Failure to complete apoptosis following neonatal hypoxia-ischemia manifests as "continuum" phenotype of cell death and occurs with multiple manifestations of mitochondrial dysfunction in rodent forebrain

Controversy surrounds proper classification of neurodegeneration occurring acutely following neonatal hypoxia-ischemia (HI). By ultrastructural classification, in the first 24 h after neonatal hypoxia-ischemia in the 7-day-old (p7) rat, the majority of striatal cells die having both apoptotic and necrotic features. There is formation of a functional apoptosome, and activation of caspases-9 and -3 occurring simultaneously with loss of structurally intact mitochondria to 34.7+/-25% and loss of mitochondrial cytochrome c oxidase activity to 34.7+/-12.7% of control levels by 3 h after hypoxia-ischemia. There is also loss of the mitochondrial motor protein, kinesin. This combination of activation of apoptosis pathways simultaneous with significant mitochondrial dysfunction may cause incomplete packaging of nuclear and cytoplasmic contents and a hybrid of necrotic and apoptotic features. Evidence for an intermediate biochemistry of cell death including expression of the 17 kDa isoform of caspase-3 in dying neurons lacking a classic apoptotic morphology and degradation of the neuronal cytoskeletal protein spectrin by caspase-3 and calcium-activated calpains yielding 120 kDa and 145/150 kDa fragments, respectively, is also found. In summary, neonatal hypoxia-ischemia triggers apoptotic cascades, and simultaneously causes mitochondrial structural and functional failure. The presence of a "continuum" phenotype of cell death that varies on a cell-by-cell basis suggests that the phenotype of cell death is dependent on the energy available to drive the apoptotic pathways to completion.     

Social support and relationship change after childbirth: An expectancy model

Much has been written about social support, but little is known about the processes that promote continuity or discontinuity in supportive relationships. A proposed model of relationship processes (Levitt, 1991) specifies that changes in the quality of close relationships are likely to occur when expectations for social support are tested and disconfirmed. Relationships are particularly vulnerable to change after major life events, such as childbirth, when increased support needs precipitate the testing of expectations. In a preliminary assessment of this model, 43 mothers were interviewed at 1 month and 13 months after birth. Changes in relationship satisfaction were related strongly to the extent to which mothers perceived that their expectations for support had been disconfirmed. The results are consistent with the proposed model and suggest the value of considering the effects of social support in light of the individual's expectancies.     

Book reviews

ENCOUNTERS OF AGING: MYTHOLOGIES OF MENOPAUSE IN JAPAN AND NORTH AMERICA By Margaret Lock Berkeley: University of California Press, 1993, 440 pp. ISBN 0–520–08221–4

SURVIVING CHILD SEXUAL ABUSE, 2nd EDITION By Liz Hall and Siobhan Lloyd Washington, DC: The Falmer Press, 1993, 389 pp. ISBN 075070–153–6     

Women's perceptions and management of a pregnancy complicated by chronic illness

This exploratory longitudinal study addresses how a group of chronically ill pregnant women managed the medical risk factors associated with their pregnancies through a process termed protective governing. Protective governing was carried out through the strategies of assessing, balancing, and controlling. The respondents were 20 women with chronic illnesses of varying types. Data were gathered by means of four in‐depth interviews, two prior to delivery and two during the postpartum period, and by observations during prenatal visits, in the hospital, and at home. The data were analyzed using the grounded theory method.