The number of referrals to the urgent suspected head and neck cancer pathway is increasing exponentially with the relatively slower increase in cancer incidence. Tertiary services may find it challenging to cope with this increasing demand. We have therefore analyzed data from a novel "straight-to-scan" pathway for patients referred under the Urgent Suspected Cancer (USC) pathway in our unit. This study aims to assess the impact on the referral pathway. Data pertaining to all USC referrals for patients with a neck lump to our regional tertiary head and neck cancer unit, between January and December 2021, were collected retrospectively. All patients referred with a neck lump had a neck ultrasound prior to review. Demographic data, referral metrics, and clinical information including final diagnosis were recorded and later used for analysis of the clinical course and patient outcomes. 1808 USC referrals were screened, of which a total of 563 referrals were for patients referred with a neck lump as the only presenting symptom. The cancer conversion rate was 10% (57 cancers). Two received a diagnosis following a subsequent referral after the initial ultrasound scan was graded as indeterminate. 56% of cancers were primary head and neck cancers, while 33% of cancers were hematological. Our data showcases the robustness of ultrasound in diagnosing neck lumps. This highlights the potential for the development of a straight-to-scan (STS) pathway which can further streamline the referral process and ensure effective resource allocation and workforce planning. N/A.
The ideal management of appendicular lump in children is still debated, with traditional interval appendectomy being challenged by early laparoscopic intervention. The purpose of this study was to evaluate the safety and efficacy of emergency laparoscopic appendectomy (LA) in children with an early appendicular lump. A retrospective chart review of 30 patients (≤15 years) presenting with an early appendicular lump who underwent emergency LA over a five-year period was performed. Outcomes measured included conversion rate, operative time, complications, and length of hospital stay. The mean age was 9.2 ± 2.8 years. The mean duration of symptoms was 3.1 ± 0.9 days. Laparoscopic approach was successful in 28 patients (93.3%). Two (6.7%) patients had to be converted to open surgery due to dense adhesions and inability to delineate anatomy clearly. The mean operative time was 68 ± 18 minutes. Operative findings included phlegmon in 18 patients (60%), contained perforation in 10 patients (33%), and abscess (≤5 cm) in two patients (6.6 %). Minor complications were seen three patients (10%). One port-site infection and two postoperative ileus occurred; all were managed conservatively. No major complications or re-operations were recorded. The mean postoperative hospital stay was 3.2 ± 1.1 days. We conclude that emergency LA for early appendicular lump in carefully selected, hemodynamically stable children is a safe and feasible procedure. It offers the benefits of minimally invasive surgery while avoiding the morbidity and psychological burden of a delayed operation.
In this study, we present the neural networks generalized Kudryashov (NNGK) method for the first time to explore exact solutions of the generalized doubly dispersive equation. This is a novel analytical technique that combines neural networks (NNs) models with the generalized Kudryashov approach. The NNs are multilayer computational models composed of activation functions and weights that connect neurons in the input, hidden, and output layers. The generalized Kudryashov solutions are assigned to each neuron in the first hidden layer of the NNGK method. This is how the new trial functions are produced. A key novelty of this study is the construction of the novel activation functions from the Kudryashov approach solutions, which creates a new mathematical connection between differential equations theory and deep learning, which is a major innovation of this approach. There are different types of soliton solutions constructed, such as lump interaction, lump-singular and lump-dark, lump-bright, breather solitons, breather-kink, breather-antikink, and other interaction solitons. Some of these solutions are drawn in the form of 3D, 2D, and planar waves and corresponding contours for the physical interpretations of these solutions. This study offers a new methodological approach for dealing with NLPDEs that is widely applicable in engineering and science domains.
To evaluate a precision-triage, direct-to-test (DTT) neck-lump referral pathway under the National Health Service (NHS) Faster-Diagnosis-Standard (FDS). A district-general hospital in England. Prospective review of FDS referrals for "neck lump" or "unexplained thyroid lump" from November 1, 2023 to December 31, 2024. After triage, patients proceeded directly to ultrasound (DTT-USS) with further tests as needed. Minimum follow-up: 6-months. 417/440 referrals were included; 55.6% lacked clinical details. USS was normal in 110 (26.4%). Suspicious lesions requiring biopsy were found in 130, with malignancy in 12.7%, consistent with national data. Following benign/normal USS, 348 (83.5%) were removed from the cancer pathway; 71 (20%) requested review and 21 (6%) chose routine surgery. Straight-to-biopsy reduced diagnostic intervals (15 vs. 24 days, p < 0.001). The DTT-USS pathway streamlines referrals, ensures diagnostic accuracy, and improves efficiency. Standardized referral data, radiologist-led biopsy, and structured benign follow-up could further enhance sustainability.
