Determination of mineral oil hydrocarbon contamination in Citrus essential oils by using on-line liquid-gas chromatography: critical aspects.

The present manuscript reports and discusses critical issues related to the determination of mineral oil hydrocarbon contamination in Citrus essential oils (EOs); an on-line liquid-gas chromatography system equipped with a Y-interface was used (with no additional off-line step for pre-concentration). In total, eighteen samples were analyzed, specifically eleven cold-pressed (CP) and seven distilled EOs. With regard to the CP EOs, various degrees of mineral oil saturated hydrocarbon (MOSH) contamination were detected, ranging between 10.7 and 338.4 mg kg-1 (only one sample was MOSH-free); different MOSH sub-fractions were determined, with the > C25- ≤ C35 sub-fraction always present, with an average concentration of 74.5 mg kg-1. Based on the EO composition, different sample amounts were injected to avoid the overloading of the LC column and consequently the GC one, thus leading to different limits of quantification (LoQ), which were either 2 mg kg-1 (for bergamot EO) or 5 mg kg-1 (for all the other investigated samples). For all samples, the mineral oil aromatic hydrocarbon level was always lower than the LoQ.

A method for the determination of 70 pesticides in extra virgin olive oil based on a limited-volume solvent extraction step prior to comprehensive two-dimensional gas chromatography-tandem mass spectrometry.

The goal of the present research was to develop a method based on a miniaturized solvent extraction step (using only 500 µL of acetonitrile, with no further clean-up or concentration processes) prior to cryogenic-modulation comprehensive two-dimensional gas chromatography-tandem mass spectrometry for the determination of seventy pesticides in extra virgin olive oil, exploiting the enhanced specificity and sensitivity of this technique. Limits of quantification were always below European legislation residue limits, intra-day precision was between 0.3 and 4.9% (at the 50 and 100 µg kg-1 concentration levels), inter-day precision was between 1.6 and 6.1% (at the 100 µg kg-1 concentration level), recovery (at the 20, 50, and 100 µg kg-1 concentration levels) was in the 14-120% range, accuracy at the initial stage of the work (within repeatability conditions) was between 79 and 110%, while accuracy after 3 months (within intermediate precision conditions) was between 91 and 121% (at the 50 and 100 µg kg-1 concentration levels). Finally, the matrix effect was always positive, between 16 and 197%. The method was applied to the investigation of twenty samples, and eleven of these were found to be contaminated.

A miniaturized comprehensive approach for total lipidome analysis and vitamin D metabolite quantification in human serum.

The balance between the different lipid molecules present in biological fluids accurately reflects the health state of the organism and can be used by medical personnel to finely tune therapy to a single patient, a process known as precision medicine. In this work, we developed a miniaturized workflow for the analysis of different lipid classes at the intact level, as well as their fatty acid constituents, starting from human serum. Fatty acids were identified by using flow-modulated comprehensive gas chromatography coupled to mass spectrometry (FM-GC × GC-MS), and their relative amount as well as the ratio of specific FA classes was determined by using FM-GC × GC with a flame ionization detector. Ultra-high-performance liquid chromatography coupled to tandem mass spectrometry was used for the simultaneous quantification of vitamin D metabolites and assessment of different intact lipid classes. An MRM method was developed for the quantification of five vitamin D metabolites (vitamin D2, vitamin D3, 25-hydroxyvitamin D2, 25-hydroxyvitamin D3, 24R,25-dihydroxyvitamin D3), and validated in terms of LoD, LoQ, accuracy, and precision, also using a certified reference material. At the same time, a combination of SCAN, precursor ion scan, and neutral loss scan, in both positive and negative modes, was used for the identification of 81 intact lipid species, such as phospholipids, cholesteryl esters, and triacylglycerols, in less than 25 min. In order to easily monitor the lipid composition and speed up the identification process, a two-dimensional map of the lipidome was generated, by plotting the molecular weight of the identified molecules versus their retention time. Moreover, a relative quantification was performed within each lipid class identified. The combination of untargeted and targeted data could provide useful information about the pathophysiological condition of the organism and evaluate, in a tailored manner, an efficient action.

A dilute-and-inject low-pressure gas chromatography-tandem mass spectrometry method for phthalate determination in extra virgin olive oil.

