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Background: Lung adenocarcinoma (LUAD) has a complex tumor heterogeneity. Our research attempts to clearness LUAD subtypes and build a reliable prognostic signature according to the activity changes of the hallmark and immunologic gene sets. Methods: According to The Cancer Genome Atlas (TCGA) - LUAD dataset, changes in marker and immune gene activity were analyzed, followed by identification of prognosis-related differential gene sets (DGSs) and their related LUAD subtypes. Survival analysis, correlation with clinical characteristics, and immune microenvironment assessment for subtypes were performed. Moreover, the differentially expressed genes (DEGs) between different subtypes were identified, followed by the construction of a prognostic risk score (RS) model and nomogram model. The tumor mutation burden (TMB) and tumor immune dysfunction and exclusion (TIDE) of different risk groups were compared. Results: Two LUAD subtypes were determined according to the activity changes of the hallmark and immunologic gene sets. Cluster 2 had worse prognosis, more advanced tumor and clinical stages than cluster 1. Moreover, a prognostic RS signature was established using two LUAD subtype-related DEGs, which could stratify patients at different risk levels. Nomogram model incorporated RS and clinical stage exerted good prognostic performance in LUAD patients. A shorter survival time and higher TMB were observed in the high-risk patients. Conclusions: Our findings revealed that our constructed prognostic signature could exactly predict the survival status of LUAD cases, which was helpful in predicting the prognosis and guiding personalized therapeutic strategies for LUAD.

Two new 13,28-epoxy oleanane-type triterpenoids, namely heterogenoside E and F, were isolated from Lysimachia heterogenea Klatt, together with the eight known compounds: palmitic acid, β-stigmasterol, kaempferol, quercetin, hyperin, isorhamnetin, isorhamnetin-3-O-galactopyranoside and anagallisin C. Heterogenoside F possesses acetoxyl groups at the unusual C-21 and C-22 positions of its oleanane skeleton. The cytotoxic activities of anagallisin C, heterogenoside E and F were weak.

Promoting competition between brand-name and generic drugs has long been recognized as an approach adopted to save on health care costs. However, there are substantial variations in the extent of the generic competition across countries. This study empirically estimates the determinants of the generic market share in Taiwan, wheremedical providers are in a position to profit directly fromthe sale of prescription drugs. Our empirical results point out that the profit-seeking behavior ofmedical providers plays an important and dominant role behind generic competition in the pharmaceutical market. As a result, there is a positive association between the generic-to-brand price ratio and the generic market share in Taiwan's pharmaceutical market, which contrasts with the conventional empirical finding that the relationship between the generic-to-brand price ratio and generic market share is negative. An important implication of our study is that the profitseeking behavior ofmedical providers undermines the policy effectiveness of using generic competition as the cost containment strategy in the health care market. [ABSTRACT FROM AUTHOR]

Objectives: Data from the Survey of Health and Living Status of the Middle-aged and the Elderly in Taiwan and the concentration index (CI) and relative index of inequality (RII) were used to examine inequalities in income-related mortality among the elderly in Taiwan. Methods: Survey data on the 60 and over population in 1999 and 2003 were linked to 2003-2007 data from a national death registry. Participants had been requested to provide information regarding annual income (including that of the respondent and his/her spouse). The income variable included nine categories ranging from below NTD 36000 to 1 million NTD and above. The sample was divided into three birth cohorts: before 1928, 1929-1946, and 1946-1953. Results: Results indicated that mortality was more pronounced among lower income groups of Taiwan's elderly. For example, age-adjusted CIs were -0.1222 and -0.1201 in 2003 and 2007, respectively, while age-adjusted RIIs were -0.7496 and -0.7355, respectively. In 2003, the CIs for the cohorts before 1928 and 1929-1946 were -0.1010 and -0.1301, while the RIIs were -0.6217 and -0.8023. In 2007, the CIs for the cohorts 1928, 1929-1946, and 1946-1953 were -0.0823, -0.0686 and -0.2887, respectively; while the RIIs were -0.5142, -0.4206 and -1.8061. These results indicated that the extent of inequality in mortality in the younger cohort was greater than that in the older cohorts. The decreased inequalities among the cohorts before 1928 and 1929-1946 also supported the age-asleveler hypothesis. Conclusions: Income-related inequalities in mortality exist among the elderly in Taiwan, but health inequalities increase with age. Policy efforts are needed to reduce the social disparities in health among the elderly and in the young or middle aged as well. [ABSTRACT FROM AUTHOR]

This study empirically examines the effect of hospital competition on prescribing behaviors of oral hypoglycemic agents (OHAs) for ambulatory care in a market setting where hospitals are classified into three levels according to the Taiwanese accreditation system. Without distinguishing the types of market structures and hospital levels, there might be no significant relationship between hospital competition and prescribing behavior. However, the relationship between competition and prescribing behaviors may differ among hospitals at various levels under each type of market structure. Our findings suggest that a market mechanism may improve the prescribing quality of regional and district hospitals under a market structure composed of three level hospitals where more medical resources and information are likely allocated. [ABSTRACT FROM AUTHOR]

Background/Aims: Preeclampsia (PE) is a gestational disorder defined as hypertension and proteinuria, which is deemed a major cause of maternal and neonatal mortality and morbidity worldwide. The aim of this study was to investigate the expression patterns of placental laminin (LN)-α5 expression in normal and PE pregnancies, as well as evaluating the effects of LN-α5 on trophoblast proliferation, apoptosis, and invasion. Methods: LN-α5 expression levels were examined by reverse-transcriptase polymerase chain reaction (RT-PCR), and further confirmed by western blotting and immunofluorescence staining. Cell proliferation and apoptosis were measured by CCK-8 assay and flow cytometry. Cell invasion was assessed by matrigel-based transwell assay. LN-α5 DNA methylation in placentas was determined by bisulfite sequencing PCR (BSP). Results: LN-α5 expression levels in PE placentas were significantly lower than that of normal pregnancies. Deficiency in LN-α5 expression resulted in decreased trophoblast proliferation and invasion but increased cell apoptosis, meanwhile, PI3K/AKT/mTOR signaling pathway was impaired by LN-α5 silencing. LN-α5 promoter methylation didn’t show significant difference between PE and normal placentas. Conclusion: LN-α5 downregulation is associated with PE placenta and impairs trophoblast viability and invasiveness, which could be a causative factor of PE pathogenesis.