{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:44:31Z","timestamp":1760150671725,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cast21 Inc."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>The effects of occupational isocyanate exposure range from asthma and contact dermatitis to neurotoxicity and cancer. Respiratory sensitization due to orthopedic cast application has been well documented. This study aims to compare the safety of standard-of-care fiberglass casts and a novel waterproof cast alternative by measuring the amount of isocyanate released during off-gassing over time. A 3D-printed arm simulator with comparable casing material amounts was placed in a sealed chamber. An isocyanate-sensing color-changing (SafeAir) tag was used to measure the levels of toxic exposure. Triplicate trials were conducted across all time periods (15 min, 1 h, and 24 h) and conditions. The bare arm simulator and freshly opened tags served as negative controls. Normalized pixel intensity indexes and isocyanate release estimates in ppb were derived from ImageJ-analyzed SafeAir tag photos. Fiberglass casts exhibited greater isocyanate release than both the waterproof alternative (p = 0.0002) and no-cast controls (p = 0.0006), particularly at 24 h. The waterproof alternative and no-cast control did not statistically differ (p = 0.1603). Therefore, the waterproof alternative released less isocyanate than the fiberglass casts. Waterproof cast alternatives may be safer than fiberglass by limiting medical professionals\u2019 exposure to toxic isocyanates and, thus, decreasing their risk of suffering occupational asthma.<\/jats:p>","DOI":"10.3390\/toxics11121002","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T05:47:30Z","timestamp":1702014450000},"page":"1002","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reduced Isocyanate Release Using a Waterproof, Resin-Based Cast Alternative Relative to Fiberglass Casts"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8773-9742","authenticated-orcid":false,"given":"Kristen","family":"Stefanescu","sequence":"first","affiliation":[{"name":"Keck School of Medicine of the University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0756-5210","authenticated-orcid":false,"given":"Claire L.","family":"Timlin","sequence":"additional","affiliation":[{"name":"Cast21, 1623 W Fulton St., Chicago, IL 60612, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley S.","family":"Moy","sequence":"additional","affiliation":[{"name":"Cast21, 1623 W Fulton St., Chicago, IL 60612, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2036-2992","authenticated-orcid":false,"given":"Grzegorz","family":"Zapotoczny","sequence":"additional","affiliation":[{"name":"Consortium for Technology & Innovation in Pediatrics, Lurie Children\u2019s Hospital, 225 E Chicago Ave., Chicago, IL 60611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"key":"ref_1","first-page":"44","article-title":"Isocyanates and human health: Multi-stakeholder information needs and research priorities","volume":"57","author":"Lockey","year":"2015","journal-title":"Brain Lang."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Streicher, R.P., Reh, C.M., Key-Schwartz, R., Schlecht, P.C., and Cassinelli, M.E. (1998). Determination of Airborne Isocyanate Exposure. NIOSH Man. Anal. Methods, 115\u2013140.","DOI":"10.3320\/1.2763136"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1002\/ajim.22815","article-title":"Occupational asthma risk from exposures to toluene diisocyanate: A review and risk assessment","volume":"61","author":"Daniels","year":"2018","journal-title":"Am. J. Ind. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lenzi, V., Crema, A., Pyrlin, S., and Marques, L. (2022). Current State and Perspectives of Simulation and Modeling of Aliphatic Isocyanates and Polyisocyanates. Polymers, 14.","DOI":"10.3390\/polym14091642"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Olivito, F., Jagdale, P., and Oza, G. (2023). Synthesis and Biodegradation Test of a New Polyether Polyurethane Foam Produced from PEG 400, L-Lysine Ethyl Ester Diisocyanate (L-LDI) and Bis-hydroxymethyl Furan (BHMF). Toxics, 11.","DOI":"10.3390\/toxics11080698"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1002\/ajim.21010","article-title":"Occupational asthma related to low levels of airborne methylene diphenyl diisocyanate (MDI) in orthopedic casting work","volume":"54","author":"Suojalehto","year":"2011","journal-title":"Am. J. Ind. Med."},{"key":"ref_7","unstructured":"Pedata, P., Corvino, A.R., Lamberti, M., Petrarca, C., Di Giampaolo, L., Sannolo, N., and Di Gioacchino, M. (2017). Current Topics in Environmental Health and Preventive Medicine: Allergy and Immunotoxicology in Occupational Health, Springer."},{"key":"ref_8","unstructured":"National Toxicology Program (2021). Report on Carcinogens, Fifteenth Edition: Toluene Diisocyanates, U.S. Department of Health and Human Services, Public Health Service."