Timely referral from primary care is pivotal for early diagnosis. The National University Health System (NUHS) introduced referral guidelines for suspected cancer in January 2022 but the concordance with them is unknown. Using breast lumps as an exemplar, we assessed guideline concordance, defined operationally as adherence to NUHS guideline recommendations regarding: (1) whether a referral was made, and (2) whether it was timely (within four weeks). We further examined patient- and consultation-factors associated with non-referral and non-timely referral. Retrospective cohort study METHODS: We analysed female patients presenting with breast lumps to public polyclinics in Western Singapore between August 2022 and November 2024. Two primary outcomes were assessed for guideline concordance: (1) specialist referral occurrence, and (2) referral timeliness. Multivariable logistic regression analyses examined the associations between socio-demographic and consultation factors, and referral occurrence and timeliness. We included 2513 patients, with 2160 (86·0%) referred overall, and 1760 (70·0%) referred within 4 weeks. Predictors of non-referral when it would have been supported by the guidelines included patients of Indian ethnicity (OR 1·78; 95% CI:1·21-2·61, p = 0·013 versus Chinese ethnicity) and being seen during a chronic disease consultation (OR 1·52, 95%CI: 1·00-2·29 p = 0·048; versus acute consultation). Predictors of delays in referral included being seen in a chronic disease consultation (OR 1·65, 95% CI:1·05-2·59, p = 0·030), and younger age (OR 4·94, 95%CI: 2·86-8·52, p < 0·001; 20-29 years versus 60-69 years). We found variations in the likelihood and timeliness of guideline-concordant referrals for breast lumps in Singapore primary care. Our findings suggest a need for the development of targeted educational interventions to reduce inequalities in early cancer diagnosis between consultation types, ethnicities, and age groups.
The Breast Imaging-Reporting and Data System (BI-RADS) serves as a standardized classification system for breast imaging interpretation and management recommendations. This study evaluates the correlation between BI-RADS categories and histopathological findings in patients presenting with breast lumps at a tertiary care center in India.  Methods: A retrospective observational study was conducted at R.L. Jalappa Hospital and Research Centre, Kolar, from 1st November 2024 to 30th November 2025. Female patients aged 22-78 years who underwent breast imaging with BI-RADS categorization (categories 3-5) followed by histopathological examination were included. Statistical analysis was performed using chi-square tests with calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.  Results: A total of 215 patients were analyzed with a mean age of 48.7 ± 13.2 years. BI-RADS category distribution was: BI-RADS 3 (45 cases, 20.9%), 4A (52 cases, 24.2%), 4B (41 cases, 19.1%), 4C (28 cases, 13.0%), and 5 (49 cases, 22.8%). Malignancy rates showed progressive increase: BI-RADS 3 (8.9%), 4A (32.7%), 4B (46.3%), 4C (82.1%), and 5 (91.8%). Overall diagnostic performance showed sensitivity 96.3%, specificity 38.3%, PPV 61.2%, NPV 91.1%, and accuracy 67.4%. Strong positive correlation was found between BI-RADS categories and malignancy rates (p < 0.001, X² = 36.849).  Conclusion: BI-RADS classification demonstrates strong correlation with histopathological malignancy rates in breast lump evaluation. Higher BI-RADS categories are reliably associated with increased malignancy probability, supporting the clinical utility of BI-RADS in breast lesion management and biopsy decision-making in the Indian healthcare context.
In this work, we present a complete dynamical analysis of lump, breather, M-shaped, and other waveforms propagating in a nonlinear PDE governing nonlinear low-pass electrical transmission lines. We utilize the Hirota bilinear transformation approach with the help of Mathematica to report a number of wave solutions, including bright and dark lumps, solitons, breathers, and kink waves, along with their periodic and aperiodic forms. Energy distribution, wave interactions, and changes are presented in the form of 3D, contour, and 2D plots, which demonstrate the nonlinear characteristics that govern the dynamics. These results provide a better understanding of the propagation, stability, and interaction of waveforms which are useful in signal and energy transport and also in the construction of complex nonlinear electric circuits.
