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Cheng T, Yu D, Tan J, Liao S, Zhou L, OuYang W, Wen Z. Development a nomogram prognostic model for survival in heart failure patients based on the HF-ACTION data. BMC Med Inform Decis Mak 2024; 24:197. [PMID: 39030567 PMCID: PMC11264587 DOI: 10.1186/s12911-024-02593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/27/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The risk assessment for survival in heart failure (HF) remains one of the key focuses of research. This study aims to develop a simple and feasible nomogram model for survival in HF based on the Heart Failure-A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) to support clinical decision-making. METHODS The HF patients were extracted from the HF-ACTION database and randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Multivariate Cox regression was used to identify and integrate significant prognostic factors to form a nomogram, which was displayed in the form of a static nomogram. Bootstrap resampling (resampling = 1000) and cross-validation was used to internally validate the model. The prognostic performance of the model was measured by the concordance index (C-index), calibration curve, and the decision curve analysis. RESULTS There were 1394 patients with HF in the overall analysis. Seven prognostic factors, which included age, body mass index (BMI), sex, diastolic blood pressure (DBP), exercise duration, peak exercise oxygen consumption (peak VO2), and loop diuretic, were identified and applied to the nomogram construction based on the training cohort. The C-index of this model in the training cohort was 0.715 (95% confidence interval (CI): 0.700, 0.766) and 0.662 (95% CI: 0.646, 0.752) in the validation cohort. The area under the ROC curve (AUC) value of 365- and 730-day survival is (0.731, 0.734) and (0.640, 0.693) respectively in the training cohort and validation cohort. The calibration curve showed good consistency between nomogram-predicted survival and actual observed survival. The decision curve analysis (DCA) revealed net benefit is higher than the reference line in a narrow range of cutoff probabilities and the result of cross-validation indicates that the model performance is relatively robust. CONCLUSIONS This study created a nomogram prognostic model for survival in HF based on a large American population, which can provide additional decision information for the risk prediction of HF.
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Affiliation(s)
- Ting Cheng
- Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dongdong Yu
- First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Jun Tan
- Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaojun Liao
- Guangdong Provincial Hospital of Chinese Medicine (Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Li Zhou
- Guangdong Provincial Hospital of Chinese Medicine (Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Wenwei OuYang
- Guangdong Provincial Hospital of Chinese Medicine (Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese Medicine (Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
- Science and Technology Innovation Center of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Pei Z, Zhou R, Yao W, Dong S, Liu Y, Gao Z. Different exercise training intensities prevent type 2 diabetes mellitus-induced myocardial injury in male mice. iScience 2023; 26:107080. [PMID: 37416463 PMCID: PMC10320508 DOI: 10.1016/j.isci.2023.107080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) usually develop myocardial injury and that exercise may have a positive effect on cardiac function. However, the effect of exercise intensity on cardiac function has not yet been fully examined. This study aimed to explore different exercise intensities on T2DM-induced myocardial injury. 18-week-old male mice were randomly divided into four groups: a control group, the T2DM, T2DM + medium-intensity continuous training (T2DM + MICT), and T2DM + high-intensity interval training (T2DM + HIIT) groups. In the experimental group, mice were given high-fat foods and streptozotocin for six weeks and then divided into two exercise training groups, in which mice were subjected to exercise five days per week for 24 consecutive weeks. Finally, metabolic characteristics, cardiac function, myocardial remodeling, myocardial fibrosis, oxidative stress, and apoptosis were analyzed. HIIT treatment improved cardiac function and improved myocardial injury. In conclusion, HIIT may be an effective means to guard against T2DM-induced myocardial injury.
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Affiliation(s)
- Zuowei Pei
- Department of Cardiology, Central Hospital of Dalian University of Technology, Dalian, China
- Department of Central Laboratory, Central Hospital of Dalian University of Technology, Dalian, China
| | - Rui Zhou
- Department of Internal Medicine, Affiliated Zhong Shan Hospital of Dalian University, Dalian, China
| | - Wei Yao
- Department of Internal Medicine, Affiliated Zhong Shan Hospital of Dalian University, Dalian, China
| | - Shuang Dong
- Department of Cardiology, Central Hospital of Dalian University of Technology, Dalian, China
| | - Yingshu Liu
- Department of Endocrinology, Central Hospital of Dalian University of Technology, Dalian, China
| | - Zhengnan Gao
- Department of Endocrinology, Central Hospital of Dalian University of Technology, Dalian, China
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3
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Sándor-Bajusz KA, Kraut A, Baasan O, Márovics G, Berényi K, Lohner S. Publication of clinical trials on medicinal products: follow-up on trials authorized in Hungary. Trials 2022; 23:330. [PMID: 35449017 PMCID: PMC9022244 DOI: 10.1186/s13063-022-06268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical research should provide reliable evidence to clinicians, health policy makers, and researchers. The reliability of evidence will be assured once study planning, conducting, and reporting of results are transparent. The present research investigates publication rates, time until publication, and characteristics of clinical trials on medicinal products associated with timely publication of results, measures of scientific impact, authorship, and open access publication. METHODS Clinical trials authorized in Hungary in 2012 were followed until publication and/or June 2020. Corresponding scientific publications were searched via clinical trial registries, PubMed (MEDLINE), and Google. RESULTS Overall, 330 clinical trials were authorized in 2012 of which 232 trials were completed for more than 1 year in June 2020. The proportion of industry initiation was high (97%). Time to publication was 21 (22) months [median (IQR)]. Time to publication was significantly shorter when trials involved both European and non-European countries (26 vs 69 months [median]; hazard ratio = 0.38, 95% CI 0.22-0.66, p< 0.001), and were registered in both EU CTR and clinicaltrials.gov (27 vs 88 months; hazard ratio = 0.24, 95% CI 0.11-0.54; p< 0.001) based on survival analyses. A significant amount (24.1%) of unpublished clinical trial results were accessible in a trial register. The majority of available publications were published "open access" (70.93%). A minority of identified publications had a Hungarian author (21.5%). CONCLUSIONS We encourage academic researchers to plan, register and conduct trials on medicinal products. Registries should be considered as an important source of information of clinical trial results. Publications with domestic co-authors contribute to the research output of a country. Measurable domestic scientific impact of trials on medicinal products needs further improvement.
