Hospital Quirónsalud Barcelona

To provide an ESSKA-ESA formal Consensus to help general practitioners in their daily clinical decisions regarding the diagnosis and treatment of traumatic anterior shoulder instability (TASI) according to age and timing after injury. Part 1 is dedicated to the history-taking, physical examination and imaging studies. Patients were categorised into three age groups: adolescents (<20 years), young adults (20-40 years) and older adults (>40 years). Two clinical scenarios were addressed: first-time and recurrent dislocations. A formal consensus process was followed, including a steering group (15 experts from 9 countries), a rating group (18 experts from 18 countries) and a reader group (28 experts from 13 countries). The steering group formulated 35 clinical questions, 12 of which related to Part 1. Each question was answered with a statement and grade of recommendation (A-D), based on literature and expert opinion. The rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Consensus was reached with high agreement: median (range) 9 (8-9). One question received a grade A recommendation, nine were B, and two were C. Most debated topics included imaging to guide treatment decisions in first-time dislocations, assessment of glenoid bone loss, and soft tissue quality. Each age group presents unique diagnostic considerations: younger patients have higher recurrence risk and activity levels; older patients more often present with associated soft-tissue injuries. While physical exam findings were consistent across ages, associated injuries gain importance with age. The distinction between first-time and recurrent dislocations significantly impacts imaging needs. The ESSKA-ESA Consensus highlights that age and timing (first-time versus recurrent) influence the decision-making when managing TASI. All parameters related to history taking, physical exam and imaging studies should be considered according to the patient's age and the number of dislocation episodes. Level II.

Inflammation and oxidative stress are key mechanisms in aging, contributing to neurodegenerative diseases, cardiovascular diseases, type 2 diabetes, obesity, and other conditions. In the aging process, the increase in reactive oxygen species and the decrease in antioxidant pathways damage cellular components, accelerating deterioration. Persistent inflammation and oxidative stress also favor the progression of diseases such as atherosclerosis, where LDL oxidation and infiltration in the arteries generate plaques that can lead to myocardial infarction or stroke. In addition, inflammation and oxidative stress can affect the immune system, as well as the development of chronic inflammatory diseases and nonalcoholic fatty liver disease, and may affect mental health, healthy menopause and muscle recovery. Research from both human studies and laboratory tests indicates that taking 80-320 mg per day of anthocyanin-rich extracts from bilberries and blackcurrants (Anthocyanin-EBB) can moderately enhance cholesterol levels, lower markers of inflammation, boost blood vessel health, increase insulin responsiveness, and reduce indicators linked to cardiovascular and metabolic risks. They also have antioxidant, anti-inflammatory and neuroprotective effects, helping in the prevention and management of chronic diseases. As a result, supplementation with anthocyanin-rich extracts may be a promising strategy to promote healthy aging and reduce the risk of development and progression of conditions related to oxidative stress and chronic inflammation. Nevertheless, due to the limited patient populations and short follow-up periods in most existing studies, long-term clinical trials are necessary to determine the definitive advantages of Anthocyanin-EBB in clinical practice.

Abstract Brain tumours invade neural tissue, disrupting the functional organisation of neural networks. This disruption can trigger compensatory neuroplastic mechanisms that help preserve cognitive function despite pathological burden. Resting-state functional connectivity (rs-FC) provides a valuable approach for examining these alterations, yet the scope and trajectory of network-level changes remain unclear. In this study, we used rs-FC to characterise compensatory responses induced by left-hemisphere brain tumours affecting the integrity of the language network. The comparison of connectivity patterns at diagnosis and after surgery allowed us to track the temporal progression of these patterns. Relative to healthy participants, patients showed significant deviations in pre-surgical rs-FC, with widespread changes involving the dorsal attention, sensorimotor, frontoparietal, default mode, and cerebellar networks. These differences persisted post-surgically, with no significant longitudinal modifications. Network-level alterations also influenced topological properties: patients showed increased segregation while preserving global integration relative to controls. These properties changed significantly from pre- to postoperative period, with a postoperative increase in segregation and integration towards a pattern more closely resembling that of healthy controls. Furthermore, preoperative network segregation was identified as a predictor of postoperative cognitive recovery. These findings suggest that brain tumours induce network remapping, affecting functional connectivity far beyond the regions strictly related to the affected region. The observed changes in network topological organisation likely reflect the adaptive role of domain-general networks in facilitating homeostatic processes. Surgical strategies aimed at preserving these changes seem to promote sustained cognitive function, regardless of malignancy grade or lesion extent. Key points Presurgical patients show widespread inter- and intrahemispheric rs-FC alterations, reflecting tumour-driven network remapping. Network integration and segregation show longitudinal recovery, approaching neurotypical topology four months post-surgery. Preoperative network segregation predicts postoperative cognitive recovery. Importance of the Study Brain tumours disrupt large-scale brain networks, yet the extent, temporal dynamics, and cognitive relevance of these alterations remain poorly understood. Using resting-state functional connectivity, this study provides a longitudinal, network-level characterisation of tumour-induced neuroplasticity in patients with left-hemisphere lesions affecting language-related regions. Compared with prior work focused on local effects or single networks, our results demonstrate widespread inter- and intrahemispheric connectivity changes involving multiple domain-general resting-state networks, highlighting extensive network remapping beyond lesion boundaries. Importantly, we show that postoperative recovery is accompanied by a rebalancing of network integration and segregation toward a neurotypical configuration. Critically, preoperative network segregation emerges as a predictor of postoperative cognitive recovery, identifying a potential biomarker of resilience. These findings have direct translational relevance, suggesting that preserving and supporting large-scale network organisation during surgical planning may promote cognitive outcomes independently of tumour grade or lesion extent.