The Jimbo-Miwa (3 + 1)-dimensional nonlinear equation is a well-known high-dimensional extension of integrable models and is widely used to describe nonlinear wave behavior in plasma physics, fluid dynamics, nonlinear optics, and quantum field theory. In this paper, we present a structured symbolic approach based on the Bilinear Neural Network Method (BNNM) to address the complexities associated with solving this equation. The proposed framework combines two complementary approaches: deriving exact soliton solutions through the Hirota bilinear method and developing a neural network-based scheme to obtain analytical approximations of the Jimbo-Miwa dynamics. Within this framework, we introduce several neural network ansatz structures, including 4-2-1, 4-3-1, and deep 4-2-2-1 architectures, which allow for the systematic construction of broad families of exact analytical solutions. Our results include explicit rational lump solutions, periodic breather solutions, and rich hybrid interactions between lumps and solitons. This combined approach not only recovers known solution forms but also provides greater flexibility for exploring solution spaces that are difficult to handle with conventional methods. Furthermore, the neural network framework offers an effective route to approximate analytical solutions of the Jimbo–Miwa model, improving computational efficiency and enhancing predictive capability in application-oriented settings.
The purpose of this study is to present a pediatric case report involving the incidental finding of a torcular pseudomass. A retrospective chart review was conducted at the Cleft and Craniofacial SA, Women's and Children's Hospital in Adelaide, South Australia. Clinical data were collected and analyzed, including medical history, examination, and imaging results. A 17-month-old female infant born by normal vaginal delivery at 41 weeks' gestation was found to have occipital region bony lump at birth with otherwise normal neonatal examination findings. Torcular pseudomass is considered as redundant physiological tissue in the torcular region. Because of its benign nature and likelihood of spontaneous resolution, follow-up imaging is not usually indicated.
Dermoid cysts require meticulous differential diagnosis, prompt surgical intervention, proactive management of infection and other complications, precise delineation of the lesion prior to operation, and efforts to achieve complete excision. We report a case initially diagnosed as an epidermoid cyst but finally confirmed as a dermoid cyst.
Breast cancer is a leading cause of morbidity and mortality among women worldwide, with early detection playing a critical role in improving survival and quality of life. Mammography remains the cornerstone of breast cancer screening; however, its limited accessibility in many regions necessitates supportive diagnostic approaches. Self-breast examination (SBE) offers a simple, cost-effective, and empowering means for women to recognize early breast changes. When used as an adjunct to mammography, SBE can facilitate earlier presentation, particularly in younger women and resource-limited settings. Promoting awareness and proper education in SBE has the potential to strengthen breast cancer detection strategies and reduce diagnostic delays.
Breast-related symptoms are common in primary care and frequently prompt imaging or referral. While a palpable breast lump is strongly associated with breast cancer, isolated mastalgia is generally considered low risk. Most evidence comes from secondary care, limiting applicability to general practice. To estimate the likelihood of breast cancer associated with breast-related symptoms in primary care and to evaluate current GP management of women with isolated mastalgia. Retrospective cohort study using electronic health records from a Dutch primary care research network. We included women aged ≥ 30 years presenting with breast-related symptoms or diagnosed with breast cancer between 2014 and 2021. Multivariable logistic regression assessed associations between symptoms and breast cancer. Mastalgia was classified as either isolated (without any other breast-related symptoms) or in combination with other symptoms. In women with isolated mastalgia, GP-initiated imaging and referrals were recorded and evaluated. We included 2073 episodes from 1752 women (median age: 45.0 years, range 30-100 years); 189 episodes (9.1%) resulted in breast cancer. Presentation with a breast lump (OR 10.57, 95%-CI 4.89-22.84), skin or nipple retraction (OR 5.54, 95%-CI 2.28-13.48), and increasing age (OR 1.07 per year, 95%-CI 1.05-1.08) were independently associated with breast cancer. Mastalgia was associated with lower odds (OR 0.56, 95%-CI 0.34-0.92). Mastalgia was reported in 26 episodes that ultimately resulted in a breast cancer episode, but no cases occurred among women with isolated mastalgia (0 of 588 episodes). Despite this, 39.6% of women with isolated mastalgia underwent breast imaging, nearly half within three months. In primary care, breast cancer is strongly associated with a palpable lump, skin or nipple retraction, and increasing age. Isolated mastalgia was not associated with breast cancer. However, mastalgia occurring in combination with other breast-related symptoms may indicate a higher risk. Imaging and referral may often be safely deferred in women presenting with short-duration isolated mastalgia.
