), higher HbEO levels were significantly associated with an increased prevalence of diabetes mellitus. The OR (95% CI) of diabetes across increasing quartiles of HbEO was 1.00 (reference), 1.45 (1.08, 1.96), 1.76 (1.31, 2.36), and 1.77 (1.22, 2.57), respectively (P_trend <0.001). Similar results were observed when analyses were stratified by smoking status, age, sex, race/ethnicity, and BMI. In a nationally representative sample of US adults, higher levels of HbEO were significantly associated with an increased prevalence of diabetes mellitus. Further prospective studies are needed to confirm these findings.

Associations between observed concentrations of ethylene oxide in whole blood and smoking, exposure to environmental tobacco smoke, and cancers including breast cancer: data for US children, adolescents, and adults

For the first time, National Health and Nutrition Examination Survey released data on ethylene oxide (ETO) into public domain for US children aged 6-11 years, adolescents aged 12-19 years, and adults aged ≥ 20 years for 2013-2016. This study was undertaken to evaluate the associations between concentrations of ETO in whole blood and smoking, exposure to environmental tobacco smoke (ETS), and self-reported diagnosis of cancers including breast cancer. Both adolescent (29.6 vs. 49.6 pmol/g Hb, p < 0.01) and adult smokers (31.5 vs. 142.7 pmol/g Hb, p < 0.01) were found to have substantially higher adjusted levels of ethylene oxide than nonsmokers. Non-Hispanic blacks had higher levels of ethylene oxide than other race/ethnicities for children and adolescents. Non-Hispanic Asians had higher levels of ethylene oxide than other race/ethnicities for adults. Exposure to ETO measured by the number of smokers smoking inside the home (p < 0.01) and number of days smokers smoked inside the home (p = 0.03) during the prior week was found to be associated with elevated levels of ETO (p < 0.01) among US adults. Increased age was associated with elevated levels of ETO among adolescents (p = 0.02) and adults (p < 0.01) but the reverse was true for children (p = 0.04). For the general US population, levels of ETO were not found to be associated with cancers including breast cancer.