The goal of this study was to develop a method for the determination of nine phthalic acid esters in extra virgin olive oils using low-pressure gas chromatography-triple-quadrupole mass spectrometry. Sample preparation was simple, environmental friendly, and rapid inasmuch that it involved only dilution (< 1 mL of hexane). The low-pressure gas chromatography analyses were performed by using a 5 m wide-bore column. The limit of quantification for the phthalates ranged from 0.06 to 1.14 mg kg-1 . Both intra- and interday precisions were measured, with coefficient of variation values ranging from 0.2% to 11.7%. The trueness of the method was measured by evaluating accuracy at the initial stage of the work and after 2 months, with values ranging between -8.7% and 12.1%. Moreover, blind accuracy was comprised between -11.6% and 14.2%. The method involves the use of simplified instrumentation and reduced analysis times (nearly two times faster) compared to a previously published comprehensive two-dimensional gas chromatography-triple-quadrupole mass spectrometry method, leading to a reduction of energy and helium consumption. The approaches were compared in analytical terms and for the environmental impact. In total, 23 olive oil samples were analyzed, with at least one phthalate detected in all but one sample.

Further delineation and long-term evolution of electroclinical phenotype in Mowat Wilson Syndrome. A longitudinal study in 40 individuals.

BACKGROUND: Epilepsy is a main feature of Mowat Wilson Syndrome (MWS), a congenital malformation syndrome caused by ZEB2 variants. The aim of this study was to investigate the long-term evolution of the electroclinical phenotype of MWS in a large population. METHODS: Forty-individuals with a genetically confirmed diagnosis were enrolled. Three age groups were identified (t1 = 0-4; t2 = 5-12; t3 = >13 years); clinical data and EEG records were collected, analyzed, and compared for age group. Video-EEG recorded seizures were reviewed. RESULTS: Thirty-six of 40 individuals had epilepsy, of whom 35/35 aged >5 years. Almost all (35/36) presented focal seizures at onset (mean age at onset 3.4 ±â€¯2.3 SD) that persisted, reduced in frequency, in 7/22 individuals after the age of 13. Absences occurred in 22/36 (mean age at onset 7.2 ±â€¯0.9 SD); no one had absences before 6 and over 16 years old. Paroxysmal interictal abnormalities in sleep also followed an age-dependent evolution with a significant increase in frequency at school age (p = 0.002) and a reduction during adolescence (p = 0.008). Electrical Status Epilepticus during Sleep occurred in 14/36 (13/14 aged 5-13 years old at onset). Seven focal seizure ictal video-EEGs were collected: all were long-lasting and more visible clinical signs were often preceded by prolonged electrical and/or subtle (erratic head and eye orientation) seizures. Valproic acid was confirmed as the most widely used and effective drug, followed by levetiracetam. CONCLUSIONS: Epilepsy is a major sign of MWS with a characteristic, age-dependent, electroclinical pattern. Improvement with adolescence/adulthood is usually observed. Our data strengthen the hypothesis of a GABAergic transmission imbalance underlying ZEB2-related epilepsy.

Cryogenic-zone-compression gas chromatography-mass spectrometry for the determination of 16 polycyclic aromatic hydrocarbons in extra virgin olive oil.

The present study is based on the development of a straightforward method for the determination (semi-quantification) of 16 polycyclic aromatic hydrocarbons (PAHs) in extra virgin olive oil (EVOO) using "cryogenic-zone-compression" (CZC) gas chromatography-single quadrupole mass spectrometry (GC-QMS). The use of CZC (through a loop-type cryogenic modulator) to achieve enhanced signal-to-noise ratios (s/n), enabled a simplification of the sample preparation step. In fact, a single extraction process (using only 500 µL of acetonitrile) was performed prior to injection. The CZC GC-QMS method aligns with the principles of green analytical chemistry, and enabled an average s/n increase of 14-fold compared to conventional GC-QMS. The method limits of quantification were in the 0.07-8.33 µg kg-1 range. Accuracy (at the 2 µg kg-1 and 10 µg kg-1 concentration levels) was in the 82-103 % range. Intra-day and inter-day precision (at 2 µg kg-1 and 10 µg kg-1 concentration levels) were in the 1.9-14.7 % and 5.9-9.1 % ranges, respectively, while the recovery values (at 10 µg kg-1) ranged from 24 % to 99 %. For all the PAHs investigated, a positive matrix effect was observed. Two PAHs were detected (in the selected-ion-monitoring mode) in six EVOOs among the ten samples (not more than one PAH per sample).

