Unhealthy lifestyles are linked to a higher risk of mortality; however, this association may be more pronounced among individuals with lower education levels.

To analyze the association between unhealthy lifestyles and mortality in a Chilean cohort, considering education level as a potential moderating factor.

A prospective study was conducted with 2,671 participants from the 2009-2010 Chilean National Health Survey. The healthy lifestyle score was based on seven variables: alcohol consumption, urinary sodium, sedentary time, physical activity, smoking, sleep, and fruit and vegetable intake. Education level was categorized into three groups. The outcomes were all-cause, cardiovascular, and cancer mortality extracted from the Chilean death register. Cox regression models were used to estimate mortality risk, both in individual and combined analyses, adjusted through four progressive models, and expressed as hazard ratios (HRs) with 95% confidence intervals (95% CI).

Compared to individuals with a high education level and a healthy lifestyle, those with a low education level and an unhealthy lifestyle showed a 10.7-fold higher risk of all-cause mortality (95% CI: 6.62-17.5), a 10.1-fold higher risk of cardiovascular mortality (95% CI: 3.51-29.4), and a 5.4-fold higher risk of cancer mortality (95% CI: 2.02-14.2).

An unhealthy lifestyle combined with a low education level was associated with an increased risk of all-cause and cardiovascular mortality, but not with cancer mortality.

Timely and accurate diagnosis of dermatological diseases remains a global challenge, particularly in healthcare systems with limited access to dermatopathology services. Advanced optical microscopy techniques have emerged as powerful tools for non-invasive skin imaging, offering real-time visualization of microscopic structures with near-histological resolution. Reflectance confocal microscopy (RCM) and ex vivo confocal microscopy (EVCM) have achieved significant clinical traction, demonstrating high concordance with conventional histopathology and high diagnostic accuracy for melanocytic lesions and non-melanoma skin cancers. In parallel, developments in optical coherence tomography (OCT) and its variants-including dynamic OCT and line-field confocal OCT (LC-OCT)-provide complementary morphological and vascular information with greater penetration depth. LC-OCT further combines near-cellular resolution with simultaneous vertical and horizontal imaging, narrowing the gap between non-invasive imaging and histopathology. Emerging multimodal imaging platforms integrating OCT, Raman spectroscopy, photoacoustic tomography, and ultrasound, together with artificial intelligence-assisted image analysis, continue to expand the diagnostic capabilities of optical microscopy. Although RCM, EVCM, OCT, and LC-OCT are increasingly being incorporated into routine dermatological practice, several emerging technologies remain largely confined to specialized academic centers because of their cost, technical complexity, and limited clinical validation. This narrative review summarizes current evidence on confocal microscopy and related optical imaging technologies for skin diagnostics, emphasizing diagnostic performance, clinical utility, implementation challenges, and future directions.

Pigmented purpuric dermatosis-like mycosis fungoides (PPD-MF) is an uncommon clinical presentation of mycosis fungoides characterized by purpuric lesions that may closely mimic pigmented purpuric dermatosis (PPD). This study evaluates dermoscopic features that may help differentiate PPD-MF from PPD.

This retrospective study assesses the diagnostic utility of dermoscopy in distinguishing PPD from PPD-MF. It included 11 patients with histopathologically confirmed PPD-MF and 19 patients with PPD. Categorical variables were compared using Fisher's exact test.

Curved vessels, straight vessels, serpentine vessels, and curved linear vessels with a terminal dot were significantly more frequent in PPD-MF. In contrast, an orangish-brown background and white lines were significantly more common in PPD.

Dermoscopy may provide useful supportive clues for distinguishing PPD-MF from PPD, particularly through the assessment of vascular morphology and background color. However, because of overlapping clinical and dermoscopic features, dermoscopic findings should be interpreted together with clinicopathological and immunohistochemical evaluation. Further studies with larger sample sizes and follow-up data are warranted to validate these findings.

