Eastern Virginia Medical School (EVMS) is a public medical school in Norfolk, Virginia.Founded by grassroots efforts in the Southeastern part of Virginia known as Hampton Roads, EVMS is not affiliated with an undergraduate institution and coordinates training through multiple medical centers in the Hampton Roads region. EVMS campus includes the 555-bed Sentara Norfolk General Hospital, the region's only tertiary level 1 trauma medical care facility, and the 212-bed Children's Hospital of The King's Daughters, a regional pediatric referral care facility and only stand-alone children's hospital in the state. EVMS is the first institution in the US to have produced a viable fetus through in vitro fertilization. EVMS is most known for its reproductive medicine, simulation/standardized-patient education as well as research in pediatrics, geriatrics, diabetes, and cancer. In addition, EVMS is well known for its leadership in community service and medical missions, as evidenced by faculty and alumni responsible for the founding of Operation Smile, Physicians for Peace, Global Brigades, and CONRAD.
Background:. Wound complications following primary closure after abdominoperineal resection reach rates of up to 66%. The de-epithelialized V-Y flap has emerged as a common closure technique, particularly in irradiated patients. This study evaluates the 10-year experience of the modified V-Y flap at our institution. Methods:. A retrospective review of patients who underwent de-epithelialized V-Y flap reconstruction for abdominoperineal resection defects between 2013 and 2024 was performed. An analysis of wound complications (eg, infections, dehiscence) and surgical outcomes (eg, reoperations, readmissions) was performed. Multivariate logistic regression assessed the effects of comorbidities and operative factors on wound complications, 30-day reoperations, 30-day readmissions, interventional radiology drainage, and length of stay. Results:. Eighty-three patients were included, with a wound complication rate of 30.1%. The most common complication was pelvic fluid collections (22.9%), followed by dehiscence (21.7%). Within 30 days, 6 (7.2%) patients required reoperation, and 13 (15.7%) patients were readmitted. Patients with chronic obstructive pulmonary disease (P = 0.046) or atrial fibrillation (P = 0.048) were more likely to have wound complications. Mesh use (n = 6) was associated with higher wound complications (P = 0.02), reoperations (P = 0.03), readmissions (P < 0.001), and interventional radiology drainage (P = 0.01). Conclusions:. The modified V-Y flap demonstrated improved wound complication with more robust data compared with our prior study. Patients with chronic obstructive pulmonary disease or atrial fibrillation may face higher risks of wound complications. Mesh use was associated with an increased rate of complications and interventions.
This publication represents the first part of an update to the clinical practice guideline on the diagnosis and management of group A streptococcal (Streptococcus pyogenes or GAS) pharyngitis, developed by the Infectious Diseases Society of America (IDSA). Diagnosis of GAS pharyngitis by clinician judgement alone is unreliable, and unselective testing incurs cost and inconvenience for individuals at low risk of having GAS infection. Clinical scoring systems have been used to quantify the probability of a positive GAS throat culture based on standardized criteria such as the presence of fever; tonsillar enlargement or exudate; tender and enlarged anterior cervical lymph nodes; and the absence of cough. The goal of this paper is to determine whether a scoring system should be used to decide which patients should have a diagnostic test performed by rapid antigen detection test (RADT), molecular methods, and/or throat culture. We performed a systematic review of randomized and non-randomized studies that compared the use of a clinical scoring system to clinician judgement alone in predicting the outcome of a throat culture. Evidence from studies in children and adults suggests the diagnostic accuracy of a clinical scoring system is comparable to or slightly higher than clinician judgement alone. However, the studies are limited due to small size, lack of uniformity in outcome measures, and incomplete data. The consensus of the panel is that the balance of benefits and harms favors use of a clinical scoring system as part of the evaluation of patients with sore throat. The principal utility of using a scoring system is to identify patients with low probability of GAS pharyngitis and to reduce unnecessary testing.