A dilute-and-inject liquid-gas chromatography-mass spectrometry method for the analysis of sixteen polycyclic aromatic hydrocarbons in extra-virgin olive oil.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) represent a diverse group of organic compounds characterized by the fusion of two or more benzene rings arranged in various structural forms. Due to their harmful effects on human health, it is essential to implement monitoring systems and preventive measures to regulate human exposure. Given the affinity of PAHs for lipids, extensive research has been focused on their presence in vegetable oils. This study aimed to develop an on-line liquid-gas chromatography (LC-GC) method (using tandem mass spectrometry) with minimized solvent consumption for the determination of 16 PAHs in extra-virgin olive oil (EVOO). RESULTS: A side-by-side comparison of the selected-ion-monitoring and the pseudo multiple-reaction-monitoring (p-MRM) acquisition modes was performed, in terms of specificity and detectability. The results obtained using the p-MRM mode were superior, and for this reason it was selected. The method was linear over the concentration range 1-200 µg kg-1 (except in five cases, over 2-200 and 5-200 µg kg-1 ranges). Accuracy (at the 2 µg kg-1 and 20 µg kg-1 concentration levels) was in the 86.9-109.3 % range, with an RSD <10 %. Intra-day and inter-day precision (at 2 µg kg-1 and 20 µg kg-1 concentration levels) were in the 1.2-9.7 % and 3.2-10.8 % ranges, respectively. For all the PAHs, a negative matrix effect was observed. Three out of sixteen PAHs were detected in three EVOOs (among ten samples), albeit at the low ppb level. Limits of quantification were satisfactory in relation to EU legislation on the presence of PAHs in vegetable oils. SIGNIFICANCE: A dilute-and-inject LC-GC-tandem mass spectrometry method is herein proposed fulfilling EU legislation requirements; sample preparation was very simple, inasmuch that it involved only a dilution step, thus avoiding extraction, clean-up, and thus a high consumption of organic solvents. In fact, considering both oil dilution and the LC mobile phase, less than 8 mL of solvents were used.

Monitoring of 260 pesticides in extra virgin olive oil and risk assessment for consumers within the framework of the European multiannual control program.

The aim of the present research was to develop and validate a robust analytical method for the monitoring of 260 pesticide residues in Extra Virgin Olive Oil (EVOO) expanding the 185 molecules requested by the multiannual control program. The analytical procedure included an ultrasound-assisted liquid-liquid microextraction followed by low-pressure gas chromatography (LP-GC) and ultra-high-performance liquid chromatography (UHPLC), both coupled to triple quadrupole mass spectrometry. Matrix-matched calibration curves showed good linearity with coefficients of determination greater than 0.999. Accuracy values ranged from 65.5 % to 122.3 % and from 61.1 % to 133.3 % for LP-GC and UHPLC, respectively. The recoveries ranged from 14.0 % to 131.3 %. Fifty commercial EVOO, from Italian and EU production, were analyzed to assess pesticide contamination during the 2021-2023 harvesting seasons. The research focused on evaluating consumer risk by assessing both chronic and acute dietary exposure, using the Pesticide Residue Intake Model developed by EFSA.

Positive Impact of Home ERT for Mucopolysaccharidoses and Pompe Disease: The Lesson Learnt from the COVID-19 Pandemic.

OBJECTIVE: Patients with Lysosomal disorders (LSDs) are treated with regular infusions of enzyme replacement therapy (ERT). During the COVID-19 pandemic, home treatment was permitted. This study aimed at monitoring the patients' compliance with home therapy and its effects on physical, psychological, and relational issues. Moreover, we also tested the possible impact of home therapy on familial relationships and contacts with the referral hospital. MATERIALS AND METHODS: Thirteen patients with Pompe disease (N = 8) and MPS (N = 5) were tested through an online questionnaire designed to assess their level of appreciation and satisfaction with home therapy and their feelings about the referral centre and psychological support provided. RESULTS: Most of the patients (84%) stressed the positive impact of home therapy. All patients described a significant reduction in stressful conditions associated with the need to attend the hospital every week or two. CONCLUSIONS: Home ERT leads to a clear improvement in "daily life skills", as represented in our by sample by positive feelings, better emotional self-control, and an increased ability to understand the feelings of relatives. Our data underline the paramount positive effect home ERT has on both patients and their families.

