Young@Heart: empowering the next generation of cardiovascular researchers.

In recognition of the increasing health burden of cardiovascular disease, the Dutch CardioVascular Alliance (DCVA) was founded with the ambition to lower the cardiovascular disease burden by 25% in 2030. To achieve this, the DCVA is a platform for all stakeholders in the cardiovascular field to align policies, agendas and research. An important goal of the DCVA is to guide and encourage young researchers at an early stage of their careers in order to help them overcome challenges and reach their full potential. Young@Heart is part of the DCVA that supports the young cardiovascular research community. This article illustrates the challenges and opportunities encountered by young cardiovascular researchers in the Netherlands and highlights Young@Heart's vision to benefit from these opportunities and optimise collaborations to contribute to lowering the cardiovascular disease burden together as soon as possible.

Cardiac foetal reprogramming: a tool to exploit novel treatment targets for the failing heart.

As the heart matures during embryogenesis from its foetal stages, several structural and functional modifications take place to form the adult heart. This process of maturation is in large part due to an increased volume and work load of the heart to maintain proper circulation throughout the growing body. In recent years, it has been observed that these changes are reversed to some extent as a result of cardiac disease. The process by which this occurs has been characterized as cardiac foetal reprogramming and is defined as the suppression of adult and re-activation of a foetal genes profile in the diseased myocardium. The reasons as to why this process occurs in the diseased myocardium are unknown; however, it has been suggested to be an adaptive process to counteract deleterious events taking place during cardiac remodelling. Although still in its infancy, several studies have demonstrated that targeting foetal reprogramming in heart failure can lead to substantial improvement in cardiac functionality. This is highlighted by a recent study which found that by modulating the expression of 5-oxoprolinase (OPLAH, a novel cardiac foetal gene), cardiac function can be significantly improved in mice exposed to cardiac injury. Additionally, the utilization of angiotensin receptor neprilysin inhibitors (ARNI) has demonstrated clear benefits, providing important clinical proof that drugs that increase natriuretic peptide levels (part of the foetal gene programme) indeed improve heart failure outcomes. In this review, we will highlight the most important aspects of cardiac foetal reprogramming and will discuss whether this process is a cause or consequence of heart failure. Based on this, we will also explain how a deeper understanding of this process may result in the development of novel therapeutic strategies in heart failure.

High Redox Capacity of Al-Doped La1-x Srx MnO3-δ Perovskites for Splitting CO2 and H2 O at Mn-Enriched Surfaces.

Perovskites are attractive candidates for the solar-driven thermochemical redox splitting of CO2 and H2 O into CO and H2 (syngas) and O2 . This work investigates the surface activity of La1-x Srx Mn1-y Aly O3-δ (0≤x≤1, 0≤y≤1) and La0.6 Ca0.4 Mn0.6 Al0.4 O3-δ . At 1623 K and 15 mbar O2 , the oxygen non-stoichiometry of La0.2 Sr0.8 Mn0.8 Al0.2 O3-δ increases with the strontium content and reaches a maximum of δ=0.351. X-ray photoelectron spectroscopy analysis indicates that manganese is the only redox-active metal at the surface. All La1-x Srx Mn1-y Aly O3-δ compositions exhibit surfaces enriched in manganese and depleted in strontium. We discuss how these compositional differences of the surface from the bulk lead to the beneficially higher reduction extents and lower strontium carbonate concentrations at the aluminum-doped surfaces. Using first principles calculations, we validate the experimental reduction trends and elucidate the mechanism of the partial electronic charge redistribution upon perovskite reduction.

Peripartum cardiomyopathy: Euro Observational Research Program.