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1177\/07482337211060133","article-title":"Absorption, distribution, metabolism, and excretion of methylene diphenyl diisocyanate and toluene diisocyanate: Many similarities and few differences","volume":"38","author":"Schupp","year":"2022","journal-title":"Toxicol. Ind. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1007\/s00204-015-1606-6","article-title":"Toluene diisocyanate and methylene diphenyl diisocyanate: Asthmatic response and cross-reactivity in a mouse model","volume":"90","author":"Pollaris","year":"2016","journal-title":"Arch. Toxicol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1046\/j.1365-2222.2001.01125.x","article-title":"Importance of inflammatory and immune components in a mouse model of airway reactivity to toluene diisocyanate (TDI)","volume":"31","author":"Matheson","year":"2001","journal-title":"Clin. Exp. Allergy"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhuang, J., Cui, H., Zhuang, L., Zhai, Z., Yang, F., Luo, G., He, J., Zhao, H., Zhao, W., and He, Y. (2020). Bronchial epithelial pyroptosis promotes airway inflammation in a murine model of toluene diisocyanate-induced asthma. Biomed. Pharmacother., 125.","DOI":"10.1016\/j.biopha.2020.109925"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1093\/toxsci\/kfv120","article-title":"Phosphatidylinositol 3-kinase mediates \u03b2-catenin dysfunction of airway epithelium in a toluene diisocyanate-induced murine asthma model","volume":"147","author":"Yao","year":"2015","journal-title":"Toxicol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Peng, X., Huang, M., Zhao, W., Lan, Z., Wang, X., Yuan, Y., Li, B., Yu, C., Liu, L., and Dong, H. (2022). RAGE mediates airway inflammation via the HDAC1 pathway in a toluene diisocyanate-induced murine asthma model. BMC Pulm. Med., 22.","DOI":"10.1186\/s12890-022-01832-3"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"73S","DOI":"10.1378\/chest.80.1_Supplement.73S","article-title":"Specific IgE antibodies in patients with isocyanate asthma","volume":"80","author":"Baur","year":"1981","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0091-6749(98)70181-2","article-title":"Specific IgE to isocyanates: A useful diagnostic role in occupational asthma","volume":"101","author":"Tee","year":"1998","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/JOM.0000000000000138","article-title":"Genetic variants in the major histocompatibility complex class i and class II genes are associated with diisocyanate-induced asthma","volume":"56","author":"Yucesoy","year":"2014","journal-title":"J. Occup. Environ. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3109\/1547691X.2015.1017061","article-title":"Genetic variants in TNF, TGFB1, PTGS1 and PTGS2 genes are associated with diisocyanate-induced asthma","volume":"13","author":"Yucesoy","year":"2016","journal-title":"J. Immunotoxicol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S1567-5769(01)00174-6","article-title":"Diisocyanate asthma: Clinical aspects and immunopathogenesis","volume":"2","author":"Redlich","year":"2002","journal-title":"Int. Immunopharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3672","DOI":"10.3390\/ijerph8093672","article-title":"Environmental Isocyanate-Induced Asthma: Morphologic and Pathogenetic Aspects of an Increasing Occupational Disease","volume":"8","author":"Bartsch","year":"2011","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1289\/ehp.9557","article-title":"Skin exposure to isocyanates: Reasons for concern","volume":"115","author":"Bello","year":"2007","journal-title":"Environ. Health Perspect."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Coureau, E., Fontana, L., Lamouroux, C., Carole, P., and Charbotel, B. (2021). Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182413181"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1513\/pats.201002-025RM","article-title":"Skin exposure and asthma is there a connection?","volume":"7","author":"Redlich","year":"2010","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1097\/JOM.0000000000000890","article-title":"Incidence of Occupational Asthma and Exposure to Toluene Diisocyanate in the United States Toluene Diisocyanate Production Industry","volume":"59","author":"Collins","year":"2017","journal-title":"J. Occup. Environ. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s00420-002-0403-8","article-title":"A 17-year epidemiological study on changes in lung function in toluene diisocyanate foam workers","volume":"76","author":"Clark","year":"2003","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1002\/ajim.22385","article-title":"Inception cohort study of workers exposed to toluene diisocyanate at a polyurethane foam factory: Initial one-year follow-up","volume":"57","author":"Gui","year":"2014","journal-title":"Am. J. Ind. