The effect of temperature on di(2‐ethylhexyl) phthalate leaching from PVC infusion sets exposed to lipid emulsions

Prevalence and clinical implications of heightened plastic chemical exposure in pediatric patients undergoing cardiopulmonary bypass

BACKGROUND

Phthalate chemicals are used to manufacture plastic medical products, including many components of cardiopulmonary bypass (CPB) circuits. We aimed to quantify iatrogenic phthalate exposure in pediatric patients undergoing cardiac surgery and examine the link between phthalate exposure and postoperative outcomes.

STUDY DESIGN AND METHODS

The study included pediatric patients undergoing (n=122) unique cardiac surgeries at Children's National Hospital. For each patient, a single plasma sample was collected preoperatively and two additional samples were collected postoperatively upon return from the operating room and the morning after surgery. Concentrations of di(2-ethylhexyl) phthalate (DEHP) and its metabolites were quantified using ultra high-pressure liquid chromatography coupled to mass spectrometry.

RESULTS

Patients were subdivided into three groups, according to surgical procedure: (1) cardiac surgery not requiring CPB support, (2) cardiac surgery requiring CPB with a crystalloid prime, and (3) cardiac surgery requiring CPB with red blood cells (RBCs) to prime the circuit. Phthalate metabolites were detected in all patients, and postoperative phthalate levels were highest in patients undergoing CPB with an RBC-based prime. Age-matched (<1 year) CPB patients with elevated phthalate exposure were more likely to experience postoperative complications. RBC washing was an effective strategy to reduce phthalate levels in CPB prime.

DISCUSSION

Pediatric cardiac surgery patients are exposed to phthalate chemicals from plastic medical products, and the degree of exposure increases in the context of CPB with an RBC-based prime. Additional studies are warranted to measure the direct effect of phthalates on patient health outcomes and investigate mitigation strategies to reduce exposure.

Impact of DEHP exposure on female reproductive health: Insights into uterine effects

Several endocrine disrupting compounds released from plastics, including polyfluoroalkyl substances, bisphenols, flame retardants, phthalates and others, are of great concern to human health due to their high toxicity. This review discusses the effects of di-(2-ethylhexyl) phthalate (DEHP), the most common member of the phthalate family, on female reproduction. In vitro and in vivo studies link DEHP exposure to impaired hypothalamic-pituitary-ovarian s (HPO) axis function, alteration of steroid-hormone levels and dysregulation of their receptors, and changes in uterine morphophysiology. In addition, high urinary DEPH levels have been associated with several reproductive disorders in women, including endometriosis, fibromyoma, fetal growth restriction and pregnancy loss. These data suggest that DEHP may be involved in the pathophysiology of various female reproductive diseases. Therefore, exposure to these compounds should be considered a concern in clinician surveillance practices for women at reproductive age and should be regulated to protect their health and that of their progeny.

Evidence for the cardiodepressive effects of the plasticizer di-2-ethylhexyl phthalate

Di-2-ethylhexyl phthalate (DEHP) is commonly used in the manufacturing of plastic materials, including intravenous bags, blood storage bags, and medical-grade tubing. DEHP can leach from plastic medical products, which can result in inadvertent patient exposure. DEHP concentrations were measured in red blood cell units stored between 7 and 42 days (17-119 μg/ml). Using these concentrations as a guide, Langendorff-perfused rat heart preparations were acutely exposed to DEHP. Sinus activity remained stable with lower doses of DEHP (25-50 μg/ml), but sinus rate declined by 43% and sinus node recovery time (SNRT) prolonged by 56.5% following 30-min exposure to 100 μg/ml DEHP. DEHP exposure also exerted a negative dromotropic response, as indicated by a 69.4% longer PR interval, 108.5% longer Wenckebach cycle length (WBCL), and increased incidence of atrioventricular (AV) uncoupling (60-min exposure). Pretreatment with doxycycline partially rescued the effects of DEHP on sinus activity, but did not ameliorate the effects on AV conduction. DEHP exposure also prolonged the ventricular action potential and effective refractory period, but had no measurable effect on intracellular calcium transient duration. Follow-up studies using human-induced pluripotent stem cell-derived cardiomyocytes confirmed that DEHP slows electrical conduction in a time (15 min-3 h) and dose-dependent manner (10-100 μg/ml). Previous studies have suggested that phthalate toxicity is specifically attributed to metabolites of DEHP, including mono-2-ethylhexylphthalate. This study demonstrates that DEHP exposure also contributes to cardiac dysfunction in a dose- and time-dependent manner. Future work is warranted to investigate the impact of DEHP (and its metabolites) on human health, with special consideration for clinical procedures that employ plastic materials.

Co-occurrence of phthalic acid esters (PAEs) and cyclic volatile methylsiloxanes (cVMSs) in fine particulate matter (PM0.5 and PM0.1) collected from an industrial area in Vietnam