Direct extraction with acetonitrile of hemp seed oil for the analysis of pesticides by using comprehensive two-dimensional gas chromatography-triple quadrupole mass spectrometry.

The method herein described involves a rapid and limited-volume (0.5 mL of acetonitrile) solvent-extraction sample preparation process, for pesticide determination in hemp seed oil. The extraction method was characterized by the absence of both clean-up or pre-concentration steps. The extracts were directly analyzed through cryogenic-modulation comprehensive two-dimensional gas chromatography coupled to triple quadrupole mass spectrometry. The novelty characterizing the present research [compared to a previous one (Arena et al., 2023)] is related to the extension of the number of pesticides (97), and to the investigation of a more challenging matrix, contained in a vegetable oil of increasing interest among consumers. Linearity, limits of detection and quantification, accuracy, precision, recovery, and matrix effect were measured. Particular emphasis was devoted to the matrix effect, with the co-extracted matrix amount defined. Three international regulations (Canada, California, Europe) were considered, and the obtained limits of quantification were found to be too high in five (Canada) and twelve (Europe) cases, for a total number of 15 pesticides. The analysis of ten commercial samples showed the presence of seven pesticide residues in four of them, at concentration levels ranging from 0.02 to 0.98 mg kg-1, with most over the regulation residue limits.

Butyrylcarnitine Elevation in Newborn Screening: Reducing False Positives and Distinguishing between Two Rare Diseases through the Evaluation of New Ratios.

One of the main challenges of newborn screening programs, which screen for inherited metabolic disorders, is cutting down on false positives (FPs) in order to avoid family stresses, additional analyses, and unnecessary costs. False positives are partly caused by an insubstantial number of robust biomarkers in evaluations. Another challenge is how to distinguish between diseases which share the same primary marker and for which secondary biomarkers are just as highly desirable. Focusing on pathologies that involve butyrylcarnitine (C4) elevation, such as short-chain acylCoA dehydrogenase deficiency (SCADD) and isobutyrylCoA dehydrogenase deficiency (IBDD), we investigated the acylcarnitine profile of 121 newborns with a C4 increase to discover secondary markers to achieve two goals: reduce the FP rate and discriminate between the two rare diseases. Analyses were carried out using tandem mass spectrometry with whole blood samples spotted on filter paper. Seven new biomarkers (C4/C0, C4/C5, C4/C5DC\C6OH, C4/C6, C4/C8, C4/C14:1, C4/C16:1) were identified using a non-parametric ANOVA analysis. Then, the corresponding cut-off values were found and applied to the screening program. The seven new ratios were shown to be robust (p < 0.001 and p < 0.01, 0.0937 < ε2 < 0.231) in discriminating between FP and IBDD patients, FP and SCADD patients, or SCADD and IBDD patients. Our results suggest that the new ratios are optimal indicators for identifying true positives, distinguishing between two rare diseases that share the same primary biomarker, improving the predictive positive value (PPV) and reducing the false positive rate (FPR).

Higher frequency of TMEM199-CDG in the southern mediterranean area is associated with c.92G>C (p.Arg31Pro) mutation.

Congenital disorders of glycosylation (CDG) are genetic multisystem diseases, characterized by defective glycoconjugate synthesis. A small number of CDG with isolated liver damage have been described, such as TMEM199-CDG, a non-encephalopathic liver disorder with Wilson disease-like phenotype. Only eight patients with TMEM199-CDG have been described including seven Europeans (originating from Greece and Italy) and one Chinese. Three patients from southern Italy (Campania) shared the same known missense mutation pathogenetic variant NM_152464.3:c. 92G > C (p.Arg31Pro), also found in a Greek patient. Here we report a new patient from southern Italy (Sicily), with a homozygous c.92G > C p.(Arg31Pro) variant in TMEM199. The patient's phenotype is characterized by mild non-progressive hepatopathy with a normal hepatic echo structure. A persistent increase in serum transaminases, total and low-density lipoprotein cholesterol and low serum ceruloplasmin and copper levels and normal urinary copper excretion were observed. Matrix-assisted laser desorption/ionization mass spectrometry analyses showed abnormal N- and O- protein glycosylation, indicative of a Golgi processing defect and supporting the function of TMEM199 in maintaining Golgi homeostasis. TMEM199-CDG is an ultra-rare CDG relatively frequent in the southern Mediterranean area (7 in 9 patients, 77%). It is mainly associated with the c.92G > C (p.Arg31Pro) pathogenetic allele globally reported in 4 out of 7 families (57%), including one from Greece and three unrelated families from southern Italy. The almost uniform clinical phenotype described in patients with TMEM199-CDG appears to reflect a higher prevalence of the same variant in patients from the southern Mediterranean area.

