Taking Control of Castleman Disease: Leveraging Precision Medicine Technologies to Accelerate Rare Disease Research.

Castleman disease (CD) is a rare and heterogeneous disorder characterized by lymphadenopathy that may occur in a single lymph node (unicentric) or multiple lymph nodes (multicentric), the latter typically occurring secondary to excessive proinflammatory hypercytokinemia. While a cohort of multicentric Castleman disease (MCD) cases are caused by Human Herpes Virus-8 (HHV-8), the etiology of HHV-8 negative, idiopathic MCD (iMCD), remains unknown. Breakthroughs in "omics" technologies that have facilitated the development of precision medicine hold promise for elucidating disease pathogenesis and identifying novel therapies for iMCD. However, in order to leverage precision medicine approaches in rare diseases like CD, stakeholders need to overcome several challenges. To address these challenges, the Castleman Disease Collaborative Network (CDCN) was founded in 2012. In the past 3 years, the CDCN has worked to transform the understanding of the pathogenesis of CD, funded and initiated genomics and proteomics research, and united international experts in a collaborative effort to accelerate progress for CD patients. The CDCN's collaborative structure leverages the tools of precision medicine and serves as a model for both scientific discovery and advancing patient care.

Self-administered preoperative antiseptic wash to prevent postoperative infection after deep brain stimulation.

BACKGROUND: Prevention of surgical site infections is critical in deep brain stimulation (DBS). In the present study, we tested the ability of a self-administered preoperative alcohol-based (70% ethyl alcohol) preparation to reduce the rate of postoperative infection after DBS surgery. METHODS: This Institutional Review Board-approved retrospective review was conducted at our institution between January 2005 and October 2007 (mean follow-up, 23 months). The participants comprised a consecutive sample of 172 patients with movement disorders who underwent DBS surgery at our institution. Starting in January 2007, all patients were required to use the alcohol-based preparation. These patients (n = 48) were instructed to self-administer the wash on the night before surgery and the morning of surgery. Before this time, no self-administered wash was used (n = 122). RESULTS: There was no difference in preoperative skin cleansing between the 2 groups, and all patients received intravenous antibiotics immediately before and after surgery for 24 hours. We compared the rate of postoperative infection in the 2 groups and reviewed other possible factors underlying infection. We found 11 cases of infection (6.47%), all in the group without the preoperative antiseptic wash. The infection rate was 9.02% in the group without the preoperative wash and 0 in the group with the preoperative wash (P < .029). There was no difference between the 2 groups in terms of mean age, duration of operative procedure, or number of microelectrode tracts attempted. CONCLUSIONS: Our results support the incorporation of this self-administered antiseptic wash into our standard antiseptic protocol for patients undergoing DBS surgery.

Progress report: the prevalence of required medical school instruction in musculoskeletal medicine at decade's end.

BACKGROUND: In a 2003 report, required courses in musculoskeletal medicine were found in only 65 of the 122 medical schools in the United States. Since then, national efforts to promote musculoskeletal medicine education were led by the US Bone and Joint Decade, the American Medical Association, the Association of American Medical Colleges, the American Academy of Orthopaedic Surgeons, and the National Board of Medical Examiners, among others. Whether these efforts resulted in any changes in curricula is unclear. QUESTIONS/PURPOSES: We assessed the change, if any, in the prevalence of required instruction in musculoskeletal medicine, which might be attributed to these reform efforts. METHODS: Curriculum requirements were ascertained by an email survey sent to all 127 medical schools in the United States and from the schools' websites. The presence of a preclinical course or block dedicated to musculoskeletal medicine was noted. Likewise, the requirement for a clerkship in a musculoskeletal discipline (comprising orthopaedic surgery, rheumatology, or physical medicine) was recorded. RESULTS: One hundred of the 127 medical schools in the United States had required preclinical courses in musculoskeletal medicine. Among the schools without such a course, six had a required musculoskeletal clerkship. Thus, 106 schools had some requirement, with only 21 (17%) lacking required instruction in musculoskeletal medicine. This rate compares favorably with the 47% rate (57 of the 122 schools) reported previously. CONCLUSION: The prevalence of required instruction in musculoskeletal medicine is greater compared with the prevalence reported in previous studies. Musculoskeletal medicine appears to have attained a more prominent place in the curriculum at most schools.