Racial and ethnic survival disparities exist in pediatric and young adult acute lymphoblastic leukemia (ALL), with differential treatment toxicity and setting of care as possible drivers. Whether treatment cost and utilization disparities exist, or how they may contribute to differences in ALL survival, is unknown. Patients with ALL diagnosed between 2000 and 2019 at ages 1 to 24 years were identified using ICD-9/10 codes in the administrative claims data from the OptumLabs Data Warehouse and the Surveillance, Epidemiology, and End Results program. Sex, race and ethnicity, age, year, and subtype of ALL diagnosis were collected. Reimbursed treatment cost and utilization (number of inpatient and outpatient days) were computed over the initial 8 months of treatment. Regression models assessed associations with demographic and clinical characteristics. Survival analyses assessed associations between race and ethnicity and overall survival. Among 374 individuals with ALL, treatment costs were 57% lower for Black patients than for White patients (estimate 0.43, 95% CI: 0.19-0.96; P=0.04). Utilization was similar across groups, though Black patients had 24% fewer outpatient visits (estimate 0.76, 95% CI: 0.58-0.99; P=0.04). No significant differences in survival were detected, but observations are consistent with previous reports. Despite a small sample size, the statistically significantly lower cost and utilization among Black relative to White ALL patients are concerning and warrant further research.

Multiple myeloma (MM) exhibits marked clinical heterogeneity, with outcomes ranging from long-term disease control to rapid progression. Accurate identification of high-risk patients is therefore essential. Over the past decades, cytogenetic abnormalities have emerged as key prognostic factors, leading to successive staging systems integrating genomic data. However, limitations in existing models and a lack of standardization have hindered optimal risk assessment. The recent Consensus Genomic Staging (CGS) provides a unified definition of high-risk disease, emphasizing TP53 alterations, biallelic 1p32 deletion, and combinations of intermediate-risk lesions. Validation studies confirm its prognostic value, while also highlighting residual heterogeneity and the concept of functional high-risk disease. Advances in next-generation sequencing, particularly whole-genome sequencing, offer deeper insight into genomic complexity and may further refine stratification. Integration of genomic profiling, gene expression, and minimal residual disease assessment is likely to enhance precision medicine. Ultimately, improved risk stratification is critical to guide risk-adapted therapeutic strategies and improve outcomes in multiple myeloma.

To assess health care resource utilization and costs among commercially insured patients with colorectal cancer (CRC) or ovarian cancer (OC) participating in clinical trials (PCTs).

A retrospective claims analysis from 2017 to 2022 was conducted using the Milliman Consolidated Health Cost Guidelines Sources Database, a proprietary database that aggregates deidentified claims data from multiple large commercial insurers representing more than 75 million covered lives.

Participants in CTs were identified with diagnosis, modifier, or procedure codes for a CT and a diagnosis code for either CRC or OC. The first observed CT claim was assigned as the index date (index). For patients with CRC or OC not participating in a CT, proxy episodes were created for each qualified 18-month period following the first observed cancer claim. We compared average allowed costs (per-patient-per-month) incurred in the 9 months following index after adjusting for confounding using inverse probability of treatment weighting.

We identified 69 CT participants with CRC, 40,716 nonparticipants with CRC, 49 CT participants with OC, and 17,041 nonparticipants with OC for the study. Adjusted mean costs for both medical and drugs, in the 9 months following index, were lower for CT participants than nonparticipants. Among CRC patients, mean medical costs were $2806 for the CT cohort vs $3996 for the non-CT cohort, a difference of $1190 ( P  = .015), and drug costs were $447 and $1635, respectively, a difference of $1189 ( P  = .0002). Among OC patients, mean medical costs were $2211 and $2508, respectively, a difference of $296 ( P  = .524), and mean drug costs were $371 and $2294, a difference of $1924 ( P  < .0001).

Commercially insured patients with OC and CRC enrolled in CTs incurred lower costs following CT initiation than those not enrolled, driven by payers not incurring costs for oncology therapies.

Unlike patient age, which has been a well-established and routinely used primary biological prognostic factor in the risk stratification of papillary thyroid cancer (PTC), the prognostic value of patient sex remains controversial in this common endocrine malignant neoplasm.

To examine PTC-specific mortality risk of sex with respect to patient age and tumor genetics-specifically the status of BRAF V600E and TERT promoter (TERTp) mutations.