Peripartum cardiomyopathy is a rare but potentially life-threatening form of heart failure affecting women late in pregnancy or in the first months after delivery. Peripartum cardiomyopathy is difficult to diagnose and its onset and progression are variable between individuals. The pathophysiology remains poorly understood, hence treatment options are limited and possibly harmful to the foetus. Furthermore, geographical incidence varies greatly and little is known about the incidence in Western countries. To gain further understanding of the pathophysiology and incidence of peripartum cardiomyopathy, the European Society of Cardiology initiated a study group to implement a registry. This review provides an overview of current insights into peripartum cardiomyopathy, highlights the need for such a registry and provides information about this Euro Observational Research Program.

Practice methods among nurse practitioners treating depressed women.

OBJECTIVE: To determine practice methods and beliefs about degree of competence in the assessment, diagnosis, and treatment of depressive symptoms in women by nurse practitioners (NPs). DATA SOURCES: A survey about the diagnosis and treatment of depressive symptoms in women was mailed to 3,000 NPs randomly selected from the membership of the American Academy of Nurse Practitioners. Family, adult, women's and gerontological NPs were included; 1,647 surveys were returned (55%). CONCLUSIONS: Assessment and treatment protocols used by NPs were consistent with the AHCPR guidelines and similar to the protocols used by psychiatrists and non-psychiatric physicians, yet only 65% believed their education had adequately prepared them to assess/diagnose depression and only 52% believed they had been adequately prepared to treat depression. IMPLICATIONS FOR PRACTICE: Findings suggest areas for improvement in the formal education and continuing education of NPs.

A literary dessert.

This paper contains an expression of gratitude towards the organizers of the congress 'Psychiatry, Food and Addiction', and the Board members of the Interdisciplinary Society for Biological Psychiatry, of the Sections 'Biological Psychiatry' and 'Psychiatry and Addiction' of the Dutch Society of Psychiatry and the former Editorial Board of Acta Neuropsychiatry. The author has been a long-term board member of the society and cofounder of both sections and cofounder and editor-in-chief of this Journal from 1989 to 1999.

Recent antipsychotics in the treatment of psychoses.

Antipsychotic drugs are effective in psychoses, whatever the etiology of the disorder. The positive symptoms tend to respond more readily. The need for developing new drugs arises from the refractoriness of the negative symptoms, the 10-25% of the patients that are treatment-resistant and the problems of short-, and long-term extrapyramidal side-effects. Thus far, six drugs, differing from the classical antipsychotics, have been licensedfor use: olanzepine, risperidone and quetiapine; the longest registration exists for sulpiride and clozapine while the most recent one is for amisulpride. This review starts with a brief introduction to symptomatology, and takes differences with the classical drugs in pharmacology, pharmacokinetics, clinical aspects and side-effects into consideration. Clozapine, risperidone and sulpiride may be considered for clinical use in refractory patients; these three, olanzapine and amisulpride when extrapyramidal side-effects cause a clinical problem. Amisulpride and sulpiride have a dual therapeutic acion: On negative symptoms at low dose, on positive symptomen at high doses.

Improvement in alcoholics measured using the General Health Questionnaire.

Over a 1-year study period all patients admitted to the department of psychiatry in a general hospital were asked to complete the General Health Questionnaire at admission, discharge, and first polyclinic (outpatient) follow-up contact. Seventeen per cent of admissions were alcoholics. Alcoholics improved rapidly after admission to the psychiatric department. This improvement was comparable to that of all the (psychiatric) patients admitted and continued after discharge.

Recent developments in the management of psychosis.

Antipsychotic drugs are effective in psychoses, whatever the aetiology of the disorder. The positive symptoms tend to respond more readily. The need for developing new drugs arises from the refractoriness of the negative symptoms, the 10-25% of the patients that are treatment-resistant and the problems of short-, and long-term extrapyramidal side-effects. Thus far, five drugs differing from the classical antipsychotics have been licensed for use: clozapine, olanzepine, risperidone, sertindole and sulpiride, and in at least some European countries quetiapine is now in the final phase of clinical research. This review starts with a brief introduction to symptomatology, is limited to the registered drugs and addresses differences with the classical drugs in pharmacology, pharmacokinetics, clinical aspects and side-effects. Clozapine, risperidone and sulpiride can be considered for clinical use in refractory patients, and these three together with olanzapine and sertindole are candidates when extrapyramidal side-effects cause a clinical problem.