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Affiliation(s)
- Kinga Amália Sándor-Bajusz
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Neurosciences, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Kraut
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Law, Faculty of Law, University of Pécs, Pécs, Hungary
| | - Odgerel Baasan
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Gergely Márovics
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Károly Berényi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary. .,Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary.
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Pei Z, Yang C, Guo Y, Dong M, Wang F. Effect of different exercise training intensities on age-related cardiac damage in male mice. Aging (Albany NY) 2021; 13:21700-21711. [PMID: 34520392 PMCID: PMC8457595 DOI: 10.18632/aging.203513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Aging is the most important risk factor for cardiovascular diseases. Although exercise is known to be beneficial for the health of aging heart, the optimal exercise training intensity to prevent natural aging-induced cardiac damage has not been defined. In this study, we used 32-week-old male mice and randomly divided them into three groups, namely, untrained (UNT) mice, moderate-intensity exercise training (MET) mice, and high-intensity interval training (HIIT) mice. Mice in the two exercise training groups were subjected to exercise 5 days per week for 24 consecutive weeks. Metabolic characteristics, cardiac function and morphology, myocardial remodeling, myocardial fibrosis (collagen III, α-SMA, and TGF-β), oxidative stress (NRF2, HO-1, SOD, and NOX4), and apoptosis (BAX, Bak, Bcl-2, and Bcl-XL) were analyzed 24 weeks after the different treatments. MET improved cardiac function and reduced myocardial remodeling, myocardial fibrosis, and oxidative stress in the aging heart. MET treatment exerted an anti-apoptotic effect in the heart of the aging mice. Importantly, HIIT did not protect against cardiac damage during the natural aging process. These findings suggest that MET may be one of the main methods to prevent cardiac damage induced by natural aging.
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Affiliation(s)
- Zuowei Pei
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,School of Life Science, University of the Chinese Academy of Sciences, Beijing 100049, China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Min Dong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zhang Z, Wang SD, Li GS, Kong G, Gu H, Alfonso F. The contributor roles for randomized controlled trials and the proposal for a novel CRediT-RCT. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:812. [PMID: 32042828 DOI: 10.21037/atm.2019.12.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The past decade has witnessed a rapid increase in the number of contributors per article, which has made explicitly defining the roles of each contributor even more challenging. The Contributor Roles Taxonomy (CRediT) was developed to explicitly define author roles, but there is a lack of empirical data on how CRediT is used in clinical trials. This study aimed to provide empirical data on the use of CRediT in randomized controlled trials (RCTs) and discuss some limitations of CRediT. A new taxonomy (CRediT-RCT) is proposed to explicitly define the author roles in RCTs. Methods The electronic database of PubMed was searched from July 2017 to October 2019 to identify component trials with a randomized controlled design. Publications from the Public Library of Science (PLoS) were included because they embed the CRediT roles within the authors' metadata rather than solely as a separate paragraph of text. Results A total of 446 articles involving 4,185 authors were included in the study. Most authors participated in the study's conceptualization (44.9%) and investigation (48.8%), but only a fraction of the authors participated in software management (7.4%). Many CRediT roles were correlated with each other: the strongest correlation was the one between funding acquisition and conceptualization (correlation metric =0.39), followed by the one between conceptualization and methodology (0.37). The authors who acquired funding (OR: 2.06; 95% CI: 1.54-2.76; P<0.001), did project administration (OR: 1.54; 95% CI: 1.17-2.03; P=0.002), performed supervision (OR: 2. 60; 95% CI: 1.93-3.52; P<0.001), wrote the original draft (OR: 4.83; 95% CI: 3.54-6.60; P<0.001), or were the first author (OR: 7.85; 95% CI: 5.71-10.87; P<0.001), were more likely to be the corresponding author. Also, while the original draft writing was significantly associated with the designation of the first author (OR: 37.49; 95% CI: 25.29-57.57; P<0.001), the first author did not perform review and editing (OR: 0.55; 95% CI: 0.40-0.75; P<0.001), supervision (OR: 0.49; 95% CI: 0.36-0.67; P<0.001), or resource management (OR: 0.71; 95% CI: 0.50-1.00; P=0.053). We further propose a novel Contributor Roles Taxonomy for Randomized Controlled Trials (CRediT-RCT) which includes 10 roles. Conclusions The present study provides empirical data on the use of CRediT for RCTs, and some limitations of the taxonomy are discussed. We further propose a new CRediT-RCT which includes 10 roles.
