Federazione Medico Sportiva Italiana

Patient and public involvement and engagement (PPIE) in research is crucial for producing knowledge that is meaningful to the participating community. Sharing PPIE principles into practical tools and strategies enriches the development of participatory research methodologies. This article describes the co-creation process of ProSafe, a Community-Based Participatory Research (CBPR) project conducted in Italy, which explores community perspectives on the reorganization of territorial healthcare toward proximity care. The aims are: (1) to describe the co-creation process, (2) to examine its successes and challenges, and (3) to propose strategies and practical recommendations for fostering partnerships and engagement throughout all research stages. The project is based on an explanatory sequential mixed-method design. A Patient Safety Council (PSC) acted as a co-researcher. The five-level spectrum of public engagement developed by the International Association for Public Participation (IAP2) guided the analysis of the decision-making power balance between academics and the PSC at each phase. Emphasis was given to the process of survey co-creation. A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis was performed to identify strategies and practical recommendations to strengthen engagement. The SWOT analysis results informed the development of OPERA-PACT (Opening a Participatory and Equitable Research Agreement based on Partnership, Awareness, Collaboration, and Trust), a framework co-created with the PSC to formalize shared principles, values, and attitudes that sustain collaborative partnerships. The framework also includes a commitment to continuous monitoring, verification, and feedback to reinforce partnership over time. All instruments, strategies, and methodological insights proposed in the article may serve as practical support tools to strengthen the voice of communities in research and to contribute to the production of valid and translational results. Implementing the OPERA-PACT framework may further help align team members with PPIE principles and lay the foundation for effective and sustainable collaboration.

This work introduces an alternative experimental approach by integrating high-resolution mass spectrometry (HRMS) with multivariate statistical analysis for metabolite detection and identification. The integration of these tools maximizes information extraction from data, improving accuracy and reducing the risk of false identifications. Seven volunteers' urine samples were collected before and after oral administration of 10 mg of methylclostebol (4-chloro-17β-hydroxy-17α-methylandrost-4-en-3-one, ClMT) and assigned to three excretion time intervals. Analyses were carried out on a GC-HRMS system (Agilent 8890 GC coupled with 7250 GC/QTOF), utilizing low-energy electron ionization (< 18 eV) to preserve the native molecular skeleton, thereby simplifying mass spectrum interpretation, with acquisition in full scan mode. Raw data were then processed and subjected to multivariate analysis. The orthogonal partial least squares-discriminant analysis (OPLS-DA) was employed to emphasize differences among specific sample conditions, and features that significantly contribute to classification in the OPLS-DA can be identified as important biomarkers. Samples from the three excretion intervals demonstrated clear separations, occupying distinct areas within the model's defined space. From this approach, the S-plot displayed seven features identified as biomarkers related to methylclostebol ingestion, comparing their mass spectra with an in-house library of LE-EI mass spectra. The application of this approach is demonstrated to enhance the identification of new markers related to the intake of prohibited substances in the anti-doping field, such as methylclostebol. Its application proved to be an alternative strategy that allows for gathering a more comprehensive range of information in the antidoping field.

The negative impact of preanalytical errors on the quality of laboratory testing is now universally recognized. Nonetheless, recent technological advancements and organizational transformations in healthcare-catalyzed by the still ongoing coronavirus disease 2019 (COVID-19 pandemic)-have introduced new challenges and promising opportunities for improvement. The integration of value-based scoring systems for clinical laboratories and growing evidence linking preanalytical errors to patient outcomes and healthcare costs underscore the critical importance of this phase. Emerging topics in the preanalytical phase include the pursuit of a "greener" and more sustainable environment, innovations in self-sampling and automated blood collection, and strategies to minimize patient blood loss. Additionally, efforts to reduce costs and enhance sustainability through patient blood management have gained momentum. Digitalization and artificial intelligence (AI) offer transformative potential, with applications in sample labeling, recording collection events, and monitoring sample conditions during transportation. AI-driven tools can also streamline the preanalytical workflow and mitigate errors. Specific challenges include managing hemolysis and developing strategies to minimize its impact, addressing issues related to urine collection, and designing robust protocols for sample stability studies. The rise of decentralized laboratory testing presents unique preanalytical hurdles, while emerging areas such as liquid biopsy and anti-doping testing introduce novel complexities. Altogether, these advancements and challenges highlight the dynamic evolution of the preanalytical phase and the critical need for continuous innovation and standardization. This collective opinion paper, which summarizes the abstracts of lectures delivered at the two-day European Federation of Laboratory Medicine (EFLM) Preanalytical Conference entitled "New Insight in Preanalytical Quality" (Padova, Italy; December 12-13, 2025), provides a comprehensive overview of preanalytical errors, offers some important insights into less obvious sources of preanalytical vulnerability and proposes efficient opportunities of improvement.