Female paediatric patients with breast symptoms may see a range of specialists with varying expertise and experience in managing their condition. There is a paucity of evidence to guide diagnosis and treatment. We report our joint paediatric breast clinic experience to describe the spectrum of symptoms and outcomes, with follow-up, in female paediatric patients presenting with breast-related symptoms. A retrospective review of clinical records of all females (<18 years) seen between December 2017 and December 2023 in a joint paediatric/surgical breast clinic was conducted. Symptoms, investigations, interventions, outcomes and histological diagnoses were reviewed. 152 patients were included: 116 (76.3%) with breast lump-related symptoms (group A) and 36 (23.7%) with other non-lump breast-related symptoms (group B).In group A, 112/116 (97%) patients underwent ultrasound evaluation. The most common diagnoses were normal breast tissue (52; 45%) and fibroadenoma (FA) (40; 35%). 13 (11%) patients underwent excision for presumed FA, all confirmed benign FA with no complications. Another eight (7%) patients re-presented after discharge; four had excision, all benign FAs.In group B, the most common clinical diagnosis was breast asymmetry 17/36 (47%). Two patients re-presented, with one having a diagnosis of FA supported by fine needle aspiration.Overall, 22 (15%) patients required onward referral/investigations for symptoms unrelated to their breast symptoms. No malignant lesion was diagnosed in this cohort of patients, and surgery was performed in 15% of those presenting with a breast lump. Paediatrician and breast surgeon collaboration facilitated the identification and referral of non-breast symptoms, supporting adoption of this model.
The perinatal period is a pivotal life stage that profoundly influences lifelong health and well-being. In 2021, the U.S. temporarily expanded the Child Tax Credit (CTC), providing monthly payments during July-December 2021 and the remaining lump-sum payment during the 2022 tax season. This study examines the impact of the 2021 expansion on perinatal health among low-income families. Data were drawn from national birth certificate data (January 2021-December 2022) and were restricted to women covered by Medicaid, who are likely to be low-income. A quasi-experimental event-study design was used to compare perinatal outcomes over time between women with and without previous live births, who had different exposure patterns to the 2021 expansion. (N=2,485,813). Analyses were conducted January-May 2025. The CTC expansion was associated with increased appropriate-for-gestational-age births and decreased small-for-gestational-age and large-for-gestational-age births. Effects were most pronounced immediately after expiration of monthly payments (1.17 percentage points; 95%CI: 0.45, 1.88)-potentially reflecting the cumulative impact of six months of income support-and several months after the lump-sum distributions, waning by the end of 2022. For maternal outcomes, an increased likelihood of hypertensive disorders of pregnancy and a decreased likelihood of no/late prenatal care were observed during the monthly payments period and persisting through the end of 2022. Sensitivity analyses supported the robustness of findings. These results suggest that the expanded CTC had positive effects on certain perinatal outcomes among low-income families, highlighting the potential of income support policies to reduce health inequities during a critical life stage and informing policymaking.
Female participation in long-distance running has been increasing, raising concern about pelvic floor-related symptoms in this population. However, data on pelvic organ prolapse (POP) symptoms, particularly during running, remain limited. We hypothesized that higher training volume would be associated with greater prevalence of POP symptoms. This study aimed to determine the prevalence of POP symptoms and associated factors among Brazilian female runners. In this cross-sectional study, participants were recruited at road-running events and completed a questionnaire on demographics, health history, training characteristics, and other physical activities. POP symptoms were assessed by two questions: (1) "Do you notice a bulge or lump in your vagina in daily life situations, outside of physical exercise?" and (2) "Do you feel a sensation of pressure, bulge, or lump descending in your vagina while running?" Three hundred and one women met inclusion criteria (mean age 37.2 years). Twenty-three percent reported POP symptoms during running; 58% had a history of pregnancy, with mean values of 0.77 cesarean and 0.36 vaginal deliveries. Average weekly running distance was 28.6 km, and 76% performed additional physical activity (mean 1.98 sessions/week). POP symptoms were significantly associated with weekly running distance (OR 1.03; 95% CI 1.01-1.05) and additional activities (OR 1.53; 95% CI 1.22-1.91), while cesarean delivery was inversely associated (OR 0.42; 95% CI 0.28-0.62). POP symptoms were more frequent during running than in daily life. Weekly running distance and engagement in additional physical activity were significant predictors, whereas cesarean delivery appeared protective.
A bruise or haematoma in a non-mobile infant is a red flag prompting concern for non-accidental injury. Bruising does not always signify trauma however and may occur spontaneously due to an underlying medical cause. This case report describes a 3-month-old infant presenting with unexplained faint bruising to the axilla and an associated lump. Point of care ultrasound revealed a chest wall haematoma without any other evidence of trauma prompting blood tests, which demonstrated severely deranged coagulation and conjugated hyperbilirubinaemia. The child was subsequently diagnosed with Alagille Syndrome. Point of care ultrasound is a useful clinical adjunct for providing greater detail to the examination of unusual lumps or swellings which in this case prompted further investigations leading to a rare diagnosis.