This cohort study was conducted among patients with PTC with an overall median (IQR) follow-up time of 51.0 (26.4-109.1) months after initial treatment at 15 centers in 10 countries between 1979 and 2023. Data analysis was completed in December 2025 and examined aggregately for the association of PTC-specific mortality and patient sex with respect to patient age and BRAF V600E and TERTp mutation.

Patient deaths specifically caused by PTC.

The study included 4746 patients with PTC (median [IQR] age, 48 [37-59] years; 3612 women [76.1%]). Male patients, compared with female patients, demonstrated a higher overall PTC-specific mortality (3.7% [42 of 1134] vs 1.7% [60 of 3612]; P < .001). This male sex-associated risk was observed only in patients harboring BRAF V600E or TERTp mutations, not wild-type genes. PTC-specific mortality particularly paralleled the occurrence and accumulation of dual BRAF V600E and TERTp mutations, which all exhibited a patient age-dependent rise, beginning to be prominent around age 45 years and markedly amplified by male sex. A male sex-age synergy index of 1.81 (95% CI, 1.02-3.16) and a male-to-female hazard ratio of 3.07 (95% CI, 1.35-6.97; P = .007) after adjustment for clinicopathologic factors in mortality risk were observed in patients aged 45 years or older with dual mutations.

This cohort study reconciled previous controversies on the prognostic value of patient sex and establishes male sex as a cardinal mortality risk in PTC in a patient age- and tumor genetic-dependent manner, defining especially male patients aged 45 years and older with dual BRAF V600E and TERTp mutations as having the worst prognosis and supporting integration of patient sex into risk stratification of PTC.

South Korea's 2018 Life-Sustaining Treatment Decisions (LSTD) Act was enacted to promote patient autonomy, yet its impact on systemic antibiotic utilization near the end of life in patients with advanced cancer remains unexplored.

To evaluate shifts in systemic antibiotic use among end-of-life patients with advanced cancer following the LSTD Act.

This cohort study used the National Health Insurance Service database to evaluate decedents with 8 major advanced cancers (lung, liver, stomach, colorectal, pancreatic, prostate, gallbladder or biliary tract, and breast). Inverse probability of treatment weighting was performed to balance cancer types, comorbidities, and demographic characteristics. Data were collected and analyzed between October 2025 and February 2026.

Implementation of the LSTD Act, comparing the pre-LSTD Act (2012-2017) and post-LSTD Act (2018-2023) eras.

The primary outcomes were antibiotic prescription proportion and days of therapy (DOT) per 1000 patient-days during the final 6 months of life. Broad-spectrum antibiotics, defined as antipseudomonal β-lactams, carbapenems, or glycopeptides, were separately analyzed. The utilization patterns were evaluated across 5 predefined intervals using odds ratios and risk ratios. A seasonally adjusted monthly interrupted time-series analysis was performed to characterize the longitudinal shifts in DOT during the final months of life.

A total of 743 842 eligible decedents (mean [SD] age, 71.9 [12.2] years; 487 690 male [65.6%]) were evaluated, including 348 813 in the pre-LSTD Act era and 395 029 in the post-LSTD Act era. During the final 6 months of life, the overall prescription proportion increased from 88.3% to 90.8% (odds ratio, 1.34; 95% CI, 1.32-1.37), widening particularly in the final 3 months. Similarly, total antibiotic DOT showed a significant overall increase from 231.4 to 261.6 per 1000 patient-days (risk ratio, 1.14; 95% CI, 1.13-1.14) across all intervals. These 2 measures showed comparable trends across broad-spectrum antibiotics and other classes. Monthly interrupted time-series analysis revealed a significant postenactment slope increase in overall antibiotic DOTs (β = 0.94; 95% CI, 0.67-1.21; P < .001), driven largely by other antibiotics alongside the ongoing increase in broad-spectrum antibiotics.

In this retrospective cohort study of patients with advanced cancer, the LSTD Act was not associated with reduced end-of-life antibiotic use, suggesting the need to reshape perceptions of antibiotics as potential life-sustaining therapy.