Abstract HER2DX is a genomic test developed to guide treatment decisions in newly diagnosed HER2-positive (HER2+) breast cancer. It analyzes the expression of 27 genes grouped into 4 biological signatures: immune/immunoglobulin (IGG), luminal differentiation, proliferation, and HER2 amplicon expression. The test provides three distinct outputs: a prognostic relapse risk score, a pathologic complete response (pCR) likelihood score, and a quantitative ERBB2 mRNA score. This study investigates the relationship between HER2DX-derived outputs and standard histopathologic features in early-stage HER2+ breast cancer. The standardized HER2DX genomic test provided by Reveal Genomics was performed on paraffin tumor samples from newly diagnosed patients with early-stage HER2+ breast cancer, treated across 24 hospitals from January 2022 to June 2025. Histopathologic evaluation of hematoxylin-eosin-stained slides included tumor grade, stromal tumor-infiltrating lymphocytes (TILs) percentage, spatial TIL distribution, and presence of tertiary lymphoid structures (TLS). Hormone receptor (HR) status and Ki67 proliferative index were assessed locally by immunohistochemistry (IHC), while HER2 status was determined using IHC and in situ hybridization. Associations between HER2DX scores and pathologic features were assessed using appropriate statistical tests for continuous variables and categorical comparisons. HER2DX scores and their underlying biological signatures were analyzed in 410 HER2+ tumors. HR+ disease represented 75.7% of cases. The distribution of tumor grade, HER2 IHC status, HR status, Ki67 index, stromal TILs, TLS, and TIL spatial patterns is summarized in the Table. The HER2DX pCR score was significantly associated with all histopathologic features evaluated, the relapse-risk score five of these features (including Ki67 and TILs), and the HER2DX ERBB2 score with HER2 and HR status. Higher stromal TIL levels were moderately correlated with the IGG signature (r=0.59, p&amp;lt;0.001), and the inflamed TIL distribution was associated with increased IGG signature expression and higher HER2DX pCR scores (p&amp;lt;0.001). TLS presence also correlated with elevated IGG signature expression (p&amp;lt;0.001). HR+ tumors exhibited higher luminal signature expression (p&amp;lt;0.001), while HER2 IHC 3+ tumors had increased HER2 amplicon signature and HER2DX ERBB2 scores (p&amp;lt;0.001). Finally, higher Ki67 levels were moderately correlated with the proliferation signature (r=0.50, p&amp;lt;0.001). The HER2DX genomic test shows significant associations with multiple histopathologic features in early-stage HER2+ breast cancer, although no single feature can fully explain the outputs of the test. These findings support the notion that HER2DX integrates complex biological and histological dimensions, offering complementary information that may enhance personalized treatment decision-making. Citation Format: E. Sanfeliu, A. Martinez-Romero, M. Marín-Aguilera, S. Cobo, B. González-Farré, E. Hernandez, P. Jares, J. Puig-Butillé, M. Muñoz, R. Gómez-Bravo, M. Tapia, C. Tebar, C. Saura, S. Escrivà-de-Romaní, J. Soberino, J. Cortés, S. Morales, K. Amillano, L. Paré, P. Villagrasa, W. Buckingham, F. Pardo, J. Parker, F. Brasó-Maristany, E. Ciruelos, R. Sánchez-Bayona, O. Martinez-Sáez, J. Cejalvo, A. Prat. Biologic and Pathologic Correlations of the HER2DX Genomic Test in HER2+ Disease [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-10-24.

Radiotherapy (RT) is essential in pediatric cancer treatment and often requires complete immobility. In younger or noncompliant children, this is typically achieved through sedation or general anesthesia (GA), which raises concerns about acute complications and potential long-term neurodevelopmental effects. Despite widespread use, standardized anesthesia protocols for pediatric RT are lacking. To support the development of practice recommendations, the SIOPE Working Group on Pediatric Anesthesia in Radiation Therapy conducted a systematic literature review. Studies from Medline and Embase were reviewed (March-September 2024) according to PRISMA guidelines, focusing on sedation and GA in pediatric RT. Thirty-nine studies were included, mostly retrospective and of low to moderate quality. Considerable heterogeneity was observed in anesthetic techniques, staffing, and monitoring. Propofol-based sedation was most frequently reported, with favorable safety when delivered by experienced pediatric anesthetists. Complication rates varied widely and were often poorly defined. Additional concerns included long-term neurocognitive impact, vascular access, and procedural burden, especially in resource-limited settings. Evidence supports the safe use of sedation/GA in pediatric RT, but current literature is limited and inconsistent. Standardized protocols and prospective studies are urgently needed to better define safety, long-term outcomes, and staffing requirements.