Distribution patterns of 10 phthalic acid diesters (PAEs) and four cyclic volatile methylsiloxanes (cVMSs) were investigated in fine particulate matter (PM0.1 and PM0.5) collected from Bac Ninh, an industrial province in Vietnam during September-October in 2021. Total concentrations of PAEs found in PM0.1 and PM0.5 were in the ranges of 1.76-372 (median: 34.0 ng/m3) and 2.23-895 ng/m3 (median: 15.4 ng/m3), respectively. Among PAEs, di-n-butyl phthalate (DBP) was the most abundant compound found in PM0.1, whereas, di-2-(ethyl)hexyl phthalate (DEHP) was measured at the highest concentration in PM0.5. Total concentrations of cVMSs measured in PM0.1 and PM0.5 were in the ranges of method quantification limit (MQL)-203 (median: 2.10 ng/m3) and MQL-537 ng/m3 (median: 0.389 ng/m3), respectively. Among cVMSs, decamethylcyclopentasiloxane (D5) was found at the highest concentration in both PM0.1 and PM0.5 fractions of particulate matter. The concentration ratios between PAEs and cVMSs in PM0.1/PM0.5 were greater than 1 (except di-n-octyl phthalate: DnOP), suggesting that these chemicals tend to sorb to PM0.1 more preferentially than PM0.5. Among sampling locations, high concentrations of PAEs and cVMSs were found at traffic intersections (Que Vo district) and a craft village (Tu Son city). Relatively stronger correlations existed between cVMSs pairs in PM0.1 and PM0.5 (correlation coefficient: 0.73-1) than those of PAEs (-0.83-0.90). The human exposure doses to PAEs and cVMSs through inhalation of particulate matter were estimated based on the measured concentrations in PM0.1 and PM0.5 fractions. The estimated exposure doses of PAEs and cVMSs for infants (7.1 ng/kg-bw/d and 2.5 ng/kg-bw/d) were higher than those for adults (2.6 ng/kg-bw/d and 0.9 ng/kg-bw/d).

Evidence for the cardiodepressive effects of the plasticizer di-2-ethylhexylphthalate (DEHP)

Di-2-ethylhexylphthalate (DEHP) is commonly used in the manufacturing of plastic materials, including intravenous bags, blood storage bags, and medical-grade tubing. DEHP can leach from plastic medical products, which can result in inadvertent patient exposure. DEHP concentrations were measured in red blood cell (RBC) units stored between 7-42 days (23-119 μg/mL). Using these concentrations as a guide, Langendorff-perfused rat heart preparations were acutely exposed to DEHP. Sinus activity remained stable with lower doses of DEHP (25-50 μg/mL), but sinus rate declined by 43% and sinus node recovery time prolonged by 56.5% following 30-minute exposure to 100 μg/ml DEHP. DEHP exposure also exerted a negative dromotropic response, as indicated by a 69.4% longer PR interval, 108.5% longer Wenckebach cycle length, and increased incidence of atrioventricular uncoupling. Pretreatment with doxycycline partially rescued the effects of DEHP on sinus activity, but did not ameliorate the effects on atrioventricular conduction. DEHP exposure also prolonged the ventricular action potential and effective refractory period, but had no measurable effect on intracellular calcium transient duration. Follow-up studies using hiPSC-CM confirmed that DEHP slows electrical conduction in a time (15 min - 3 hours) and dose-dependent manner (10-100 μg/mL). Previous studies have suggested that phthalate toxicity is specifically attributed to metabolites of DEHP, including mono-2-ethylhexyl phthalate (MEHP). This study demonstrates that DEHP exposure also contributes to cardiac dysfunction in a dose- and time-dependent manner. Future work is warranted to investigate the impact of DEHP (and its metabolites) on human health, with special consideration for clinical procedures that employ plastic materials.

Prevalence and Clinical Implications of Heightened Plastic Chemical Exposure in Pediatric Patients Undergoing Cardiopulmonary Bypass

Importance

Phthalate chemicals are used to manufacture disposable plastic medical products, including blood storage bags and components of cardiopulmonary bypass (CPB) circuits. During cardiac surgery, patients can be inadvertently exposed to phthalate chemicals that are released from these plastic products.

Objective

To quantify iatrogenic phthalate chemical exposure in pediatric patients undergoing cardiac surgery, and examine the link between phthalate exposure and post-operative outcomes.

Design Setting and Participants

The study cohort included 122 pediatric patients undergoing cardiac surgery at Children's National Hospital. For each patient, a single plasma sample was collected pre-operatively and two additional samples were collected post-operatively upon return from the operating room (post-operative day 0) and the morning after surgery (post-operative day 1).

Exposures

Concentrations of di(2-ethylhexyl)phthalate (DEHP) and its metabolites were quantified using ultra high-pressure liquid chromatography coupled to mass spectrometry.

Main Outcomes and Measures

Plasma concentrations of phthalates, post-operative blood gas measurements, and post-operative complications.

Results

Study subjects were subdivided into three groups, according to surgical procedure: 1) cardiac surgery not requiring CPB support, 2) cardiac surgery requiring CPB with crystalloid prime, and 3) cardiac surgery requiring CPB with red blood cells (RBCs) to prime the circuit. Phthalate metabolites were detected in all patients, and postoperative phthalate levels were highest in patients undergoing CPB with RBC-based prime. Age-matched (<1 year) CPB patients with elevated phthalate exposure were more likely to experience post-operative complications, including arrhythmias, low cardiac output syndrome, and additional post-operative interventions. RBC washing was an effective strategy to reduce DEHP levels in CPB prime.

Conclusions and Relevance

Pediatric cardiac surgery patients are exposed to phthalate chemicals from plastic medical products, and the degree of exposure increases in the context of CPB with RBC-based prime. Additional studies are warranted to measure the direct effect of phthalates on patient health outcomes and investigate mitigation strategies to reduce exposure.

Key Points

Question: Is cardiac surgery with cardiopulmonary bypass a significant source of phthalate chemical exposure in pediatric patients?Findings: In this study of 122 pediatric cardiac surgery patients, phthalate metabolites were quantified from blood samples before and after surgery. Phthalate concentrations were highest in patients undergoing cardiopulmonary bypass with red blood cell-based prime. Heightened phthalate exposure was associated with post-operative complications.Meaning: Cardiopulmonary bypass is a significant source of phthalate chemical exposure, and patients with heightened exposure may be at greater risk for postoperative cardiovascular complications.