Introduction The importance of prenatal determination of chorionicity for the management of twin pregnancies is well recognized. However, research on the contribution of prenatal evaluation of zygosity to the management of twins is limited. We assessed the utility of adding SNP-based cell-free DNA (cfDNA) zygosity testing to ultrasound chorionicity assessment for the clinical management of twin pregnancies.Methods Prospective observational study involving 13 United States practices with proficiency in prenatal ultrasound. Patients diagnosed by ultrasound with twins in the first trimester were assessed with cfDNA screening for zygosity. Ultrasound assessment of chorionicity was performed prior to cfDNA results. Placental pathology was used as the gold standard for chorionicity assessment. Gestational age at delivery and standardized birthweights were compared, based on chorionicity and zygosity.Results 110 twin pregnancies were included. Among 79 dichorionic (DC) cases confirmed by placental pathology, one (1.3%) was misclassified as monochorionic (MC) by ultrasound, but was dizygous (DZ) by cfDNA, consistent with DC. Of 31 monozygotic (MZ) twins by cfDNA, confirmed as MC by pathology, ultrasound misclassified one (3.6%) as DC. Median gestational age at delivery was earlier for MZ twin pregnancies (35.0 weeks) compared to DZ (36.9 weeks, p = 0.02). After adjusting for fetal sex and gestational age at birth, MZDC twins had significantly lower birthweights (p = 0.006) and birthweight percentiles (p = 0.004) than DZDC twins.Conclusions Based on postpartum placental pathology as the reference standard for determining MC versus DC, cfDNA zygosity testing appears to aid in the prenatal assignment of chorionicity. Larger studies are needed to confirm the value of zygosity testing in the management of twin pregnancies.
Objective The PDN-Sensory randomized controlled trial (RCT) evaluated the effects of high-frequency 10-kHz spinal cord stimulation (10-kHz SCS) on pain and sensory function in individuals with painful diabetic neuropathy (PDN). Research Design and Methods Participants were randomized 1:1 to conventional medical management (CMM) alone or 10-kHz SCS plus CMM. The primary and key secondary endpoint were the proportions of participants with pain response (≥50% lower limb pain relief) and sensory improvement (≥3-point reduction in modified Toronto Clinical Neuropathy Score [mTCNS]). Hierarchical secondary outcomes included intraepidermal nerve fiber density (IENFD), sleep, and health/neuropathy-related quality of life (QoL). IENFD and mTCNS assessments were allocation blinded. Results Ninety-one randomized participants were assigned to CMM-alone (n = 50) or 10-kHz SCS (n = 41). In a modified intention-to-treat worst-case analysis, 27 of 34 participants in the 10-kHz SCS group who underwent a temporary trial achieved the primary outcome versus 2 of 50 CMM-alone participants (P < 0.001). Among those with 6-month data, mTCNS sensory improvement was observed in 16 of 29 (55.2%) 10-kHz SCS participants versus 12 of 48 (25.0%) CMM-alone participants (P = 0.01). Mean change in lower calf IENFD was 0.58 fibers/mm with 10-kHz SCS versus -0.07 with CMM alone (P = 0.03). Eight of 10 hierarchical secondary endpoints were met (including sleep and QoL). The PDN-Sensory RCT replicated previous pain reduction findings and showed prespecified, objective improvements in sensory function and IENFD. These 6-month findings support clinically meaningful benefit and are consistent with a potential disease-modifying effect that requires longer-term confirmation.
Families sometimes worry that donating a child’s tumor tissue after death might conflict with their religious beliefs. Similarly, clinicians may hesitate to raise this topic with their patients over concerns about causing undue distress or misunderstanding. This study reviewed official teachings from major U.S. faith traditions—Catholicism, Protestantism, Judaism, and Islam—and found that most support donation when it helps reduce suffering and advance medical research. By sharing these positions, we hope to ease concerns, encourage informed conversations, and make it easier for families who wish to donate. These donations are vital for developing new treatments and improving outcomes for children with brain tumors.
