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Exposure to neurotoxic chemicals such as pesticides, selenium, and heavy metals have been suggested to play a role in the etiology of amyotrophic lateral sclerosis (ALS). We assessed exposure to lead, cadmium, and mercury in 38 ALS patients (16 men and 22 females) and 38 hospital-admitted controls by using their cerebrospinal fluid (CSF) content as biomarker. We determined CSF heavy metal levels with inductively coupled plasma sector field mass spectrometry, according to a methodology specifically developed for this biological matrix. ALS patients had higher median values for Pb (155 vs. 132 ng/l) but lower levels for Cd (36 vs. 72 ng/l) and Hg (196 vs. 217 ng/l). In the highest tertile of exposure, ALS odds ratio was 1.39 (95% CI 0.48 to 4.25) for Pb, 0.29 (0.08 to 1.04) for Cd and 3.03 (0.52-17.55) for Hg; however, no dose-response relation emerged. Results were substantially confirmed after conducting various sensitivity analyses, and after stratification for age and sex. Though interpretation of these results is limited by the statistical imprecision of the estimates, and by the possibility that CSF heavy metal content may not reflect long-term antecedent exposure, they do not lend support to a role of the heavy metals cadmium, lead and mercury in ALS etiology.

Neurotoxic chemicals including several pesticides have been suggested to play a role in the etiology of amyotrophic lateral sclerosis (ALS). We investigated the relation between organochlorine pesticides and their metabolites (OCPs), polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) in the etiology of sporadic ALS, determining for the first time their levels in cerebrospinal fluid as indicator of antecedent exposure. We recruited 38 ALS patients and 38 controls referred to an Italian clinical center for ALS care, who underwent a lumbar puncture for diagnostic purposes between 1994-2013, and had 1mL of cerebrospinal fluid available for the determination of OCPs, PCBs and PAHs. Many chemicals were undetectable in both case and control CSF samples, and we found little evidence of any increased disease risk according to higher levels of exposure. Among males >60 years, we found a slight but statistically very unstable increased ALS risk with higher levels of the congener PCB 28 and the OCP metabolite p,p'-DDE. Overall, these results do not suggest an involvement of the neurotoxic chemicals investigated in this study in disease etiology, although small numbers limited the precision of our results.

Italian Abstract: La presente relazione verte sui profili di diritto internazionale sollevati dal caso Regeni, con particolare riguardo alle azioni che il Governo italiano potrebbe valutare di intraprendere sul piano internazionale. Il nostro contributo si articola in due parti. Nella prima parte viene tracciato il quadro normativo di riferimento, esaminando, in particolare, la compatibilita delle condotte tenute dallo Stato egiziano con gli obblighi internazionali in tema di diritti umani e di trattamento dello straniero. Nella seconda parte, vengono illustrate le azioni che il Governo italiano potrebbe in concreto promuovere nei confronti dell’Egitto, con particolare riferimento ai mezzi che il diritto internazionale offre per risolvere le controversie tra Stati. English Abstract: Giulio Regeni was an Italian PhD candidate at the University of Cambridge. He was kidnapped, tortured and killed in Egypt, allegedly by Egyptian authorities. Regeni was in Cairo to conduct field studies on the role of Egypt's independent labour unions in the Arab spring. A lot of questions have remained unanswered regarding his kidnapping, torture, and murder. In the parliamentary hearing (report), we discuss the relevant normative framework and the potential violations on the part of Egyptian authorities, and assess whether these violations implicate the international responsibility of Egypt. We also explain what actions Italy can take to seek remedy and what are the available legal routes to do so, both at a judicial and non-judicial level.

Aims In recent years, the prevalence of pregestational diabetes (PGDM) and the concern about the possibility of adverse pregnancy outcomes in affected women have been increasing. Routinely collected health data represent a timely and cost-efficient approach in PGDM epidemiological research. This study aims to evaluate the reliability of hospital discharge (HD) coding to identify a population-based cohort of pregnant women with PGDM and to assess trends in prevalence in two provinces of Northern Italy. Methods We selected all deliveries occurred in the period 1997–2010 with ICD-9-CM codes for PGDM in HD record and we matched up to 5 controls from mothers without diabetes. We used Diabetes Registers (DRs) as the gold standard for validation analysis. Results We selected 3800 women, 653 with diabetes and 3147 without diabetes. The agreement between HD records and DRs was 90.7%, with K = 0.58. We detected 350 false positives and only 1 false negative. Sensitivity was 99.3%, specificity 90.0%, positive predictive value 46.4% and negative predictive value 99.9%. Of the false positives, 48.6% had gestational diabetes and 2.3% impaired glucose tolerance. After the validation process, PGDM prevalence decreased from 4.4 to 2.0 per 1000 deliveries. Conclusions Our results show that HD facilitate detection of almost all PGDM cases, but they also include a large number of false positives, mainly due to gestational diabetes. This misclassification causes a large overestimation of PGMD prevalence. Our findings require accuracy evaluation of ICD-9-CM codes, before they can be widely applied to epidemiological research and public health surveillance related to PGDM.

This article critically reviews some of the most recent developments in relation to reforms of ISDS, focusing on both the European and the international reform efforts. As to the former, we discuss two major developments: the establishment of the Investment Court System (ICS) in the EU-Canada Comprehensive Economic and Trade Agreement (CETA) and the proposed mechanism of a Multilateral Investment Court (MIC), intended to replace ICS, once in force. At the international level, we offer an overview of the UN negotiations to reform ISDS conducted under the auspices of the United Nations Commission on International Trade Law (UNCITRAL) Working Group III. In reviewing these reform efforts we ask whether and how the (proposed) reforms address the major flaws of ISDS and, more particularly, the negative impact on the human rights of investment-affected communities and individuals. Regrettably, we find that the panoply of reform proposals discussed at the EU level and in the UN environment run the risk of reflecting the aspiration of the old adage: ‘for everything to stay the same, everything must change’. We then present two main paths more likely to achieve transformative change: the first is to maintain ISDS, but to reform it in new and radical ways; the second implies the definitive disposal of ISDS. As to the former, we discuss proposals for granting states, investment-affected communities and individuals a right to initiate a claim against investors. We conclude that a reformed international investment law, which incorporates human rights and endows investment-affected communities and individuals with enforceable rights, may be a better alternative than abandoning ISDS tout-court.