Neonatal exposure to phthalate and alternative plasticizers via parenteral nutrition

Di-(2-ethylhexyl) phthalate (DEHP), a plasticizer used to soften plastic medical devices (PMDs), was restricted in PMDs due to adverse health effects, being gradually replaced by alternative plasticizers (APs). Parenteral nutrition (PN), essential in the care for premature neonates in the neonatal intensive care unit, is stored in plastic storage bags and administered intravenously through plastic infusion circuits. We investigated to which extent PN contributes to current phthalate and AP exposure in premature neonates. First, we showed that DEHP and several APs are present in relevant amounts in PMDs used for neonatal PN administration. Secondly, ex vivo experiments mimicking clinical PN administration showed that lipid emulsions contained significant concentrations of DEHP and several APs (ATBC, TOTM, DEHT & DEHA), while hardly any plasticizers were detected in non-lipid solutions. ATBC leached from infusion circuits, while lipid emulsions were the major source for DEHP, TOTM, DEHT, and DEHA. PN administration resulted in estimated daily exposures of 13.9 µg/kg/d DEHP and 95.7 µg/kg/d ATBC in premature neonates, below their respective reference doses. Our data indicate that premature neonates requiring PN are still exposed to DEHP, as well as to a range of APs, making it a target for reduction of harmful plasticizer exposure.

Profiles of phthalic acid esters (PAEs) in bottled water, tap water, lake water, and wastewater samples collected from Hanoi, Vietnam

Contamination levels and distribution patterns of ten typical phthalic acid esters (PAEs) were investigated in various types of water samples collected from Hanoi metropolitan area in Vietnam. Concentrations of 10 PAEs in bottled water, tap water, lake water, and wastewater samples were measured in the ranges of 1640-15,700 ng/L (mean/median: 6400/5820 ng/L), 2100-18,000 ng/L (mean/median: 11,200/9270 ng/L), 19,600-127,000 ng/L (mean/median: 51,800/49,300 ng/L), and 20,700-405,000 ng/L (mean/median: 121,000/115,000 ng/L), respectively. Among PAEs, di-(2-ethylhexyl) phthalate (DEHP) accounted for a major proportion of total concentrations (45%) in wastewater, followed by diisobutyl phthalate (DiBP, 10.3%), and dibutyl phthalate (DBP, 9.53%). Concentrations of PAEs in wastewater decreased significantly with distance from the wastewater treatment plants (WWTPs). Concentrations of PAEs in surface water samples did not vary greatly between locations. PAEs were found in bottled water in the following order: DBP (22.4%), DiBP (22.3%), benzylbutyl phthalate (BzBP, 20.1%), and DEHP (15.5%). The estimated mean exposure doses of 10 PAEs through consumption of drinking water for adults and children in Vietnam were 254 and 256 ng/kg-bw/day, respectively. Capsule: Highest concentrations of PAEs were measured in wastewater, followed by lake water, tap water, and bottled water.

Consequences of combined exposure to thermal stress and the plasticiser DEHP in Mytilus spp. differ by sex

Little is known about the combined effect of environmental factors and contaminants on commercially important marine species, and whether this effect differs by sex. In this study, blue mussels were exposed for seven days to both single and combined stressors (i.e., +3 °C elevated temperature and two environmentally relevant concentrations of the plastic softener DEHP, 0.5 and 50 μg/l) in a factorial design. Males were observed to be more sensitive to high temperature, demonstrated by the significant increase in out-of-season spawning gonads and higher gene expression of the antioxidant catalase and the estrogen receptor genes. On the other hand, while the gametogenesis cycle in females was more resilient than in males, DEHP exposure altered the estrogen-related receptor gene expression. We show that the combined stressors DEHP and increased temperature, in environmentally relevant magnitudes, have different consequences in male and female mussels, with the potential to impact the timing and breeding season success in Mytilus spp.

Prevalent phthalates in air-soil-vegetable systems of plastic greenhouses in a subtropical city and health risk assessments

Wide use of plastic greenhouses for vegetable production increases human exposure to phthalate (PAEs) through vegetable intake. However, little information is available about distribution of PAEs in air-soil-vegetable systems of plastic greenhouses and PAE estrogenic effects. This study was designed to investigate PAE distributions and corresponding health risk in plastic greenhouses in Guangzhou, a subtropical city in South China. PAEs were prevalent in plastic greenhouses, with sum concentrations of 16 PAE compounds (∑16PAEs) up to 5.76 mg/kg in soils, 5.27 mg/kg in vegetables and 4393 ng/m³ in air. Di (2-ethylhexyl) phthalate, di-isobutyl phthalate, and dibutyl phthalate were predominant compounds. Average concentrations and bioconcentration factor of ∑16PAEs and the predominant PAE compounds in vegetables of greenhouses were higher than those of open fields. Plastic greenhouses exhibited significantly higher air PAE levels than those of open fields due to higher indoor temperature, which enhanced PAE accumulation by vegetables. Both carcinogenic and non-carcinogenic risks of PAEs via dietary and non-dietary exposures for farmers decreased with an order of vegetable > air > soil. Consumption of vegetables from greenhouses resulted in significantly higher estrogenic effects compared to those from open field cultivation. This study emphasizes highly potential health risks of PAEs in air-soil-vegetable systems of plastic greenhouses.

