This study tested the effectiveness of the AutoSet self-titrating nasal continuous positive airway pressure (nCPAP) system in treating obstructive sleep apnea (OSA), and choosing a suitable pressure for subsequent conventional fixed-pressure nCPAP therapy. Twenty-one adult men with untreated OSA were studied with full polysomnography on each of four nights: diagnostic, manual and AutoSet nCPAP titration (in random order), and conventional fixed-pressure nCPAP at the pressure recommended by the AutoSet titration. Titration was satisfactorily performed in 20 of 21 subjects. Severe mask leak prevented automated titration in one subject and caused transient unnecessary increases in pressure in three subjects. In the 20 subjects, respiratory disturbance index (RDI) was 60.3 +/- 5.7 events/h (mean +/- SEM) on the diagnostic night. RDI was lower with manual titration (10.1 +/- 3.0, p < 0.001), and lower still with Autoset (2.8 +/- 0.9, p < 0.01) and fixed pressure (2.5 +/- 0.7, p = ns versus AutoSet) nCPAP. There were similar changes in the arousal index, which was 52.7 +/- 4.6 events/h on the diagnostic night, 14.2 +/- 2.4 with manual titration and 8.9 +/- 0.9 with AutoSet titration, and 9.5 +/- 1.0 on the night of conventional fixed-pressure CPAP (p < 0.001 versus diagnostic). We conclude that the AutoSet system is suitable for automated nCPAP pressure titration.

ning 11 and The Weldox GroupWe investigated airborne and internal exposure to manganese (Mn) and iron (Fe) among welders. Personal sampling of welding fumes was carried out in 241 welders during a shift. Metals were determined by inductively coupled plasma mass spectrometry. Mn in blood (MnB) was analyzed by graphite furnace atom absorption spectrometry. Determinants of exposure levels were estimated with multiple regression models. Respirable Mn was measured with a median of 62 (inter-quartile range (IQR) 8.4 --320) mg/m 3 and correlated with Fe (r ¼ 0.92, 95% CI 0.90 --0.94). Inhalable Mn was measured with similar concentrations (IQR 10 --340 mg/m 3 ). About 70% of the variance of Mn and Fe could be explained, mainly by the welding process. Ventilation decreased exposure to Fe and Mn significantly. Median concentrations of MnB and serum ferritin (SF) were 10.30 mg/l (IQR 8.33 --13.15 mg/l) and 131 mg/l (IQR 76 --240 mg/l), respectively. Few welders were presented with low iron stores, and MnB and SF were not correlated (r ¼ 0.07, 95% CI À0.05 to 0.20). Regression models revealed a significant association of the parent metal with MnB and SF, but a low fraction of variance was explained by exposure-related factors. Mn is mainly respirable in welding fumes. Airborne Mn and Fe influenced MnB and SF, respectively, in welders. This indicates an effect on the biological regulation of both metals. Mn and Fe were strongly correlated, whereas MnB and SF were not, likely due to higher iron stores among welders.

It was the aim of this study to evaluate the effect of different devices on the metal concentration in exhaled breath condensate (EBC) and to prove whether working conditions in different welding companies result in diverse composition of metallic elements. The influence of two collection devices (ECoScreen, ECoScreen2) on detection of metallic elements in EBC was evaluated in 24 control subjects. Properties of ECoScreen and a frequent use can alter EBC metal content due to contamination from metallic components. ECoScreen2 turned out to be favourable for metal assessment. Concentrations of iron, nickel and chromium in EBC sampled with ECoScreen2 were compared between non-exposed controls and industrial welders. Metal concentrations in EBC were higher in 36 welders recruited from three companies. Exposure to welding fumes could be demonstrated predominantly for increased iron concentrations. Concentrations of iron and nickel differed by working conditions, but chromium could not be detected in EBC.

Iron is the major metal found in welding fumes, and although it is an essential trace element, its overload causes toxicity due to Fenton reactions. To avoid oxidative damage, excess iron is bound to ferritin, and as a result, serum ferritin (SF) is a recognized biomarker for iron stores, with high concentrations linked to inflammation and potentially also cancer. However, little is known about iron overload in welders. Within this study, we assessed the iron status and quantitative associations between airborne iron, body iron stores, and iron homeostasis in 192 welders not wearing dust masks. Welders were equipped with personal samplers in order to determine the levels of respirable iron in the breathing zone during a working shift. SF, prohepcidin and other markers of iron status were determined in blood samples collected after shift. The impact of iron exposure and other factors on SF and prohepcidin were estimated using multiple regression models. Our results indicate that respirable iron is a significant predictor of SF and prohepcidin. Concentrations of SF varied according to the welding technique and respiratory protection used, with a median of 103 μg l(-1) in tungsten inert gas welders, 125 μg l(-1) in those wearing air-purifying respirators, and 161 μg l(-1) in other welders. Compared to welders with low iron stores (SF < 25 μg l(-1)), those with excess body iron (SF ≥ 400 μg l(-1)) worked under a higher median concentration of airborne iron (60 μg m(-3) versus 148 μg m(-3)). Even though air concentrations of respirable iron and manganese were highly correlated, and low iron stores have been reported to increase manganese uptake in the gastrointestinal tract, no correlation was seen between SF and manganese in blood. In conclusion, monitoring SF may be a reasonable method for health surveillance of welders. Respiratory protection with air-purifying respirators can decrease iron exposure and avoid chronically higher SF in welders working with high-emission technologies.

Concerning possible harmful components of welding fumes, besides gases and quantitative aspects of the respirable welding fumes, particle-inherent metal toxicity has to be considered.The objective of this study was to investigate the effect markers leukotriene B4 (LTB4),prostaglandin E2 (PGE2) and 8-isoprostane (8-Iso PGF2α) as well as the acid–base balance(pH) in exhaled breath condensate (EBC) of 43 full-time gas metal arc welders (20 smokers) in relation to welding fume exposure. We observed different patterns of iron, chromium and nickel in respirable welding fumes and EBC. Welders with undetectable chromium in EBC(group A, n = 24) presented high iron and nickel concentrations. In this group, higher 8-isoPGF2α and LTB4 concentrations could be revealed compared to welders with detectable chromium and low levels of both iron and nickel in EBC (group B): 8-iso PGF2α443.3 pg mL−1 versus 247.2 pg mL−1; p = 0.001 and LTB4 30.5 pg mL−1 versus 17.3 pgmL−1; p = 0.016. EBC-pH was more acid in samples of group B (6.52 versus 6.82; p = 0.011).Overall, effect markers in welders were associated with iron concentrations in EBC according to smoking habits--non-smokers/smokers: LTB4 (rs = 0.48; p = 0.02/rs = 0.21; p = 0.37),PGE2 (rs = 0.15; p = 0.59/rs = 0.47; p = 0.07), 8-iso PGF2α (rs = 0.18; p = 0.54/rs = 0.59;p = 0.06). Sampling of EBC in occupational research provides a matrix for the simultaneous monitoring of metal exposure and effects on target level. Our results suggest irritative effects in the airways of healthy welders. Further studies are necessary to assess whether these individual results might be used to identify welders at elevated risk for developing a respiratory disease.