Direct analysis of phthalate esters in vegetable oils by means of comprehensive two-dimensional gas chromatography combined with triple quadrupole mass spectrometry.

Phthalic acid esters (PAEs), known as phthalates, have a variety of industrial applications, mainly related to their ability to increase plastic softness,flexibility, and durability. With regard to toxicological aspects, several studies suggest that phthalates would act as endocrine-disrupting chemicals, and they have been correlated to several forms of cancer. Since the analysis of PAEs in food is challenging, the aim of this study was the development of a simple and direct method, with no sample preparation (only dilution withsolvent), for the analysis of targeted phthalates in vegetable oils, by using cryogenic-modulation comprehensive two-dimensional gas chromatography combined with triple quadrupole mass spectrometry. The method was characterized by good repeatability values, limit of quantification values ranging between 0.06 and 2.10 mg/kg, accuracy values ranging from -9.2 to 10.4%, and a matrix effectranging from -4 to 78%.The developed technique was used for the analysis of 27 vegetable oils.

Occurrence of Mineral Oil Hydrocarbons in Omega-3 Fatty Acid Dietary Supplements.

Omega-3 fatty acid dietary supplements have become increasingly popular with consumers due to their multiple health benefits. In this study, the presence of mineral oil hydrocarbons (MOH) was investigated in seventeen commercial samples of such supplements, characterized by different formulations. The analyses were performed using on-line liquid chromatography-gas chromatography (with flame ionization detection), which is considered the most efficient method for the determination of MOH in foodstuffs. Analyte transfer was performed by using the retention gap technique, with partially concurrent solvent evaporation. Various degrees of mineral oil saturated hydrocarbon contamination (from 2.4 ppm to 375.7 ppm) were found, with an average value of 49.9 ppm. Different C-number range contaminations were determined, with the >C25-≤C35 range always found with an average value of 26.9 ppm. All samples resulted free of mineral oil aromatic hydrocarbons, except for two samples in which a contamination was found at the 9.9 and 6.6 ppm levels, respectively.

Neonatal Screening on Tandem Mass Spectrometry as a Powerful Tool for the Reassessment of the Prevalence of Underestimated Diseases in Newborns and Their Family Members: A Focus on Short Chain Acyl-CoA Dehydrogenase Deficiency.

Early detection of disabling diseases, prior to clinical manifestations, is the primary goal of newborn screening (NS). Indeed, the required number of core and secondary conditions selected for screening panels is increasing in many countries. Furthermore, newborn screening can lead to diagnosis of maternal diseases such as vitamin B12 deficiency or 3-MethylcrotonylCoA-carboxylase deficiency (3MCC). NS became mandatory in Sicily in December 2017. Here we report NS data collected between December 2017 and April 2020. Our results show that tandem mass spectrometry is a powerful tool for discovery of underestimated disease in newborns and their family members. Our panel included short chain acyl-CoA dehydrogenase deficiency (SCADD). Here, we report that results of our investigation led to reassessment of SCADD prevalence in our population. The infant and adult patients diagnosed in our study had previously not shown overt symptoms.

COVID-19 Pandemic Outbreak and its Psychological Impact on Patients with Rare Lysosomal Diseases.

BACKGROUND: Lysosomal storage disorders (LSDs) are rare, chronic, progressive multisystem diseases implying severe medical issues and psychological burden. Some of these disorders are susceptible to a treatment, which is administered weekly or every other week, in a hospital. During the COVID-19 (Corona Virus Disease 2019) pandemic lockdown, patients with LSDs on enzyme replacement therapy (ERT) missed their scheduled access to the Day Hospital to get their treatment. METHODS: Based on the feeling that our patients were experiencing profound distress, we designed a structured telephone interview with the aim to evaluate how, and to which extent, the pandemic outbreak was changing their behavior and feelings about their chronic disease, the impact on therapies, and future expectations. The same interview was administered to an age-matched control group. RESULTS: All interviewed people experienced an increase of anxiety, worries, and uncertainty fostered by incessant media updates. Moreover, a striking similarity emerged between the groups regarding forced home reclusion and the profound feeling to be excluded by normal life, well-known to those affected by a chronic rare disease. CONCLUSIONS: Although no statistically significant difference was found compared to controls, we felt that the reactions were qualitatively different, underlining the fragility and isolation of such patients.

