Viral hepatitis: expanding the alphabet.

Progress in understanding viral hepatitis has occurred at a rapid pace during the last 10 years; this has led directly to improvements in prevention, detection, and treatment. In previous reviews of viral hepatitis, only two forms of infectious hepatitis, hepatitis A and B, were recognized, and other unrecognized or uncharacterized agents were classified as "non-A, non-B." Currently, many more letters of the alphabet are required to designate the growing number of viral agents discovered through the application of the techniques of epidemiology and molecular virology. Furthermore, understanding of these viruses on the molecular level has led to the discovery of multiple subsets of these agents. This expansion of knowledge has immediate implications for bedside management, including the use of polymerase chain assays for diagnosis and management of chronic viral hepatitis, potent therapeutic antiviral drugs, and new vaccination strategies. In this chapter, we discuss these recent advances in the detection and management of viral hepatitis in children.

Hepatocyte nuclear factor-1alpha regulates transcription of the guanylin gene.

To study the molecular mechanisms controlling guanylin expression, we have cloned the mouse guanylin gene, including 2.7 kb of upstream sequence. We show that the first 133 base pairs (bp) of the upstream guanylin promoter are sufficient to drive near maximal (6-fold over basal) luciferase reporter gene expression in Caco-2 intestinal cells; at least 300 bp of upstream promoter are required for reporter gene expression in HT-29 intestinal cell lines. Using electromobility shift assays, we demonstrate that nuclear proteins bind to the hepatocyte nuclear factor-1 (HNF-1) consensus sequence in the guanylin promoter. The HNF-1 consensus sequence, located in the immediate 5' flanking region, is required for transcriptional activation of the guanylin gene in both intestinal cell lines. Mutagenesis of the HNF-1 consensus sequence abolishes transcriptional activation of guanylin promoter-luciferase reporter gene constructs. Cotransfection of these constructs with HNF-1alpha augments transcriptional initiation of the reporter gene. In contrast, HNF-1beta has no significant effect on transcription of the reporter gene. These experiments demonstrate that HNF-1alpha is an important regulatory element in the transcriptional activation of guanylin.

Transitional objects and borderline personality disorder.

OBJECTIVE: The relationship of possession of transitional objects to the borderline personality disorder diagnosis was explored in a psychiatric inpatient setting. It was hypothesized that a greater proportion of inpatients who bring objects of special meaning with them to the hospital have borderline personality disorder. METHOD: Psychiatric inpatients (N = 146) were administered a semistructured interview to determine the presence of special (i.e., transitional) objects in the hospital, at home, or during childhood. Borderline personality disorder was determined by criteria on a DSM-III-R borderline personality disorder checklist and by DSM-III-R discharge diagnosis. RESULTS: Significantly more patients who endorsed having transitional objects in the hospital or at home had the diagnosis of borderline personality disorder. Sensitivity, specificity, positive predictive power, and negative predictive power of the possession of the transitional object for the borderline personality disorder diagnosis were calculated. Specificity was higher than sensitivity, and negative predictive power was higher than positive predictive power in each instance. While these results suggest that absence of a transitional object is more likely to be associated with absence of borderline personality disorder than the presence of a transitional object is with the presence of borderline personality disorder, the sensitivity of a transitional object during adulthood to predict a diagnosis of borderline personality disorder was 63%, and the positive predictive power was 45%. CONCLUSIONS: A transitional object brought to the hospital may help remind the inpatient with borderline personality disorder of home or provide soothing during separation from home. The persistence of transitional objects into adulthood may inform the therapist of possible transference paradigms that may develop in treatment.

Diagnosis of cytomegalovirus infection in pediatric Menetrier's disease by in situ hybridization.

A previously healthy 7-year-old boy presented with a protein-losing enteropathy secondary to a hypertrophic gastropathy. The diagnosis of cytomegalovirus (CMV) infection was established by detection of CMV inclusion bodies in gastric biopsy samples and by hybridization with a CMV probe. This report further strengthens the association between CMV and pediatric Menetrier's disease.

Effect of human placental lactogen upon the human corpus luteum of late pregnancy.

To acertain whether human placental lactogen (HPL) functions as a luteotropin during pregnancy in humans, studies were performed to determine if receptors for HPL are present in cells of the human corpus luteum of late pregnancy. Preparations of 125I-HPL which demonstrated specific binding to late pregnant rabbit mammary gland cell homogenates showed specific binding of less than 2.5% to homogenates of human corpora lutea of late pregnancy. These studies indicate that HPL is not luteotropic at this stage of pregnancy in humans. The action of HPL upon the corpus luteum appears to vary considerably according to species.

Secretion of progesterone and relaxin by the humancorpus luteum at midpregnancy and at term.

PIP: The secretion of progesterone (P) and relaxin (R):by the human corpus luteum at midpregnancy and at term was studied in 19 women, 6 of whom had their pregnancies terminated by hysterotomy at 14-18 weeks and 13 whose pregnancies went to term and were delivered by Caesarean section. Luteectomies were performed on 6 of the women at the time of Caesarean section. P and R levels were measured. R section correlated well with luteal P secretion. After Caesarean section at term the decline in serum P was parallel to that observed after hysterotomya at midtrimester. Absolute levels of P are higher at term. P decline after luteectomy was precipitous compared with Caesarean section. Results indicate that the corpus luteum in the human remains active throughout pregnancy.^ieng