Background Breast cancer, which is a multi-factorial disease is one of the primary causes of cancer-related mortality in women. The association of serum lipids with breast cancer is being debated. Objective To examine any possible association between fasting lipid profile and breast cancer in Nepali women. Method A case-control study was conducted among 36 breast cancer patients, 40 patients with benign breast lump and 38 apparently healthy control women from February 2022 to December 2024. Ethical clearance was obtained from institutional review committee (MEMG/IRC/500/GA) prior to study. A convenient sampling technique was used. Data entry and analysis were done using SPSS version 20. Chi-square tests and analysis of variance (ANOVA) were used for statistical comparisons of categorical and continuous data respectively. P-value of <0.05 was considered statistically significant. Result Of the 114 participants included in this study, 36 were malignant breast cancer patients, 40 were benign breast lump patients and 38 controls with the mean ages of 52.75 ± 10.39, 48.45 ± 12.78 and 45.80 ± 10.14 years respectively. The prevalence of dyslipidemia was 75%, 25% and 26.31%, among malignant breast cancer patients, benign breast lump patients and control group respectively with the mean value of triglyceride (160.01 ± 78.34, 111.75 ± 60.40 and 97.99 ± 31.34) respectively and the difference was statistically significantly (p < 0.001). In addition, the mean serum concentrations of total cholesterol were significantly different between the three groups (1588.36 ± 39.95, 132.09 ± 39.95 and 138.31 ± 45.34, p=0.020). Conclusion The overall prevalence of dyslipidemia was high in breast cancer patients in comparison to patients with benign breast lump or normal controls.
Breast discharge represents the third most common reason women seek medical attention for breast-related concerns. A triple assessment is recommended for additional screening in cases of suspected ductal illness if there is nipple discharge. This study aimed to evaluate the different clinical characteristics of ductal breast disease in relation to Triple Assessment (Clinical examination, Imaging, Histopathology). This cross-sectional study was conducted among 100 purposively included female patients presented with nipple discharge (ND) selected from both Outdoor and Indoor Department of Surgery, Rajshahi Medical College Hospital (RMCH), Rajshahi, Bangladesh. Data regarding clinical, biochemical and surgical profiles were recorded. Informed written consent was taken from all the patients before data collection. Data was collected from May 2019 to October 2019. In descriptive statistics, the frequency distribution was done using STATA-18. The findings of the Triple assessment were categorized as malignant and non-malignant using the chi-squared test. All statistical tests were two-tailed. A p-value of 0.05 or less than 0.05 was considered statistically significant. Age 40 years or above (p<0.001), presence of a breast lump (p<0.001), micro-calcification found in mammography (p<0.001) and suspected malignancy in ultrasonography (p<0.001), bloody nipple discharge (p<0.001) were found statistically significant in association with malignancy compared to benign lesions. Triple assessment can help to assess high-risk patients, requiring careful treatment to rule out malignancy. Patients aged 40 years or more with the presence of breast lump and bloody discharge are at high risk of cancer. The risk of underlying cancer can be precisely established by applying the methodical, gold standard approach of Triple Assessment.
Charcoal grilling is a widespread cooking method that contributes significantly to pollutant emissions. This study investigated the release of total volatile organic compounds (TVOCs) and total suspended particulates (TSP) during the grilling of beef steak, chicken breast, and pork belly using lump charcoal and briquettes. Emission factors (EFs) were determined, and the influence of fuel and meat type, meat composition, and operational parameters was assessed through linear mixed-effects models (LMMs). Briquettes produced higher emissions than lump charcoal, with TVOC and TSP about one-third higher. LMMs confirmed that fuel type significantly affects TVOC emissions (p = 0.010), while cooking duration (p = 0.001), total grilling time (p = 0.001), and weight loss (p < 0.001) were the main predictors of TSP. Meat type also influenced emissions. Beef steak and chicken breast, despite having a lower fat content, generated significantly more TVOC than pork belly (p < 0.05) due to longer cooking times. In contrast, pork belly produced higher TSP through fat dripping. Across both pollutants, weight loss (p < 0.001) and the weight loss rate (p < 0.001) were robust indicators of pollutant emission. Meat moisture, protein, and ash content were associated with both TVOC and TSP (p < 0.001), underscoring the multifactorial origin of grilling emissions. Overall, the results demonstrate that pollutant formation cannot be explained solely by categorical distinctions between fuels or meats. Instead, proximate composition and operational parameters provide the most informative predictors, offering a mechanistic framework for evaluating grilling emissions and supporting strategies to mitigate human exposure.