Pooled analysis of genotoxicity markers in relation to exposure in the Flemish Environment and Health Studies (FLEHS) between 1999 and 2018

BACKGROUND

The Flemish Environment and Health Studies (FLEHS) are human biomonitoring surveys running in Flanders since 1999. Additionally to biomarkers of exposure, markers of genotoxicity and oxidative stress have been measured, including the alkaline comet and micronucleus assay in peripheral whole blood cells, and urinary concentrations of 8-oxo-2'-deoxyguanosine (8-oxodG).

AIM

Exposure-effect associations were explored in a pooled dataset of nine different cross-sectional FLEHS surveys. Data of adolescents collected in a time frame of about 20 years (1999-2018) were compiled. The aim of the study was to examine whether increased variation in exposure, lifestyle and environmental factors would lead to more powerful and robust exposure-effect associations.

MATERIALS & METHODS

The biomarkers were measured in 2283 adolescents in the age range of 14-18 years. Exposure to polycyclic aromatic hydrocarbons [1-hydroxypyrene (1-OHP)], benzene (tt'-muconic acid), metals (arsenic, cadmium, copper, nickel, thallium, lead, chromium), persistent organochlorines and phthalates were assessed in blood or urine. Furthermore, outdoor air levels of particulate matter (PM₁₀ and PM_2.5) at the residences of the youngsters were calculated. Pooled statistical analysis was done using mixed models. Study-specific differences in the genotoxicity markers and in the strength/direction of the association were accounted for. This was done by incorporating the random factor 'study' and a random study slope (if possible). The exposure markers were centered around the study-specific mean in order to correct for protocol changes over time.

RESULTS

A significant association was observed for the urinary oxidative stress marker 8-oxodG, which was positively associated with 1-OHP (5% increase for doubling of 1-OHP levels, p = 0.001), and with urinary copper (26% increase for doubling of copper levels, p = 0.001), a metal involved in the Fenton reaction in biological systems. 8-oxodG was also associated with the sum of the metabolites of the phthalate di(2-ethylhexyl) phthalate (DEHP) (3% increase for doubling of the DEHP levels, p = 0.02). For those associations, data pooling increased the statistical power. However, some of the associations in the individual surveys, were not confirmed in the pooled analysis (such as comet assay and 8-oxodG vs. atmospheric PM; and 8-oxodG vs. urinary nickel). This may be due to inconsistencies in exposure-effect relations and/or variations in the pollutant mix over time and regions.

CONCLUSION

Pooled analysis including a large population of 2283 Flemish adolescents showed that 8-oxodG, a marker of oxidative DNA damage is a valuable marker to assess impact of daily life pollutants, such as PAHs, Cu and the phthalate DEHP.

Prenatal exposure to di-(2-ethylhexyl) phthalate and high-fat diet synergistically disrupts mouse fetal oogenesis and affects folliculogenesis†

Di-(2-ethylhexyl) phthalate (DEHP) is a chemical that is widely used as a plasticizer. Exposure to DEHP has been shown to alter ovarian function in humans. Additionally, foods high in fat content, regularly found in the western diet, have been shown to be another potential disruptor of fetal ovarian function. Due to DEHP's lipophilicity, high-fat foods can be easily contaminated. Therefore, exposure to DEHP and a high-fat diet are both health concerns, especially in pregnant women, and the effects of these exposures on fetal oocyte quality and quantity should be elucidated. In this study, our goal was to determine if there are synergistic effects of DEHP exposure at an environmentally relevant level (20 μg/kg body weight/day) and high-fat diet on oogenesis and folliculogenesis. Dams were fed with a high-fat diet (45 kcal% fat) or a control diet (10 kcal% fat) 1 week before mating and during pregnancy and lactation. The pregnant mice were dosed with DEHP (20 μg/kg body weight/day) or vehicle control from E10.5 to litter birth. We found that treatment with an environmentally relevant dosage of DEHP and consumption of high-fat diet significantly increases synapsis defects in meiosis and affects folliculogenesis in the F1 generation.

Enhanced biodegradation of an endocrine disrupting micro-pollutant: Di (2-ethylhexyl) phthalate using biogenic self-assembled monolayer of silver nanoparticles

Di (2-ethylhexyl) phthalate (DEHP) is one of the predominant plasticizer and an endocrine disrupting chemical occurring almost in all partitions of the environment. Though DEHP occur at lower concentration, reluctance arises due to their ability to disrupt endocrine system even lower concentration. In the present study, DEHP was assessed for degradation at minimal level (1-100 μg L^-1) by a novel bacterial strain, Rhodococcus jostii PEVJ9. In the experimental design, significant variables were concentration of silver nitrate and DEHP, pH, temperature, time and agitation. Degradation without SAM-silver nanoparticles was 30-66% (predicted value = 30.8-66.8%, R² = 99.7%) while, degradation in the presence of SAM-silver nanoparticles onto bacterial cells was 100% (predicted value = 98.4-102.1%, R² = 99.6%) within 72 h. In short, this is the first report illustrating the experimental designs in biogenic synthesis of SAM-silver nanoparticles and enhanced degradation of DEHP at minimal level. The study overcomes poor bioavailability and assimilation of DEHP at lower concentration by the microbial population present in the environment. Thus, an efficient clean-up would prevent or minimize DEHP exposure at all trophic levels ranging from feminization of fishes to reproductive disorders in humans.

