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"Chen, Chun-hung"
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Abatacept in B7-1–Positive Proteinuric Kidney Disease
This report describes five patients with treatment-resistant focal segmental glomerulosclerosis and positive B7-1 immunostaining who had a response to abatacept (CTLA-4–Ig), a costimulatory inhibitor that targets B7-1 (CD80).
The renal glomeruli are highly specialized structures that ensure selective ultrafiltration of plasma, by which most proteins are retained in the blood.
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The glomerular filtration barrier consists of the glomerular capillary endothelium, the glomerular basement membrane, and specialized cells, the podocytes, that serve as a final barrier to urinary loss of plasma proteins.
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Disrupted podocyte function damages the kidney filtration mechanism, resulting in proteinuria and, in some circumstances, the nephrotic syndrome.
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Proteinuria is common to a heterogeneous group of kidney diseases, including minimal-change disease, FSGS, membranous nephropathy, and diabetic nephropathy, all of which affect millions of persons worldwide and often . . .
Journal Article
Oligopoly Modeling between Public and Private Companies with Complementarity
This study investigated the coexistence of public and private companies using a complementary model to explore mixed oligopoly strategies. Compared to the traditional theory of mixed oligopoly, the main difference of this study is that it revealed that the products produced by both companies are completely complementary. The five findings of the study were as follows: First, under the premise of having one firm classified as a public firm, although it can reach the equilibrium of the maximum solution for social welfare, this causes a loss. Second, more seriously, the private firm would view this as a huge incentive and aggressively pursue to be the price leader, which may result in a greater loss for the public firm. Third, the asymmetry of the model of the complementary mixed oligopoly is of note; that is, when the private firm is in aggressive pursuit to be the price leader, it can elevate its profit margin, but when the public firm is aggressively pursuing be the price leader, this would not result in better profits. Fourth, if the public firm is under budgetary constraints, then the private firm would have no incentive to aggressively pursue being the price leader. Fifth, if the price of the product between the public firm and the private firm is a “strategic substitute,” the coexistence of the public firm and the private firm will be better than total privatization.
Journal Article
The greybody factor for the monopole and odd-parity modes of the Proca field in the Schwarzschild black hole spacetimes
The greybody factor is one of the famous results of the black hole perturbation theory, which describes the transmission probability of a particle radiated by a black hole into spatial infinity. In this work, we separated the angular parts of the equations of motion and derived the radial equations for the Proca field in the Schwarzschild black hole spacetime. The radial equations for the monopole and odd-parity modes are fully decoupled in the Schr ö dinger-like form. We study the greybody factor by determining the rigorous bound.
Journal Article
Safety and Tolerability of Intra-Articular Injection of Adipose-Derived Mesenchymal Stem Cells GXCPC1 in 11 Subjects With Knee Osteoarthritis: A Nonrandomized Pilot Study Without a Control Arm
The current study aimed to determine the safety profile of intra-articular-injected allogeneic adipose-derived mesenchymal stem cells (ADSCs) GXCPC1 in subjects with knee osteoarthritis (OA) and its preliminary efficacy outcome. The 3 + 3 phase I study was designed with two dose-escalation cohorts: low dose (6.7 × 106 GXCPC1, N = 5) and high dose (4 × 107 GXCPC1, N = 6). The primary endpoint was safety, which was evaluated by recording adverse events throughout the trial; the secondary endpoints included total, pain, stiffness, and function subscales of the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, and 12-Item Short Form (SF-12) health survey questionnaire. The GXCPC1 treatment was found to be safe after 1 year of follow-up with no treatment-related severe adverse events observed. When compared to baseline, subjects in both the low- and high-dose cohorts demonstrated improving trends in pain and knee function after receiving GXCPC1 treatment. Generally, the net change in pain (95% confidence interval (CI) = −7.773 to −2.561t at 12 weeks compared to baseline) and knee function (95% CI = −24.297 to −10.036t at 12 weeks compared to baseline) was better in subjects receiving high-dose GXCPC1. Although this study included a limited number of subjects without a placebo arm, it showed that the intra-articular injection of ADSCs was safe and well-tolerated in subjects with therapeutic alternatives to treat knee OA. However, a larger scale study with an appropriate control would be necessary for clinical efficacy in the following study.
Journal Article
Overcoming barriers in continuous glucose monitoring: Challenges and future directions in diabetes management
Recent updates on the efficacy of continuous glucose monitoring (CGM) and a critical examination of the current challenges in its implementation were summarized. The barriers to widespread adoption of this technology should be addressed, considering the impact of different cultural contexts. The strategies to overcome these obstacles and the benefits of CGM for future glucose management will be discussed. Primary reasons for CGM discontinuation.
Journal Article
Modification of Diet in Renal Disease (MDRD) Study and CKD Epidemiology Collaboration (CKD-EPI) Equations for Taiwanese Adults
Estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations may not be accurate for Asians; thus, we developed modified eGFR equations for Taiwanese adults.
This cross-sectional study compared the Taiwanese eGFR equations, the MDRD study, and the CKD-EPI equations with inulin clearance (Cin). A total of 695 adults including 259 healthy volunteers and 436 CKD patients were recruited. Participants from the Kaohsiung Medical University Hospital were used as the development set (N = 556) to develop the Taiwanese eGFR equations, whereas participants from the National Taiwan University Hospital were used as the validation set (N = 139) for external validation.