Deciphering the Invdupdel(8p) Genotype-Phenotype Correlation: Our Opinion.

The 8p inverted duplication/deletion is a rare chromosomal rearrangement clinically featuring neurodevelopmental delay, mild to severe cognitive impairment, heart congenital defects and brain abnormalities. Patients affected also present typical facial dysmorphisms and skeletal malformations, and it is thought that the composite clinical picture may fall into the chromosomal rearrangement architecture. With the major aim of better framing its related clinical and diagnostic paths, we describe a patient carrying a de novo invdupde[8p] whose clinical features have not been described so far. Hence, through an extensive genotype-phenotype correlation analysis and by reviewing the dedicated scientific literature, we compared our patient's features with those reported in other patients, which allows us to place our proband's expressiveness in an intermediate area, widening the scope of the already known invdupde[8p] genotype-phenotype relationship.

Expanded Newborn Screening Using Tandem Mass Spectrometry: Seven Years of Experience in Eastern Sicily.

The expanded newborn screening for selected inborn errors of metabolism (IEM) in Sicily was introduced in 2007 by a Regional project entitled "Early detection of congenital metabolic diseases: expanded neonatal screening". It established two newborn screening laboratories, for Western and Eastern Sicily, which started their activity in 2011. Here we present the results of expanded screening (excluding phenylketonuria (PKU)) of the Eastern laboratory from January 2011 to December 2017. Our data highlight the importance of the expanded newborn screening as a basic health program to avoid the underestimation of rare diseases and the need of further investigations even when there are no textbook alterations of the metabolic profiles. We performed our analysis on dried blood spot by tandem mass spectrometry, according to Italian guidelines. A total of 196 samples from 60,408 newborns gave positive screening results (recall rate 0.32%) while 12 babies were true positive, including 2 newborns whose mothers resulted in being affected by a metabolic disease. The overall frequency of IEM found in the screening panel was 1:6041 (mothers excluded) or 1:5034 (mothers included). The introduction of MS/MS technology in Sicily has significantly increased the detection of inherited metabolic disorders, including those not previously covered, with a predictable improved outcome for several disorders.

A single mutation in the GALC gene is responsible for the majority of late onset Krabbe disease patients in the Catania (Sicily, Italy) region.

A high proportion of patients with late onset forms of Krabbe disease is observed in a region north of Catania in Sicily. Molecular analysis in five families from this region shows that this condition is mainly due to a not previously described p.Gly41Ser substitution in the GALC gene that abolishes catalytic activity of the galactocerebrosidase enzyme, as shown by expression studies. Three patients were homozygous for this mutation, the other two were heterozygous, one with a frameshift mutation and one with a missense mutation on the second allele. Therefore, the mutation must be a mild one since it leads to late onset disease in all patients. In addition, it is on a unique haplotype indicating that it represents a founder mutation. This is also supported by the fact that the mutation was not found in three late onset patients from other regions in Sicily, in whom four novel mutations were identified.

Magnetic fields exposure from high-voltage power lines and risk of amyotrophic lateral sclerosis in two Italian populations.

The aetiology of amyotrophic lateral sclerosis (ALS), a rare and extremely severe neurodegenerative disease, has been associated with magnetic fields exposure. However, evidence for such a relation in the general population is weak, although the previous null results might also be due to exposure misclassification, or a relationship might exist only for selected subgroups. To test such a hypothesis we carried out a population-based case-control study in two Northern and Southern Italy regions, including 703 ALS cases newly diagnosed from 1998 to 2011 and 2737 controls randomly selected from the residents in the study provinces. Overall, we found that a residence near high-voltage power lines, within the corridors yielding a magnetic fields of ≥0.1 µT, was not associated with an excess disease risk, nor did we identify a dose-response relationship after splitting the exposed corridor according to the 0.1, 0.2 and 0.4 µT cut-points of exposure. These results were confirmed taking into account age at onset, period of diagnosis, sex, geographical area, and length of exposure. Overall, despite the residual possibility of unmeasured confounding or small susceptible subgroups not identified in our study, these results appear to confirm that the exposure to magnetic fields from power lines occurring in the general population is not associated with increased ALS risk.