Ecotoxicological risk evaluation and regulatory compliance of endocrine disruptor phthalates in a sustainable wastewater treatment scheme

Due to their pervasive applications, phthalic acid esters or phthalates have ample presence in all environmental compartments. A principal source of their existence in freshwater is phthalate-laden wastewater treatment plant effluents. For its sustainable operation and biogas production, wastewater treatment scheme of up flow anaerobic sludge blanket (UASB) and polishing pond is more prevalent in developing countries. This yearlong study focused on evaluating the occurrence, fate and risk of four priority phthalates, diethyl phthalate (DEP), dibutyl phthalate (DBP), benzylbutyl phthalate (BBP), and diethylhexyl phthalate (DEHP) in a UASB+ polishing pond-based wastewater treatment plant. Concentration of the phthalates in raw wastewater ranged from nd to 17.36 μg/L (DEP), 0.92 to 18.26 μg/L (DBP), nd to 6.54 μg/L (BBP), and nd to 53.21 μg/L (DEHP). DEHP concentrations in UASB sludge were below 100 mg/kg, the recommended limit by the European Union for safe disposal of dewatered sludge. All four compounds were removed approximately 80% in the wastewater treatment plant, with larger removal in polishing pond than UASB. Sorption contributes a significant portion of BBP and DEHP removal (15-24%) in UASB than DEP and DBP (0-3%). Seasonally, larger removals of phthalates were observed during the summer season. Risk assessment showed that the treated effluents had low risk of DEP, DBP, and BBP. However, the hazard quotient (HQ) of DEHP was greater than 1. To comply with regulations, dilution requirement of effluents was investigated which showed that a dilution factor of 4.4 in summer and 2.1 in winter is required for effluents of UASB + Pond-based treatment plant.

The concentrations of phthalic acid esters in a water bath at sous-vide heat treatment

Esters of phthalic acid are common contaminants of the environment because of their large application in plastics. Phthalic acid esters are used as plasticizers in plastics, and they are also used in plastic intended for contact with food. In our research, we investigated the influence of heating on the migration of phthalic acid esters into the water used as a water bath. The water bath was used to heat the vacuum-wrapped meat, this heating is called the sous-vide method. The plastic thermostable bags containing phthalates were used on the meat packaging. Two esters of phthalic acid dibutyl phthalate (DBP) and di-2-ethylhexyl phthalate (DEHP) have been determined. Three packaged meat samples were heated in a water bath for one hour either at 50 °C or at 60 °C. The water was analyzed always before the heating and after the heating. Average DEHP concentrations in the water dropped after heating at 50 °C in two cases and average DBP concentrations rose in one case and declined in one case. Average DBP concentrations in water declined after heating at 60 °C, while average DEHP concentrations after heating at 60 °C in water increased. The concentrations of phthalic acid esters in the water ranged from 15.2311 μg.L-1 to 34.5645 μg.L-1 for DEHP and from 0.0433 μg.L-1 to 2.6529 μg.L-1 for DBP. The heating of vacuum-packed food in plastic phthalate bags in a water bath does not pose a great risk of contamination of water with phthalic acid esters.

Levels of phthalate acid esters and sex hormones and their possible sources in traffic-patrol policemen in Chongqing

To investigate the correlation between the air phthalate acid ester (PAE) exposure and serum PAE concentration and the effects of PAE exposure on reproductive health among Chongqing traffic-patrol policemen. In 2013, 32 traffic-patrol policemen working in an area with poor air quality in Chongqing and 28 traffic-patrol policemen working in an area with good air quality were selected. Their blood levels of 14 PAEs and six reproductive hormones were determined. Air samples were collected from four traffic-patrol platforms. The concentrations of 14 PAEs in the air samples were evaluated. All 14 PAEs were detected in the blood samples. The concentrations of seven PAEs in the total suspended particulate, namely, dimethyl phthalate, diethyl phthalate, dibutyl phthalate, bis (2-ethox-yethyl) phthalate, dihexyl phthalate, benzyl butyl phthalate, and bis (2-n-butoxyethyl) phthalate, were positively and significantly associated with the blood levels of these PAEs in the participants. All the sex hormone levels measured here were significantly different between the participants from the two areas. The PAE concentrations in the blood samples were correlated with the reproductive hormone levels in the participants. Air PAE pollution may be a major source of PAE exposure in the traffic-patrol policemen of Chongqing.

Phthalates in soft glass (a soft transparent PVC plastic sheet used extensively in household and public place in developing countries in recent years): Implication for oral exposure to young children

It has been several years that a soft transparent polyvinyl chloride (PVC) plastic sheet, commonly known as "soft glass", or "crystal plate" in China and other developing countries, has quietly and gradually found extensive applications. This material has widely replaced cloth and glass as table cover in household and office, and replaced cloth as door drape in public place in China. In this study, the concentration of plasticizer used in soft glass and the migration of the plasticizer from soft glass to olive oil and porcine skin during contact were determined. The oral exposure of young children to the plasticizer from soft glass was estimated for the first time. Two exposure routes, one via ingestion of contaminated food, the other via mouthing of contaminated hand, were considered. It is found that Di(2-ethylhexyl) phthalate (DEHP) is the major plasticizer used in soft glass, which could leach out of the material and migrate easily to the olive oil and porcine skin during contact. A rough estimation of oral exposure for young children to DEHP from soft glass was 126 μg/person/d, which would be converted to 12.6 μg/kg bw/d and 7.9 μg/kg bw/d, for body weight of 10 kg and 16 kg, respectively. The estimated exposure dosages would not pose immediate health hazard to the children. The implications of these dosages were also discussed.

