Association of scapholunate dissociation and two-part articular fractures of the distal radius.

Scapholunate dissociation may occur in association with distal radial fractures and is easily missed at initial presentation. The aim of this study was to examine variances in the scapholunate distance with respect to subtypes of two-part partial articular distal radial fractures. Axial computed tomography (CT) scans of acute two-part intra-articular radial fractures were assessed retrospectively from 80 patients and compared to 20 controls. From each scan, two images were analysed to identify the scaphoid, lunate and articular fracture line in the distal radius for fracture type categorization. The images were overlaid on a standardized distal radius template and the scapholunate distance measured. Significant increase in the scapholunate distance was noted in fracture subtypes: radial styloid oblique; dorsal ulnar column; sagittal ulnar column; and volar coronal. We conclude that these findings support the need for a higher index of suspicion for scapholunate dissociation in these distal radial fracture subtypes. Level of evidence: III.

Partitioning the human transcriptome using HKera, a novel classifier of housekeeping and tissue-specific genes.

High-throughput transcriptomic experiments have made it possible to classify genes that are ubiquitously expressed as housekeeping (HK) genes and those expressed only in selective tissues as tissue-specific (TS) genes. Although partitioning a transcriptome into HK and TS genes is conceptually problematic owing to the lack of precise definitions and gene expression profile criteria for the two, information whether a gene is an HK or a TS gene can provide an initial clue to its cellular and/or functional role. Consequently, the development of new and novel HK (TS) classification methods has been a topic of considerable interest in post-genomics research. Here, we report such a development. Our method, called HKera, differs from the others by utilizing a novel property of HK genes that we have previously uncovered, namely that the ranking order of their expression levels, as opposed to the expression levels themselves, tends to be preserved from one tissue to another. Evaluated against multiple benchmark sets of human HK genes, including one recently derived from second generation sequencing data, HKera was shown to perform significantly better than five other classifiers that use different methodologies. An enrichment analysis of pathway and gene ontology annotations showed that HKera-predicted HK and TS genes have distinct functional roles and, together, cover most of the ontology categories. These results show that HKera is a good transcriptome partitioner that can be used to search for, and obtain useful expression and functional information for, novel HK (TS) genes.

Preservation of ranking order in the expression of human Housekeeping genes.

Housekeeping (HK) genes fulfill the basic needs for a cell to survive and function properly. Their ubiquitous expression, originally thought to be constant, can vary from tissue to tissue, but this variation remains largely uncharacterized and it could not be explained by previously identified properties of HK genes such as short gene length and high GC content. By analyzing microarray expression data for human genes, we uncovered a previously unnoted characteristic of HK gene expression, namely that the ranking order of their expression levels tends to be preserved from one tissue to another. Further analysis by tensor product decomposition and pathway stratification identified three main factors of the observed ranking preservation, namely that, compared to those of non-HK (NHK) genes, the expression levels of HK genes show a greater degree of dispersion (less overlap), stableness (a smaller variation in expression between tissues), and correlation of expression. Our results shed light on regulatory mechanisms of HK gene expression that are probably different for different HK genes or pathways, but are consistent and coordinated in different tissues.

Health problems of late adolescence.

Late adolescents in the 18- to 24-year-old age group, which parallels the traditional college years, represent a unique subpopulation in transition between youth and adulthood. Usually considered to be a healthy group, serious injuries are not uncommon in this physically active period that is marked by new-found freedoms and participation in high-risk behaviors. Many chronic medical problems also begin during this time. A few health problems, such as eating disorders, are actually unique to this population. When the potential for lives and for productivity lost are taken into account, young people are at even greater financial risk from catastrophic medical events than are older patients; yet, people in the 18- to 24-year-old age group are the most likely to be without health insurance. The need for more effective prevention programs for late adolescents is obvious, but to be successful, the programs must consider each risk factor both individually and in the context of their high-risk behaviors.

Health problems of college students.

College health professionals deal with a range of medical problems and risky behaviors. Some medical conditions occur more frequently in the college-age population, but college health is not unique because of the types of medical problems seen. Community providers welcome the opportunity to deliver primary care to this relatively healthy population, with less emphasis on screening, intervention, mental health, social well-being, and altering unhealthy behaviors. Young people have been recognized as experiencing higher rates of morbidity, disability, and mortality from various developmental, environmental, and behavioral risk factors than the general population. These risk factors are so interrelated that successful efforts to change them require a more comprehensive approach that extends beyond the health of individuals to the wellness of an entire campus community. On the continuum of health and well-being, college health must move away from focusing on disease and move toward community wellness.

The QSHP proposal: 10 questions most often asked.

Qualified Student Health Plans (QSHPs) have gained increasing support since the authors introduced the proposal to the field of college health in 1994. This article answers 10 of the most frequently asked questions about QSHPs and summarizes changes in the proposal that have resulted from discussions among college health professionals throughout the country. The QSHP proposal, which has been endorsed by the board of directors of the American College Health Association, offers the following benefits for the college health field and for students: It is founded on the traditional prepaid college health model and assures that control remains with higher education; participation is voluntary for employers and for institutions of higher education; no new tax funding is required; QSHPs preclude state interference and provide employers with incentives to contribute to the cost of student healthcare; both the cost of student health insurance and duplication of coverage are reduced and benefits are shifted to where the students live; the problem of uninsured and underinsured students is eliminated at participating institutions. With incremental healthcare reform continuing at the state level, the time to move forward with the proposal is viewed as ideal.

Student healthcare delivery and financing programs: adapting to healthcare reform.

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an "all or nothing" proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.

Hyperosmolar nonketotic diabetic coma.

Hyperosmolar nonketotic coma occurs most frequently in the elderly patient with underlying renal impairment. It often has an insidious onset, and may be precipitated by an identifiable illness, medication or procedure. Various neurologic manifestations may occur and obscure the diagnosis. Rapid recognition and appropriate treatment can greatly reduce the high mortality rate.

Subacute carbon monoxide poisoning. Another great imitator.

The illnesses of two patients with characteristic symptoms of subacute carbon monoxide poisoning were misdiagnosed initially. This resulted in the needless exposure of one patient and two relatives to a toxic environment. The cherry-red color of the skin commonly cited in the literature was absent in both patients. The carbon monoxide poisoning probably contributed to the myocardial infarction and pulmonary emboli seen in these patients. Vague flu-like illnesses should raise the suspicion of carbon monoxide poisoning.