Urothelial carcinoma (UC) is characterized by frequent recurrence, and accurate noninvasive tests remain needed for early detection and postoperative surveillance.

To develop and validate a urine-based assay targeting AL021918.2 and vimentin (VIM) methylation for UC detection and postoperative surveillance.

This prospective, blinded, multicenter diagnostic study was performed at 3 tertiary medical centers in China. Samples were collected between December 1, 2021, and June 25, 2025. Consecutively enrolled adults with UC, benign urinary diseases, or nonurothelial malignant disease were included in a single-center training cohort, a 3-center validation cohort, and a prospective surveillance cohort. The surveillance cohort had a median follow-up of 6 months, completed December 13, 2023.

Urinary DNA methylation was assessed using quantitative methylation-specific polymerase chain reaction (PCR) analysis.

The primary outcomes were the sensitivity and specificity of the methylation assay for UC detection. Secondary outcomes included diagnostic performance according to tumor stage and grade and comparisons with urine cytology and fluorescence in situ hybridization (FISH).

This analysis included a total of 2307 participants, consisting of 643 in the training cohort (median age, 64 [IQR, 56-71] years; 494 men [76.8%]), 1620 in the validation cohort (median age, 67 [IQR, 61-73] years; 1129 men [69.7%]), and 44 with UC in the surveillance cohort (median age, 62 [IQR, 59-72] years; 32 men [72.7%]). The assay demonstrated sensitivities of 91.2% (95% CI, 87.6%-93.9%) in the training cohort and 90.8% (95% CI, 88.4%-92.8%) in the validation cohort and specificities of 90.0% (95% CI, 85.9%-93.2%) in the training cohort and 93.2% (95% CI, 91.3%-94.7%) in the validation cohort. In the training and validation cohorts, sensitivity remained high for Ta UC (79.6% [95% CI, 64.3%-89.7%] and 84.3% [95% CI, 77.8%-89.2%], respectively) and low-grade UC (86.4% [95% CI, 77.0%-92.5%] and 82.5% [95% CI, 75.7%-87.8%], respectively). Compared with urine cytology and FISH, the methylation assay demonstrated higher sensitivity while maintaining comparable specificity. After surgery, urinary methylation results were negative in 30 of 32 patients (93.8%) with positive preoperative results. During surveillance, the assay detected all 9 recurrences with a median lead time of 4.5 (IQR, 1.5-5.5) months before clinical confirmation and remained negative in 29 of 35 patients (82.9%) without recurrence.

In this diagnostic study, a noninvasive PCR-based assay showed high diagnostic accuracy for UC detection and identified all observed recurrences during surveillance. The assay may serve as an adjunct for UC diagnosis and postoperative surveillance.

Chinese Clinical Trial Registry Identifier: ChiCTR2300078302.

To evaluate the patterns of visual field (VF) defects in patients with Sturge-Weber syndrome (SWS) and phakomatosis pigmentovascularis (PPV) using standard automated perimetry.

This retrospective study analyzed the clinical and VF data of patients with SWS or PPV undergoing treatment for glaucoma and had VF test data over a 27-year period. VF defects were classified as glaucomatous, neurological, combined, or unclassifiable. Statistical analyses were performed to determine factors associated with type of field defects.

A total of 86 patients (172 eyes) were included, with 62 (72%) having SWS and 24 (28%) PPV. Glaucoma was present in 49.2% of SWS eyes and 91.6% of PPV eyes. Reliable VF tests were more common in SWS than in PPV ( P < 0.001). Glaucomatous defects were observed in 35.5% of eyes, 7.7% had neurological defects, and 4.1% had combined defects. Advanced field loss was the most common glaucomatous defect (54%). Eyes treated with external beam radiotherapy for diffuse choroidal hemangioma developed localized field defects mimicking glaucoma and homonymous hemianopia.

Glaucoma remains the primary cause of VF loss in SWS and PPV, with a significant proportion of patients demonstrating advanced glaucomatous damage. Accurate interpretation of VF results is crucial for differentiating glaucomatous progression from other ocular and neurological causes in these rare phakomatoses.