First report of mirtazapine overdose.

This report describes what is thought to be the first case of mirtazapine overdose occurring since the introduction of the antidepressant drug (Remeron) in the Netherlands in 1994. It is suggested that mirtazapine has a benign side effect profile when taken in overdose.

Treatment of the hyperventilation syndrome with bisoprolol: a placebo-controlled clinical trial.

The hyperventilation syndrome (HVS) can be regarded as a form of panic disorder associated with a relative increase in sympathomimetic tone, the effects of which can be counterbalanced by beta-adrenoceptor blockade. The efficacy of the beta-blocker bisoprolol was investigated in a double-blind placebo-controlled randomised crossover trial involving 60 patients from 17 general practices. Following a single-blind placebo prephase, patients who met the inclusion criteria were randomised to treatment with either 5 mg bisoprolol or an identical-looking placebo tablet once daily for three weeks. They were then crossed over to the other treatment arm. At the end of each treatment phase the number of hyperventilation attacks and the severity of symptoms were assessed and side effects recorded. The number of attacks decreased from 4.04 per week at baseline to 3.52 with placebo and to 1.26 with bisoprolol. The decrease of attacks with bisoprolol was significant (p < 0.05) compared to baseline and placebo. The severity of the complaints improved from 29 (scale 0 to 64) at baseline not significantly to 26 with placebo and significantly (p < 0.05) to 15 with bisoprolol. No serious side effects were reported. Five milligrams of bisoprolol once daily is effective and safe in the maintenance of symptom reduction in patients with the hyperventilation syndrome.

Reduced preabsorptive insulin response in aged rats: differential effects of amphetamine and arginine-vasopressin.

The experiments presented here have been designed to investigated whether the age-related attenuation of the vagal reactivity to emotional stressors and its modulation by amphetamine (Amph) or arginine-vasopressin (AVP) can be generalized for other physiological response patterns. We therefore studied the vagal control of the endocrine pancreas during food intake. Young (3 months old) and aged (27 months old) male Wistar rats were provided with permanent cardiac catheters allowing free movement and repeated, stress-free blood sampling. The vagally mediated preabsorptive insulin response (PIR) in relation to food intake as seen in young rats was reduced in aged ones. Blood glucose increments were the same at both ages. Administration of Amph (0.5 mg/kg; s.c.) 30 min before, or AVP (10 micrograms/kg; s.c.) 60 min before presentation of a test meal led to an elevation of the magnitude of insulin secretion in young rats but reduced the response in aged rats. Moreover, the PIR was not reinstated in aged rats. Blood glucose increments were not influenced by the treatments. The results are interpreted in terms of age-related general reduction of parasympathetic reactivity. The differential effect of amphetamine and AVP treatment on the insulin response suggests that the central aminergic or peptidergic drive of vagal output to the endocrine pancreas is also age-related.

Hyperventilation and panic attacks.

The symptoms of hyperventilation syndrome and panic disorder are very similar. A questionnaire was used to assess the incidence of panic disorder in 274 patients; 35% of the patients with hyperventilation and only 5% of the non-hyperventilating patients showed panic disorder. The authors conclude that hyperventilation plays an important role in panic disorder and in generalized anxiety disorder.

Biological markers in psychiatry.

Biological markers in psychiatry are defined as measurable and quantifiable indices of psychiatric disorders. Criteria for biological markers are discussed. The criteria for the assignment of a biological marker to the pathophysiology, pathogenesis, or etiology of a disorder are proposed. None of the biological markers described in the literature for depression, schizophrenia, alcoholism or anxiety as separate disorder fulfills the specified criteria. Most of them can at best be considered as biological markers of the aspecific processes of strain and stress. Free-floating anxiety is the clinical hallmark of strain.