Effects of flow rate on the migration of different plasticizers from PVC infusion medical devices

Infusion medical devices (MDs) used in hospitals are often made of plasticized polyvinylchloride (PVC). These plasticizers may leach out into infused solutions during clinical practice, especially during risk-situations, e.g multiple infusions in Intensive Care Units and thus may enter into contact with the patients. The migrability of the plasticizers is dependent of several clinical parameters such as temperature, contact time, nature of the simulant, etc… However, no data is available about the influence of the flow rate at which drug solutions are administrated. In this study, we evaluated the impact of different flow rates on the release of the different plasticizers during an infusion procedure in order to assess if they could expose the patients to more toxic amounts of plasticizers. Migration assays with different PVC infusion sets and extension lines were performed with different flow rates that are used in clinical practice during 1h, 2h, 4h, 8h and 24h, using a lipophilic drug simulant. From a clinical point of view, the results showed that, regardless of the plasticizer, the faster the flow rate, the higher the infused volume and the higher the quantities of plasticizers released, both from infusion sets and extension lines, leading to higher patient exposure. However, physically, there was no significant difference of the migration kinetics linked to the flow rate for a same medical device, reflecting complex interactions between the PVC matrix and the simulant. The migration was especially dependent on the nature and the composition of the medical device.

Di (2-Ethylhexyl) Phthalate and Its Role in Developing Cholestasis: An In Vitro Study on Different Liver Cell Types

OBJECTIVES

Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used in many polyvinylchloride medical devices and is washed out easily. Thereby critically ill infants can become exposed to DEHP concentrations significantly exceeding the recommended threshold. We suspect DEHP to play an important role in the development of intestinal failure-associated liver disease. The aim of this study was therefore to determine the direct influence of DEHP on different liver cell types.

METHODS

HepG2, human upcyte hepatocytes, primary murine hepatocytes, LX-2, human upcyte hepatic stellate cells, and liver organoids were cultured with DEHP (0.5-500 μmol/L) and parameters including cytotoxicity, cell-cell interactions, and expression of metabolizing enzymes were investigated.

RESULTS

DEHP modulated the expression of xenobiotic metabolizing enzymes, reduced the formation of bile canaliculi and cell polarity, and inhibited Cyp-activity in hepatocytes. DEHP had a toxic effect on LX-2 and induced the fibrogenic activation of hepatic stellate cells. The mode of action of DEHP was different in monolayer cultures compared to 3D-liver organoids, which were more sensitive to DEHP.

CONCLUSIONS

This study suggests that DEHP modulates expression and activity of drug-detoxifying liver enzymes in humans at a clinically relevant concentration. Furthermore, it may contribute to the development of cholestasis and fibrosis. These findings strongly support the opinion, that there is a significant potential for serious adverse effects of DEHP derived from medical devices on human health, especially in very young infants with immature livers.

Exposure of hospitalised pregnant women to plasticizers contained in medical devices

Background

Medical devices (MDs) in polyvinyl chloride (PVC) are not a well-known source of exposure to plasticizers, in particular during pregnancy. Because of its toxicity, the di-(2-ethylhexyl) phthalate (DEHP) has been replaced by other plasticizers such as di (isononyl)-cyclohexane-1,2-dicarboxilic acid (DINCH), tri-octyltrimellitate (TOTM) and di-(isononyl) phthalate (DiNP). Our study aimed to quantify the plasticizers (DEHP and alternative plasticizers) contained in PVC medical devices used for hospitalised pregnant women and to describe which these MDs had been used (type, number, duration of exposure).

Methods

The plasticizers contained in the MDs used for daily care in the Obstetrics Department of a French University Hospital were extracted from PVC (after contact with a chloroform solution), identified and quantified by gas-chromatography-mass-spectrometry analysis. A total of 168 pregnant women hospitalised in the Obstetrics Department with at least one catheter were included in the observational study. The median number of MDs containing plasticizers used and the daily duration of exposure to the MDs were compared in three groups of pregnant women: “Pathology group” (women hospitalised for an obstetric disorder who did not give birth during this hospitalisation; n = 52), “Pathology and delivery group” (hospitalised for an obstetric disorder and who gave birth during this stay; n = 23) and “Delivery group” (admitted for planned or spontaneous delivery without obstetric disorder; n = 93).

Results

DiNP, TOTM and DINCH were the predominant plasticizers contained in the MDs at an amount of 29 to 36 g per 100 g of PVC. Women in the “Pathology group” (preterm labour or other pathology) were exposed to a median number of two MDs containing TOTM and one MD containing DiNP, fewer than those in the “Pathology and delivery group” (p < 0.05). Women in the “Pathology group” had a median exposure of 3.4 h/day to MDs containing DiNP and 8.2 h/day to MDs containing TOTM, longer than those in the “Delivery group” (p < 0.01).

Conclusions

Our study shows that the medical management of pregnant women in a hospital setting entails exposure to MDs containing alternative plasticizers (DiNP, TOTM and DINCH).

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-017-0398-7) contains supplementary material, which is available to authorized users.

Leaching of plasticizers from polyvinylchloride perfusion lines by different lipid emulsions for premature infants under clinical conditions

Plasticizers migrate from polyvinylchloride (PVC) infusion systems into lipid emulsions. The aim of this study was to investigate the leaching of different plasticizers from PVC perfusion lines by a selection of lipid emulsions under clinical conditions. Seven PVC perfusion lines with an equal length of 150cm and three internal diameters were perfused with three lipid emulsions: Intralipid^® 20%, ClinOleic^® 20% and SMOFlipid^® 20%, mimicking clinical conditions. The concentrations of the plasticizers were measured directly in the emulsions by gas chromatography - mass spectrometry. Of the four plasticizers examined in this study, di (2-ethylhexyl) phthalate (DEHP) leached the most and was found, on average, at 46.5μg/ml in the emulsions - around one order of magnitude higher than the other plasticizers. This study demonstrates that the leaching of DEHP by lipid emulsions in conditions of total parenteral nutrition is many times higher than should be accepted and higher when compared to the other plasticizers. There was no significant difference in leaching of plasticizers in relation to the type of lipid emulsion. The influence of tube diameter on the leaching rate of plasticizers should be taken into account especially in particular exposed patients.