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Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | | | - Grace S Li
- AME Publishing Company, Hong Kong, China
| | - Guilan Kong
- National Institute of Health Data Science, Peking University, Beijing, 100191, China.,Center for Data Science in Health and Medicine, Peking University, Beijing, 100191, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100000, China
| | - Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIVER-CV, c/Diego de León 62. Madrid, Spain
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Mentz RJ, Peterson ED. Site Principal Investigators in Multicenter Clinical Trials: Appropriately Recognizing Key Contributors. Circulation 2018; 135:1185-1187. [PMID: 28348087 DOI: 10.1161/circulationaha.116.026650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert J Mentz
- From Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC.
| | - Eric D Peterson
- From Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC
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7
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Armstrong PW, Mentz RJ, Westerhout CM. Traveling the Interstices of Data Sharing. JACC-HEART FAILURE 2018; 6:533-535. [PMID: 29655824 DOI: 10.1016/j.jchf.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Paul W Armstrong
- Canadian VIGOUR Centre and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada.
| | - Robert J Mentz
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Cynthia M Westerhout
- Canadian VIGOUR Centre and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
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8
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Moderate exercise training attenuates aging-induced cardiac inflammation, hypertrophy and fibrosis injuries of rat hearts. Oncotarget 2016; 6:35383-94. [PMID: 26496028 PMCID: PMC4742112 DOI: 10.18632/oncotarget.6168] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/04/2015] [Indexed: 01/09/2023] Open
Abstract
Aging is the most important risk factor in cardiovascular disease (CVD), which is the leading causes of death worldwide and the second major cause of death in Taiwan. The major factor in heart failure during aging is heart remodeling, including long-term stress-induced cardiac hypertrophy and fibrosis. Exercise is good for aging heart health, but the impact of exercise training on aging is not defined. This study used 3-, 12- and 18-month-old rats and randomly divided each age group into no exercise training control groups (C3, A12 and A18) and moderate gentle swimming exercise training groups (E3, AE12 and AE18). The protocol of exercise training was swimming five times weekly with gradual increases from the first week from 20 to 60 min for 12 weeks. Analyses of protein from rat heart tissues and sections revealed cardiac inflammation, hypertrophy and fibrosis pathway increases in aged rat groups (A12 and A18), which were improved in exercise training groups (AE12 and AE18). There were no heart injuries in young rat hearts in exercise group E3. These data suggest that moderate swimming exercise training attenuated aging-induced cardiac inflammation, hypertrophy and fibrosis injuries of rat hearts.
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Ambrosy AP, Mentz RJ, Krishnamoorthy A, Greene SJ, Severance HW. Identifying Barriers and Practical Solutions to Conducting Site-Based Research in North America: Exploring Acute Heart Failure Trials As a Case Study. Heart Fail Clin 2015; 11:581-9. [PMID: 26462098 DOI: 10.1016/j.hfc.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although the prognosis of ambulatory heart failure (HF) has improved dramatically there have been few advances in the management of acute HF (AHF). Despite regional differences in patient characteristics, background therapy, and event rates, AHF clinical trial enrollment has transitioned from North America and Western Europe to Eastern Europe, South America, and Asia-Pacific where regulatory burden and cost of conducting research may be less prohibitive. It is unclear if the results of clinical trials conducted outside of North America are generalizable to US patient populations. This article uses AHF as a paradigm and identifies barriers and practical solutions to successfully conducting site-based research in North America.
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Affiliation(s)
- Andrew P Ambrosy
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Road Drive, Durham, NC 27710, USA.
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Road Drive, Durham, NC 27710, USA; Division of Cardiology, Duke Clinical Research Institute, 2301 Erwin Road Drive, Durham, NC 27710, USA
| | - Arun Krishnamoorthy
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Road Drive, Durham, NC 27710, USA; Division of Cardiology, Duke Clinical Research Institute, 2301 Erwin Road Drive, Durham, NC 27710, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, 2301 Erwin Road Drive, Durham, NC 27710, USA
| | - Harry W Severance
- Erlanger Institute for Clinical Research, 973 E. 3rd St. Ste B1203, Chattanooga, TN 37403, USA
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