The University of North Carolina School of Medicine is a professional school within the University of North Carolina at Chapel Hill. It offers a Doctor of Medicine degree along with combined Doctor of Medicine / Doctor of Philosophy or Doctor of Medicine / Master of Public Health degrees. It is one of the top ranked medical schools in the country: the 2013 U.S. News & World Report ranks the school 1st in primary care and 22nd in research. In 2016, the school received $449 million in research funding. With approximately two-thirds of that amount coming from the National Institutes of Health, the school received more federal research funding than any other public or private university in the South.
Prospective, multi-institutional surgical data collection in pediatric neuro-oncology remains limited despite substantial variation in operative and perioperative management across institutions. To address this, we are developing the NeuroPoint Alliance (NPA) Quality Outcomes Database (QOD) Pediatric Tumor Surgery Registry. Here, we used a modified Delphi process to define a core outcome set for the registry. A modified Delphi study was conducted among pediatric neurosurgeons serving as site principal investigators for the proposed registry. Candidate data elements were rated on a 9-point Likert scale. Consensus for inclusion was predefined as ≥70
This invited review discusses recent advancements and prospects in locoregional therapy (LRT) for hepatocellular carcinoma (HCC), a leading cause of cancer mortality globally. The epidemiology of HCC is shifting toward nonviral etiologies, prompting a focus on early surveillance and personalized treatment approaches. Updated international guidelines, such as the Barcelona Clinic Liver Cancer (BCLC) staging system, American Association for Study of Liver Disease (AASLD) guideline, and European Association for the Study of the Liver (EASL) now recognize LRT-including transarterial embolization, ablation, and radiotherapy-as cornerstone therapies in curative and downstaging strategies for HCC at multiple stages. The article reviews novel transarterial and ablative technologies, including advanced dosimetry for radioembolization, innovative embolic agents, and emerging nonthermal ablation modalities like irreversible electroporation and pulsed electric field ablation, all aimed at increasing precision, local delivery, minimizing systemic exposure. Additionally, combination approaches integrating LRT with immunotherapy are highlighted, reflecting the evolving understanding of HCC's tumor-immune microenvironment. Progress in robotic guidance, fusion imaging, and imageable radioembolics is also explored. Ongoing and future clinical trials will further define the optimal use of these evolving modalities. Overall, LRT continues to expand as a minimally invasive, indispensable backbone in multidisciplinary HCC management.
Non-invasive laboratory-based models have been proposed to estimate portal hypertension severity in patients with compensated advanced chronic liver disease (cACLD), but external validation in diverse populations remains limited. We aimed to externally validate two such models, originally developed in European cohorts, for predicting clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mmHg) and severe portal hypertension (HVPG ≥ 16 mmHg) in a U.S.-based cACLD cohort. We conducted a retrospective single-center study of adults with cACLD who underwent HVPG measurement between 2014 and 2024. Patients with active hepatic decompensation, hepatocellular carcinoma, or prior transjugular intrahepatic portosystemic shunt were excluded. Model performance of the Vienna laboratory-based model and the FIB-4 plus albumin (FIB4 +) model was evaluated using discrimination (area under the receiver operating characteristic curve [AUROC]) and calibration metrics, including calibration intercepts, slopes, and Brier scores. The cohort included 143 patients (median age 56 years; 54
The concept of a therapeutic window of opportunity, defined as the period from symptom onset during which treatment initiation yields the most favorable patient outcomes, is applied in routine clinical practice across a range of inflammatory conditions. It has become an increasingly important area of interest in hidradenitis suppurativa (HS), a disease in which recurrent inflammation and accumulating damage can lead to irreversible destruction of skin architecture. Biologic therapies, aiming to suppress the inflammatory burden and prevent disease progression, are currently only permitted in moderate to severe HS. However, as there is no consensus definition of moderate disease, physicians may face uncertainty about when to consider or switch biologic therapy. To identify the boundaries of the window of opportunity within HS, global HS experts have developed frameworks for defining moderate HS and disease progression. It is proposed that prompt medical treatment should be administered to patients with moderate HS, defined as patients with inadequate control of HS symptoms on conventional therapies, or one inflamed skin tunnel (draining/non-draining), or four or more inflammatory lesions (including inflammatory nodules and abscesses) involving two or more anatomic areas. Furthermore, the proposed definition for disease progression is the development of one or more new tunnel(s) and/or the extension of existing tunnels, or development of one or more persistent HS lesions in an anatomical region not previously affected, or any increase in the number of persistent HS lesions in an affected anatomical region. The proposed frameworks aim to provide practical advice to physicians and support targeting the window of opportunity during routine clinical practice.
Hemodialysis, hemodiafiltration, and peritoneal dialysis are among the most resource-intensive medical therapies, owing to their high energy and water consumption, heavy reliance on disposable materials, and frequent, recurring delivery. Although "green dialysis" initiatives have been adopted in some regions, broader implementation is needed, together with the development of new technologies and care models to further mitigate the environmental impact of dialysis. In April 2025, Kidney Disease: Improving Global Outcomes (KDIGO) held the Controversies Conference on Green Dialysis: Environmentally Sustainable Care, Growth, and Innovation. Participants included physicians, nurses, patients, and engineers who examined how existing hemodialysis (in-center and home) and peritoneal dialysis practices might be optimized to promote environmental sustainability. Additionally, opportunities for green innovations in dialysis procedures and technologies were identified. Recognizing the need for urgent and coordinated action among patients, clinicians, and organizations, participants also discussed how industry, policy, and regulations could support embedding environmental sustainability within dialysis care.