Comparative assessment of phthalate removal and risk in biological wastewater treatment systems of developing countries and small communities

Phthalates are widely used in plastic and personnel care products. Being non-steroid endocrine disrupting compounds, their exposure have toxic effects on aquatic life and human health. The aim of this study was a comparative assessment of their fate and risk in full scale wastewater treatment along with influence of seasonal variations. Four priority phthalates, Diethylphthalate (DEP), Dibutylphthalate (DBP), Benzylbutyl phthalate (BBP) and Diethylhexyl phthalate (DEHP) were chosen for this study and wastewater treatment plants investigated were designed as nutrient removal based sequencing batch reactor (SBR), conventional activated sludge process (ASP) and up flow anaerobic sludge blanket (UASB) with polishing pond. Results showed that the main removal mechanism of phthalates was biotransformation with removal contribution of 74% in SBR, 65% in conventional ASP and 37% in UASB. Overall removal of phthalates was maximum in the treatment combination of UASB and pond (83%) followed by SBR (80%) and conventional ASP (74%). Seasonal influences on occurrence, removal and risk of these phthalates were also studied. The concentration of DEP, DBP and DEHP in untreated wastewater increased by 2, 7 and 2μg/L, respectively in summer. However in sludge, only large molecular weight phthalates BBP and DEHP increased in winter by 3mg/kg and 12mg/kg, respectively. Seasonal variations in removal of phthalates were discrepant in each process with better removal during summer. Risk assessment of phthalates to aquatic life showed that there is no potential risk of DEP, DBP and BBP from effluents of treatment plants however risk quotient of DEHP was in the range of 27-73 in both seasons which indicate probable risk to aquatic organisms. Phthalate risk to human beings estimated by daily intake of phthalates was in the range of 0.3±0.1 to 20±0.7ng/kg/d and far below their respective reference dosages, demonstrating the potential of these treatment plants to reduce the risk of phthalates.

Phthalates in neonatal health: friend or foe?

Exposure to environmental chemicals has adverse effects on the health and survival of humans. Emerging evidence supports the idea that exposure to endocrine-disrupting compounds (EDCs) can perturb an individual’s physiological set point and as a result increase his/her propensity toward several diseases. The purpose of this review is to provide an update on di-(2-ethylhexyl) phthalate, the primary plasticizer found in plastic medical devices used in neonatal intensive care units, its effects on the fetus and newborn, epidemiological studies, pharmacokinetics, toxicity and epigenetic implications. We searched the PubMed databases to identify relevant studies. Phthalates are known EDCs that primarily are used to improve the flexibility of polyvinyl chloride plastic products and are called plasticizers in lay terms. Neonates and infants are particularly vulnerable to the effects of phthalates, beginning with maternal exposure and placental transfer during gestation and during infancy following birth. In line with the developmental origins of adult disease, a focus on the effects of environmental chemicals in utero or early childhood on the genesis of adult diseases through epigenome modulation is timely and important. The epigenetic effects of phthalates have not been fully elucidated, but accumulating evidence suggests that they may be associated with adverse health effects, some of which may be heritable. Phthalate exposure during pregnancy and the perinatal period is particularly worrisome in health-care settings. Although the clinical significance of phthalate exposure has been difficult to assess with epidemiologic studies, the evidence that physiological changes occur due to exposure to phthalates is growing and points toward the need for more investigation at a molecular, specifically epigenetic level.

Influence of polyvinyl chloride infusion extension tube on propofol injection pain: a randomised controlled study

BACKGROUND

Propofol injection pain is a common and unsolved anaesthesia problem.

OBJECTIVES

The present study attempted to confirm that the plasticiser di(2-ethylhexyl) phthalate in polyvinyl chloride (PVC) infusion tubes may increase propofol injection pain by increasing the aqueous propofol concentration.

DESIGN

A randomised controlled study.

SETTING

University teaching hospital, 1 April to 25 June 2013.

PATIENTS

One hundred patients scheduled for elective surgery were allocated randomly to the PVC or the control (C) group. The PVC group received a propofol (Diprivan) infusion via a 1-m PVC infusion extension tube, whereas group C received propofol injected directly through the port of the cannula.

INTERVENTION

After the syringe was loaded with propofol, air was expelled from the tube and the syringe was left standing for 5 min; intravenous propofol 0.5 mg kg⁻¹ was then injected either through the PVC tube or directly into the cannula.

MAIN OUTCOME MEASURE

A verbal rating scale was used to evaluate the propofol injection pain in both groups. Di(2-ethylhexyl) phthalate and aqueous propofol concentrations were also measured in samples of propofol after simulated injection. To investigate whether the increase in aqueous propofol concentration was caused by leached di(2-ethylhexyl) phthalate, the same amount of di(2-ethylhexyl) phthalate as that measured in the PVC group was added to the samples (group D).

RESULTS

The incidences of pain in groups PVC and C were 88 and 46%, respectively (P < 0.0001). The di(2-ethylhexyl) phthalate concentration in group PVC (1.01 ± 0.07 μg ml⁻¹) was greater than that in group C (lower than the detection limit of 0.03 μg ml⁻¹). No significant difference was found between the aqueous propofol concentrations in groups PVC (25.9 ± 1.8 μg ml⁻¹) and D (24.4 ± 1.1 μg ml⁻¹) (P = 0.22), which were significantly higher than that in group C (14.3 ± 1.0 μg ml⁻¹) (P = 0.079).

