Bladder and urothelial carcinoma are marked by profound genomic diversity. Using a large, multi-institutional dataset, we performed comprehensive genomic profiling of 4631 tumor samples from 4050 individuals. A retrospective analysis of bladder and urothelial cancer was performed using the AACR Project GENIE database. Demographic associations, mutation frequencies, copy number changes, and survival correlations were analyzed with a p-value < 0.05. Frequent mutations were identified in TP53, TERT, KDM6A, KMT2D, ARID1A, and FGFR3. Mutation frequencies varied by sex and race, with specific alterations enriched in female and Asian patients. Distinct patterns of co-occurrence, including TP53 with RB1, and mutual exclusivity, including TP53 with FGFR3 or KDM6A, revealed distinct molecular subtypes. This study highlights the extensive heterogeneity of bladder cancer, and our findings emphasize the clinical importance of molecular stratification and support the need for further mechanistic and prospective studies to inform the development of targeted therapies.

This article is a narrative following a patient's experience through the American Healthcare system. This article is written by a second-year medical student. During this time the individual repeatedly engaged in different specialties of medicine such as neurology, neurosurgery, oncology, emergency medicine, gynecology, and primary care. This narrative demonstrates how certain issues such as healthcare access, patient demographics, defective communication, and general mistrust of the healthcare system negatively impact patient outcomes. As an uninsured immigrant, the patient was in a disadvantaged position when her health problems first began. Due to her lack of insurance, she did not have an established primary care physician. She struggled to find compassionate care that focused on her symptoms and prioritized outcomes. She often felt ignored and overlooked by her physicians. Through this article, we explore a patient's perspective on how American physicians operate, and why they make certain decisions. This article provides the perspective of individuals whose voices are rarely heard in medicine. Lastly, we provide possible solutions and how they would have impacted the patient in this narrative.

Introduction: Osteomyelitis, an infection of the bone and bone marrow, causes substantial morbidity and mortality, particularly in older adults and those with comorbidities such as diabetes and peripheral vascular disease. This study examines national trends in mortality among patients with osteomyelitis from 1999 to 2023 using CDC WONDER. Despite therapeutic advances, U.S. mortality is rising, with significant demographic and geographic disparities. Methods: Using CDC WONDER Multiple Cause-of-Death data, we identified U.S. adults ≥ 35 years with osteomyelitis (ICD-10 M86) as a contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population, and trends analyzed with Joinpoint regression to estimate annual and average annual percent change (APC, AAPC) with 95% CIs. Results: From 1999 to 2023, 111,115 deaths among patients with osteomyelitis occurred. AAMR rose from 1.7 to 4.1 (AAPC: 3.6%), peaking in 2018–2021 (APC: 13.2%). Males had higher rates than females (2023 AAMR: 5.7 vs. 2.9), but both increased proportionally. American Indian/Alaska Native individuals had the highest 2023 rate (8.0) and largest post‑2010 rise, followed by Black individuals (7.1). Mortality increased with age, reaching 33.6 in those ≥ 85 years. Rural areas saw faster increases than urban areas, surpassing them by 2020. Conclusions: Mortality among patients with osteomyelitis in U.S. adults more than doubled since 1999, accelerating sharply in the last decade and during the COVID‑19 pandemic. Disproportionate burdens among males, AI/AN and Black populations, the oldest adults, and rural residents highlight the need for targeted, equity‑focused interventions and improved access to preventive and specialty care.