Musculoskeletal disorders, research quality, and pelvic floor health in sports: exploring current evidence and new perspectives

Background. Pelvic floor dysfunction (PFD) is an umbrella term that includes a myriad of conditions such as urinary (UI) and anal incontinence, pelvic organ prolapse, pelvic pain, and sexual dysfunction. Literature showed high prevalence rates of PFD among athletes, especially UI, with high-impact sports have been linked with an increased risk of developing symptoms. However, comprehensive research summarising PFD prevalence across sexes, exploring treatment options, and the absence of a standardised referral screening tool are notable gaps. Misinformation is also prevalent in the sports medicine field. Methods. This doctoral project comprises four studies addressing different aspects of pelvic health in athletes. The first two studies were scoping reviews of epidemiological PFD data in male and female athletes, as well as available interventions. Study 3 concerned the development of a new screening tool for PFD in female athletes, aiming to guide sports medicine clinicians in referring patients to PFD specialists through a worldwide Delphi consensus. Study 4 summarised all previous findings, integrating data into an infographic. Results and conclusions. In Study 1, the findings of 100 articles on PFD in both sexes have been collected, highlighting a higher prevalence of studies on female athletes evaluating UI across multiple sports. Other conditions remain rarely investigated. Study 2 found a diverse range of interventions for female PFD, with a notable emphasis on conservative approaches. Recommendations for clinical practice often relied on the transferability of results from the nonathlete population or expert opinions. In Study 3, 41 international experts took part in the consensus development of the Pelvic Floor Dysfunction-ScrEeNing Tool IN fEmale athLetes (PFD-SENTINEL). It incorporates a cluster of PFD symptoms, items (risk factors, clinical, and sports-related characteristics), and a clinical algorithm. Lastly, Study 4 included ten evidence-based information with a relative description concerning pelvic floor health in athletes.

Development of Mass Spectrometry-based analytical tools for characterization of bioconjugate vaccines in E. coli

Antigen design is generally driven by the need to obtain enhanced stability,efficiency and safety in vaccines.Unfortunately,the antigen modification is rarely proceeded in parallel with analytical tools development characterization.The analytical tools set up is required during steps of vaccine manufacturing pipeline,for vaccine production modifications,improvements or regulatory requirements.Despite the relevance of bioconjugate vaccines,robust and consistent analytical tools to evaluate the extent of carrier glycosylation are missing.Bioconjugation is a glycoengineering technology aimed to produce N-glycoprotein in vivo in E.coli cells,based on the PglB-dependent system by C. jejuni,applied for production of several glycoconjugate vaccines.This applicability is due to glycocompetent E. coli ability to produce site-selective glycosylated protein used,after few purification steps, as vaccines able to elicit both humoral and cell-mediate immune-response.Here, S.aureus Hla bioconjugated with CP5 was used to perform rational analytical-driven design of the glycosylation sites for the glycosylation extent quantification by Mass Spectrometry.The aim of the study was to develop a MS-based approach to quantify the glycosylation extent for in-process monitoring of bioconjugate production and for final product characterization.The three designed consensus sequences differ for a single amino-acid residue and fulfill the prerequisites for engineered bioconjugate more appropriate from an analytical perspective.We aimed to achieve an optimal MS detectability of the peptide carrying the consensus sequences,complying with the well-characterized requirements for N-glycosylation by PglB.Hla carrier isoforms,bearing these consensus sequences allowed a recovery of about 20 ng/μg of periplasmic protein glycosylated at 40%.The SRM-MS here developed was successfully applied to evaluate the differential site occupancy when carrier protein present two glycosites.The glycosylation extent in each glycosite was determined and the difference in the isoforms were influenced either by the overall source of protein produced and by the position of glycosite insertion.The analytical driven design of the bioconjugated antigen and the development of accurate,precise and robust analytical method allowed to finely characterize the vaccine.