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1067\/mai.2002.128806","article-title":"Airway inflammation and functional changes after exposure to different concentrations of isocyanates","volume":"110","author":"Romeo","year":"2002","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1080\/10473220290107039","article-title":"Biomarkers of toluene diisocyanate exposure","volume":"17","author":"Brown","year":"2002","journal-title":"Appl. Occup. Environ. Hyg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3109\/1354750X.2011.645166","article-title":"Determination of isocyanate specific albumin-adducts in workers exposed to toluene diisocyanates","volume":"17","author":"Sabbioni","year":"2012","journal-title":"Biomarkers"},{"key":"ref_30","first-page":"758","article-title":"Isocyanate Exposure Assessment Combining Industrial Hygiene Methods with Biomonitoring for End Users of Orthopedic Casting Products","volume":"57","author":"Pearson","year":"2013","journal-title":"Ann. Occup. Hyg"},{"key":"ref_31","first-page":"606","article-title":"A Case of Suspected Occupational Asthma in an Orthopedist, Due to Cast Materials Containing MDI","volume":"32","author":"Tanaka","year":"1994","journal-title":"J. Jpn. Thorac. Soc."},{"key":"ref_32","first-page":"505","article-title":"Asthma for\u00e5rsaget af methylen-diphenyl-diisocyanat-gips hos en sygeplejerske [Asthma caused by methylene-diphenyl-diisocyanate cast in a nurse]","volume":"162","author":"Sommer","year":"2000","journal-title":"Ugeskr Laeger"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1093\/occmed\/kqg133","article-title":"Occupational asthma after exposure to plaster casts containing methylene diphenyl diisocyanate","volume":"53","author":"Donnelly","year":"2004","journal-title":"Occup. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.injury.2022.09.002","article-title":"Innovations in orthopaedic trauma: Top advancements of the past two decades and predictions for the next two","volume":"53","author":"Rodham","year":"2022","journal-title":"Injury"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"291","DOI":"10.2174\/1874325001711010291","article-title":"Plaster of Paris\u2013Short History of Casting and Injured Limb Immobilzation","volume":"11","author":"Szostakowski","year":"2017","journal-title":"Open Orthop. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.5694\/j.1326-5377.1976.tb128927.x","article-title":"New Fibreglass Casting System in Orthopaedic Practice","volume":"1","author":"Davie","year":"1976","journal-title":"Med. J. Aust."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e13640","DOI":"10.1016\/j.heliyon.2023.e13640","article-title":"Revolution in orthopedic immobilization materials: A comprehensive review","volume":"9","author":"Ekanayake","year":"2023","journal-title":"Heliyon"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"30","DOI":"10.5435\/00124635-200801000-00005","article-title":"Cast and splint immobilization: Complications","volume":"16","author":"Halanski","year":"2008","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/pde.14884","article-title":"Dermatologic complications of orthopedic casts in pediatric patients","volume":"39","author":"Ravi","year":"2022","journal-title":"Pediatr. Dermatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s00216-019-02295-y","article-title":"A validated UPLC-MS\/MS method for the determination of aliphatic and aromatic isocyanate exposure in human urine","volume":"412","author":"Sleno","year":"2020","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"700636","DOI":"10.3389\/fgene.2021.700636","article-title":"Epigenetic Markers Are Associated With Differences in Isocyanate Biomarker Levels in Exposed Spray-Painters","volume":"12","author":"Taylor","year":"2021","journal-title":"Front. Genet."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1308\/rcsann.2020.0030","article-title":"The relationship between temperature and hip and wrist fracture incidence","volume":"102","author":"Johnson","year":"2020","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s41205-017-0019-y","article-title":"Application of 3D\u2013printed and patient-specific cast for the treatment of distal radius fractures: Initial experience","volume":"3","author":"Chen","year":"2017","journal-title":"3D Print. Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Guebeli, A., Thieringer, F., Honigmann, P., and Keller, M. (2023). In-house 3D-printed custom splints for non-operative treatment of distal radial fractures: A randomized controlled trial. J. Hand Surg. Eur. Vol., 1\u20139.","DOI":"10.1177\/17531934231187554"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.injury.2022.07.020","article-title":"Personalized 3D-printed forearm braces as an alternative for a traditional plaster cast or splint: A systematic review","volume":"53","author":"Verhofstad","year":"2022","journal-title":"Injury"}],"container-title":["Toxics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6304\/11\/12\/1002\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:35:15Z","timestamp":1760132115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6304\/11\/12\/1002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,8]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["toxics11121002"],"URL":"https:\/\/doi.org\/10.3390\/toxics11121002","relation":{},"ISSN":["2305-6304"],"issn-type":[{"type":"electronic","value":"2305-6304"}],"subject":[],"published":{"date-parts":[[2023,12,8]]}}}