Beaumont Hospital

Abstract Aims This study aims to summarize the available data on the efficacy of minimally invasive ablative (MIA) therapies as the definitive treatment for primary localized breast cancer. Methods This systematic review and meta-anlysis was performed in accordance with PRISMA guidelines. Studies that applied MIA modalities such as radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and stereotactic body radiotherapy (SBRT) were included. Random effects meta-analyses were conducted to produce pooled local control (LC), recurrence-free survival (RFS), overall survival (OS), and breast-cancer-specific survival (BCSS). Results Our study summarized the results of 24 studies and 1112 patients. LCs at 1 year and 5 years were 94 and 96% for CA, 95 and 97% for RFA, 87 and 88% for SBRT. LCs for MWA were 94% at 1 year and 95% at 4 years. RFS at 1 year and 5 years was 93 and 97% for CA, 94 and 88% for RFA, 87 and 88% for SBRT, and lasty 95 and 90% for MWA at 1 year and 4 years. OS at 3 years was 91% for RFA, 94% for MWA, 97% for CA, and 91% for SBRT. BCSS at 3 years was 97% for CA, 89% for RFA, 91% for SBRT, and 94% for MWA. Conclusions The current evidence suggests MIA modalities are effective in producing sustained LC and strong survival outcomes in select patients with localized breast cancer. Future studies may elucidate the extent of their utility, particularly in those with small tumours and contraindications to surgery.

Abstract Introduction Robotic mastectomy (RM) is a novel technique that may improve preservation of skin and nipple–areolar complex sensation compared with conventional open surgery. We hypothesise that this is due to the small lateral incision performed in RM that differs from traditional methods. Methods We prospectively evaluated nine patients undergoing robotic mastectomy with immediate reconstruction. Objective sensory testing was performed using graded stimuli across four thresholds (300, 4, 0.4, 0.07 Hz) at three and six months postoperatively. To correlate clinical findings with anatomical pathways, cadaveric dissections of four breasts were performed. Results Cadaveric analysis demonstrated that the lateral intercostal nerves traversed the parenchyma of the breast and were necessarily divided during mastectomy. In contrast, medial intercostal nerves were found to course superficially, immediately deep to the dermis, allowing potential preservation during robotic surgery. Clinically, preservation of medial breast skin sensation at three months was observed in 7 of 9 patients, whereas all patients demonstrated complete loss of sensation in the lateral breast. Conclusions In contrast to traditional open mastectomy, RM permits preservation of medial breast skin sensation due to the superficial course of medial intercostal nerves. Preservation of lateral breast sensation is not possible for anatomical reasons as the lateral intercostal nerves are unavoidable during mastectomy.

Dual-specificity phosphatase 1 (DUSP1) is a negative regulator of mitogen-activated protein kinase (MAPK) activity, and a player in the control of glial function. Several disease models have identified that the expression of DUSP1 is altered in tissue samples, which may contribute to disease pathogenesis. Using post-mortem brain tissue from a cohort of progressive multiple sclerosis (MS) cases, this study set out to determine if the expression of DUSP1 is altered in the brain in MS. We employed the use of a combination of PCR, western immunoblotting and immunohistochemical analysis to profile the expression of DUSP1. Data presented herein indicate that DUSP1 is significantly downregulated at gene and protein level in MS white matter tissue, when compared to samples from a non-MS control cohort. We also identify that DUSP1 is expressed on Iba1+ cells in the brain and that ITGAM (CD11b) expression is elevated in white matter in progressive MS. These findings provide evidence that DUSP1 is dysregulated centrally in CNS white matter in progressive MS.

<h2>ABSTRACT</h2> Not Published: The evolution of <i>Cronobacter sakazakii</i> reflects both scientific progress and enduring legacy. Its reclassification from <i>Enterobacter</i> marked the shift toward molecular precision in microbial taxonomy and reshaped our understanding of neonatal infection and powdered formula safety. The genus name, drawn from <i>Cronos,</i> the Titan of Greek mythology who consumed his offspring to prevent their succession, evokes themes of loss and renewal, which mirror the organism's tragic association with infant disease and the scientific advances that followed. The nomenclature also preserves the legacy of Dr Riichi Sakazaki, whose pursuit of order, precision and international collaboration continues to influence modern microbial taxonomy.

A two parallel group exploratory single center feasibility randomised controlled trial. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapists experiences of the interventions. The aim of this trial is to test the feasibility of undertaking an RCT investigating the effectiveness of a mult- component structured physical rehabilitation intervention aimed at reducing physical disability in adults with mild stable DCM compared with clinical surveillance. The study will take place in the national neurosurgical centre in Dublin, Ireland. A two parallel group exploratory single center feasibility RCT with will recruit 24 people with mild stable DCM from the outpatient clinics of a tertiary neurosurgical referral service. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapist experiences of the interventions. The intervention will include education, a physical activity behavioural change intervention, cervical range of motion exercises, neck, upper limb and scapular strengthening exercises and task specific hand function training. The primary outcomes are the feasibility of recruitment, adherence, and retention. The secondary outcomes which will be completed at baseline and 12 weeks follow up are the DCM core outcome set and an NRS for neck and arm pain. Developing novel rehabilitation interventions for people with DCM is the sixth most important research priority in the field of DCM. The findings from this feasibility RCT will inform the feasibility and design of a future definitive RCT. Caroline Treanor is undertaking a professional doctorate for which she has received financial support from the Royal College of Surgeons in Ireland Strategic Academic Recruitment (StAR) programme.

IntroductionAcute calculous cholecystitis (ACC) is a common surgical emergency with varying severity. The Tokyo Guidelines stratified ACC into grades I-III based on severity. Patients with grade III ACC and high ASA scores can be managed with percutaneous cholecystostomy drain (PCD) insertion to control sepsis. There are currently no guidelines in the literature concerning PCD management. This questionnaire highlights the current real-life practices of PCD across Ireland and the UK.MethodsThe Irish Surgical Research Collaborative sought to explore PCD practices in Ireland and the UK. This study utilised a 23-item digital questionnaire, which included questions pertaining to indications, follow-up, and scheduling of post-PCD cholecystectomy. The questionnaire was disseminated between August and October 2024 to surgical trainees and consultant surgeons from Ireland and the UK.ResultsThere were 94 responses from various general surgical subspecialties. Of the respondents, 61% (n = 57) were consultant surgeons, 64% (n = 60) worked in a university hospital, and 66% (n = 61) worked in a hospital without a hepatobiliary department. Forty-three Participants (46%) agreed to perform a laparoscopic cholecystectomy for ACC. However, 40% (n = 38) would insert PCD for ACC with septic shock in surgically unfit patients. Forty-six respondents (49%) chose not to perform a post-PCD cholecystogram during the index admission, and 81% (n = 76) wouldn't remove the PCD during the index admission. Regarding follow-up, forty-six participants (49%) wouldn’t perform a clamping test before PCD removal, and fifty-four would schedule an outpatient cholecystogram (57%). The majority agreed that the optimal time for a cholecystectomy is 6–12 (66%) weeks, with the laparoscopic approach (81.3%) being the most commonly chosen.ConclusionWhile laparoscopic cholecystectomy remains the gold standard for managing ACC, PCDs are safe, effective, and a commonly used tool in the surgical arsenal for managing acutely unwell patients who are poor surgical candidates. Guidelines regarding management and follow-up are necessary to guide the treatment.