CONCLUSION

Propofol injection pain is increased by contact with PVC infusion tubing as a result of an increase in aqueous propofol concentration caused by di(2-ethylhexyl) phthalate leaching into the lipid emulsion.

TRIAL REGISTRATION

chictr.org identifier: ChiCTR-TRC-12003170.

Migrability of PVC plasticizers from medical devices into a simulant of infused solutions

Medical devices (MD) for infusion and artificial nutrition are essentially made of plasticized PVC. The plasticizers in the PVC matrix can leach out into the infused solutions and may enter into contact with the patients. In order to assess the risk of patient exposure to these plasticizers we evaluated the migration performance of DEHP, DEHT, DINCH, and TOTM using a model adapted to the clinical use of the MDs. Each PVC tubing sample was immersed in a simulant consisting of a mixture of ethanol/water (50/50v/v) at 40°C and migration tests were carried out after 24h, 72h, and 10 days.DEHP had the highest migration ability, which increased over time. The amount of TOTM released was more than 20 times less than that of DEHP, which makes it an interesting alternative. DEHT is also promising, with a migration level three times smaller than DEHP. However, the migration ability of DINCH was similar to DEHP, with the released amounts equaling 1/8th of the initial amount in the tubing after 24h of contact. Taking into account the available toxicological data, TOTM and DEHT appear to be of particular interest. However, these data should be supplemented and correlated with clinical and toxicological studies on plasticizers and their metabolites.

Leaching of the plasticizer di(2-ethylhexyl)phthalate (DEHP) from plastic containers and the question of human exposure

Di(2-ethylhexyl)phthalate (DEHP) is a widely used plasticizer to render poly(vinyl chloride) (PVC) soft and malleable. Plasticized PVC is used in hospital equipment, food wrapping, and numerous other commercial and industrial products. Unfortunately, plasticizers can migrate within the material and leach out of it over time, ending up in the environment and, frequently, the human body. DEHP has come under increased scrutiny as its breakdown products are believed to be endocrine disruptors and more toxic than DEHP itself. DEHP and its breakdown products have been identified as ubiquitous environmental contaminants, and daily human exposure is estimated to be in the microgram per kilogram level. The objective of this review is to summarize and comment on published sources of DEHP exposure and to give an overview of its environmental fate. Exposure through bottled water was examined specifically, as this concern is raised frequently, yet only little exposure to DEHP occurs through bottled water, and DEHP exposure is unlikely to stem from the packaging material itself. Packaged food was also examined and showed higher levels of DEHP contamination compared to bottled water. Exposure to DEHP also occurs in hospital environments, where DEHP leaches directly into liquids that passed through PVC/DEHP tubing and equipment. The latter exposure is at considerably higher levels compared to food and bottled water, specifically putting patients with chronic illnesses at risk. Overall, levels of DEHP in food and bottled water were below current tolerable daily intake (TDI) values. However, our understanding of the risks of DEHP exposure is still evolving. Given the prevalence of DEHP in our atmosphere and environment, and the uncertainty revolving around it, the precautionary principle would suggest its phaseout and replacement. Increased efforts to develop viable replacement compounds, which necessarily includes rigorous leaching, toxicity, and impact assessment studies, are needed before alternative plasticizers can be adopted as viable replacements.

Phthalate levels in cord blood are associated with preterm delivery and fetal growth parameters in Chinese women

Data concerning the effects of phthalate exposure on preterm delivery and fetal growth are limited in humans. In this paper, we assessed the relationship between 15 phthalate levels in cord blood and preterm delivery and fetal growth parameters in 207 Chinese women going into labor. Exposure to phthalates except DCHP was associated with gestational age reduction and preterm delivery (p<0.05). There were associations between phthalates and fetal growth parameters, many of which disappeared when analyses were adjusted for gestational age, especially in male infants (Only DEEP was associated with birth weight; DEP, DNHP, BBP, DNP with abdominal circumference; DEP, DBP, DCHP, DEHP with femur length in female infants. And DPP, DBEP was associated with birth length in male infants. p<0.05). This study indicates that prenatal exposure to phthalates is associated with younger gestational age and preterm delivery. Also, phthalate exposure may adversely affect fetal growth parameters via gestational age reduction and preterm delivery with a significant gender effect.

Canine toys and training devices as sources of exposure to phthalates and bisphenol A: quantitation of chemicals in leachate and in vitro screening for endocrine activity

Chewing and mouthing behaviors exhibited by pet dogs are likely to lead to oral exposures to a variety of environmental chemicals. Products intended for chewing and mouthing uses include toys and training devices that are often made of plastics. The goal of the current study was to determine if a subset of phthalates and bisphenol A (BPA), endocrine disrupting chemicals commonly found in plastics, leach out of dog toys and training devices (bumpers) into synthetic canine saliva. In vitro assays were used to screen leachates for endocrine activity. Bumper leachates were dominated by di-2-ethylhexyl phthalate (DEHP) and BPA, with concentrations reaching low μg mL(-1) following short immersions in synthetic saliva. Simulated chewing of bumpers during immersion in synthetic saliva increased concentrations of phthalates and BPA as compared to new bumpers, while outdoor storage had variable effects on concentrations (increased DEHP; decreased BPA). Toys leached substantially lower concentrations of phthalates and BPA, with the exception of one toy which leached considerable amounts of diethyl phthalate. In vitro assays indicated anti-androgenic activity of bumper leachates, and estrogenic activity of both bumper and toy leachates. These results confirm that toys and training devices are potential sources of exposure to endocrine disrupting chemicals in pet dogs.