Sudden cardiac death is the leading medical cause of death among football players. Determining the optimal cardiac screening, the use of carefully selected medical assessments to detect underlying cardiovascular conditions associated with sudden cardiac arrest/death, is a desired objective of the Fédération Internationale de Football Association (FIFA) for football players of all ages. To date, cardiac screening recommendations in football have primarily focused on adult competitive players. Acknowledging its responsibility for player health worldwide, FIFA convened an international working group of cardiology and sports medicine experts to develop cardiac screening recommendations for youth football players. This group performed structured literature reviews and ultimately congregated in January of 2024, when recommendations were presented, scrutinised and judged using a systematic process. The final FIFA recommendations for youth cardiac screening include personal medical history, family medical history, focused physical examination and resting 12-lead electrocardiography. This document provides detailed rationale and clinical recommendations for youth cardiac screening and emphasises the importance of emergency action planning.

PurposeThe metabolic pathways of APP-CHMINACA were characterized to select the markers of intake for implementation into analytical assays used by the clinical and forensic communities. We have combined the evidences obtained by both in vitro experiments and administration studies on mice.MethodsAPP-CHMINACA was incubated with either human or mouse liver microsomes. Urine and blood samples were collected at different time points from mice after injection of a 3 mg/kg dose of the test compound. Samples were analyzed using liquid chromatography-tandem mass spectrometry.ResultsThe in vitro studies allowed to isolate eight different metabolic reactions, formed by two metabolic routes, with no differences between human and mouse liver microsomes. The main biotransformation route involved the hydrolysis of the distal amide group and the subsequent hydroxylation on the cyclohexyl-methyl ring. The second route involved multiple hydroxylation of the parent compound, followed by reduction to generate minor metabolites. In blood samples, the most abundant substances identified were APP-CHMINACA unchanged and the metabolites formed by the hydrolysis of the distal amide together with its hydroxylated products. In urine samples, four metabolites formed following the hydroxylation of the distal amide hydrolysis metabolite were detected as the most abundant and long-term metabolites.ConclusionsThe outcomes of our study showed that the most suitable markers to detect the intake of APP-CHMINACA in blood and urine samples in the framework of toxicological, clinical and forensic investigations were the metabolite formed by the hydrolysis of the distal amide and its hydroxylated products.

Methyltestosterone (MT) is one of the most frequently misused anabolic androgenic steroids detected in doping control analysis. The metabolism of MT in humans leads to several phase І metabolites and their corresponding phase Ⅱ conjugates. Previous studies have postulated the 3α-sulfoconjugate of 17α-methyl-5β-androstane-3α,17β-diol (S2) as principal sulfate metabolite of MT, with a detection window exceeding 10 days. However, a final direct and unambiguous confirmation of the structure of this metabolite is missing until now. In this study, we established an approach to detect and identify S2, using intact analysis by liquid chromatography hyphenated with tandem mass spectrometry (LC-MS/MS) without complex sample pretreatment. An in vitro study yielded the LC-MS/MS reference retention times of all 3-sulfated 17-methylandrostane-3,17-diol diastereomers, allowing for accurate structure assignment of potentially detected metabolites. In an in vivo excretion study with a single healthy male volunteer, the presence of the metabolite S2 was confirmed after a single oral dose of 10 mg MT. The reference standard was chemically synthesized, characterized by accurate mass mass spectrometry (MS) and nuclear magnetic resonance (NMR), and quantified by quantitative NMR (qNMR). Thus, this study finally provides accurate structure information on the S2 metabolite and a direct analytical method for detection of MT misuse. The availability of the reference material is expected to facilitate further evaluation and subsequent analytical method validation in anti-doping research.

Injury of the deltoid ligament is an infrequent injury, when it occurs isolate, without ankle fracture. This disorder is therefore difficult to diagnose especially when it is the result of multiple, repetitive mild energy trauma. The treatment has traditionally been surgical, with a direct repair through an open approach, followed by a 4 to 6-week non-weight bearing period. Arthroscopic repair allows for less invasive surgery and consequently less restrictive postoperative management. We present the case of a 33-year-old professional soccer player who underwent an arthroscopic repair of an isolated deltoid rupture and a successful comprehensive rehabilitation program that allowed him to return to play in fourteen weeks from surgery without any complication or reinjury.

The aim of the study was a comprehensive and quantitative determination of salbutamol and its sulfoconjugated major metabolite in urine samples using achiral ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Therefore, salbutamol-4′-O-sulfate was biosynthesized as a reference using genetically modified fission yeast cells, and the product was subsequently characterized by NMR and HRMS. In competitive sports, salbutamol is classified as a prohibited drug; however, inhalation at therapeutic doses is permitted with a maximum allowance of 600 µg/8 h. In contrast, the enantiopure levosalbutamol is prohibited under any condition. For analytical discrimination, the amount of salbutamol and its main metabolite excreted in the urine was studied. As proof of concept, a longitudinal study in one healthy volunteer was performed in order to investigate excreted amounts and to study potential discrimination using achiral chromatography. Discrimination of administration of racemic salbutamol or the enantiopure levosalbutamol was not achieved by solely analyzing salbutamol as the parent compound. However, a distinction was possible by evaluation of the proportion of salbutamol-4′-O-sulfate in relation to salbutamol. Therefore, reference material of metabolites is of great importance in doping control, especially for threshold substances.