The Taiwanese eGFR equations were developed by using the extended Bland-Altman plot in the development set. The Taiwanese MDRD equation was 1.309 × MDRD0.912, Taiwanese CKD-EPI was 1.262×CKD-EPI0.914 and Taiwanese four-level CKD-EPI was 1.205 × four-level CKD-EPI0.914. In the validation set, the Taiwanese equations had the lowest bias, the Taiwanese equations and the Japanese CKD-EPI equation had the lowest RMSE, whereas the Taiwanese and the Japanese equations had the best precision and the highest P30 among all equations. However, the Taiwanese MDRD equation had higher concordance correlation than did the Taiwanese CKD-EPI, the Taiwanese four-level CKD-EPI and the Japanese equations. Moreover, only the Taiwanese equations had no proportional bias among all of the equations. Finally, the Taiwanese MDRD equation had the best diagnostic performance in terms of ordinal logistic regression among all of the equations.
The Taiwanese MDRD equation is better than the MDRD, CKD-EPI, Japanese, Asian, Thai, Taiwanese CKD-EPI, and Taiwanese four-level CKD-EPI equations for Taiwanese adults.
Journal Article
Hepatitis C Virus Infection Increases Risk of Developing End-Stage Renal Disease Using Competing Risk Analysis
Chronic kidney disease (CKD) and hepatitis C virus (HCV) infection are closely linked and both increase patient mortality. The association of HCV and risk of developing end-stage renal disease (ESRD) has not been analyzed with competing risk model.
We enrolled a prospective cohort of 4,185 patients (mean age, 62 years; 41% female) registered in the CKD integrated care program at two affiliated hospitals of Kaohsiung Medical University in Taiwan between November 11, 2002 and May 31, 2009. With competing risk model, we analyzed the association of HCV infection, defined by seropositive of anti-HCV antibody, and hepatitis B virus (HBV) infection, defined by seropositive of HBV surface antigen, with the risk of entering ESRD.
The prevalence of HCV infection was 7.6% and it increased with the CKD stages (trend test, P<0.001), while the prevalence of HBV infection was 7.4% and no specific trend among CKD stages (tend test, P = 0.1). During the 9,101 person-year follow-up period, there were 446 death and 1,205 patients entering ESRD. After adjusting death as the competing risk, the estimated 5-year cumulative incidence rate of ESRD among patients with and without HCV infection were 52.6% and 38.4%, respectively (modified log-rank, P<0.001). Multivariable analysis showed that HCV infection, but not HBV infection, had higher risk of developing ESRD compared with cases without infection (HCV, HR: 1.32, 95% CI: 1.07-1.62; HBV, HR: 1.10, 95% CI: 0.89-1.35). Subgroup analyses showed consistent results.
With death-adjusted competing risk analysis, HCV infection is associated with an increased risk of developing ESRD in CKD cohort.
Journal Article
The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study
Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings : We compared a pesticide/detergent intoxication cohort (N = 21,840) and an age- and gender-matched control cohort (N = 21,840) identified from the National Health Insurance Research Database between 2000 and 2011. We used the multivariable Cox proportional model to determine esophageal carcinoma risk. The overall incidence density of esophageal cancer was 1.66 per 10,000 person-years in the comparison cohort and 4.36 per 10,000 person-years in the pesticide/detergent intoxication cohort. The corresponding adjusted hazard ratio (HR) for esophageal cancer was 2.33 (95% confidence interval [CI] = 1.41–3.86) in the pesticide/detergent intoxication cohort compared with the control cohort. Patients with corrosive and detergent intoxication did not have a higher risk of esophageal cancer (adjusted HR = 0.98, 95% CI = 0.29–3.33) than those without pesticide/detergent intoxication. However, patients with pesticide intoxication had a significantly higher risk of esophageal cancer (adjusted HR = 2.52, 95% CI = 1.52–4.18) than those without pesticide/detergent intoxication. Conclusion : In the present study, after adjusting for conventional risk factors, we observed that pesticide intoxication could exert substantial effects through increased esophageal cancer risk. However, patients with detergent intoxication may not have an increased risk of esophageal cancer.
Journal Article
The interaction between self-care behavior and disease knowledge on the decline in renal function in chronic kidney disease
Multidisciplinary care can improve the outcomes of chronic kidney disease (CKD), however the contribution of self-care behavior and knowledge about CKD is unclear. This study enrolled 454 participants with CKD stages 1–5 not on dialysis. Structured questionnaires were used to evaluate self-care behavior and kidney disease knowledge. Rapid decline in renal function was defined as the decline in estimated filtration rate > 3 ml/min per 1.73 m
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/year within 1-year prior to enrollment. The mean age of all study participants was 65.8 ± 12.1 years and 55.9% were male. The elderly had better self-care behavior while younger participants had better disease knowledge. Both high self-care and high disease knowledge scores were significantly associated with and had a synergistic effect on decreasing the risk of rapid decline in renal function. CKD patients with better self-care behavior and better kidney disease knowledge had lower risk of rapid decline in renal function.
Journal Article