International Differences in Treatment and Clinical Outcomes for High Grade Glioma.

BACKGROUND: High grade gliomas are the most common type of malignant brain tumor, and despite their rarity, cause significant morbidity and mortality. This study aimed to compare the treatment patterns of high grade glioma to examine survival patterns in patients who receive specific treatments between cohorts in Ohio and Taiwan. METHOD: Patients aged 18 years and older at age of diagnosis with World Health Organization (WHO) grade III or IV astrocytoma from 2007-2012 were selected from the Ohio Brain Tumor Study and the Taiwan Cancer Registry. The treatment information was derived from medical chart reviews in Ohio and National Health Insurance Research Data in Taiwan. Treatment examined included surgical procedure (brain biopsy and/or resection), radiotherapy (radiation and/or radiosurgery), and alkylating chemotherapy. Kaplan-Meier and parametric survival models were used to examine the effect of treatment on survival, adjusted for age, sex, and comorbidities. RESULTS: 294 patients in Ohio and 1,097 patients in Taiwan met the inclusion criteria. 70.3% patients in Ohio and 51.4% in Taiwan received surgical resection, followed by concurrent chemoradiation. Patients who received this treatment had the highest survival rate, with a 1-year survival rate of 72.8% in Ohio and 73.4% in Taiwan. Patients who did not receive surgical resection, followed by concurrent chemoradiation had an increased risk of death (hazard ratio of 5.03 [95% confidence interval (CI): 3.61-7.02] in Ohio and 1.49 [95% CI: 1.31-1.71] in Taiwan) after adjustment for age, sex, and comorbidities. CONCLUSION: Surgical resection followed by concurrent chemoradiation was associated with higher survival rate of patients with high grade glioma in both Ohio and Taiwan; however, one-third of patients in Ohio and half in Taiwan did not receive this treatment.

Electroencephalography when meditation advances: a case-based time-series analysis.

Increased alpha and theta activities in electroencephalography (EEG) have been found during various forms of meditation. However, advanced stage of meditation drew less attention to date. We aimed at exploring EEG characteristics during advanced meditation. Bilateral absolute alpha and theta EEG powers were recorded when a single meditator at rest, exercising breath meditation, and reaching the advanced meditative stage in 10 sessions of meditation. Averaged time-series data were analyzed using simulation modeling analysis to compare the powers during different meditative phases. During breath meditation, significantly higher activities compared with baseline were found only in bilateral theta (P = 0.0406, 0.0158 for left and right sides, respectively), but not in alpha (P = 0.1412, 0.0978 for left and right sides, respectively) bands. When meditation advanced, significantly increased activities were found both in bilateral alpha (P = 0.0218, 0.0258 for left and right sides, respectively) and theta (P = 0.0308, 0.0260 for left and right sides, respectively) bands compared against breath meditation. When advanced meditation compared against baseline, bilateral alpha (P = 0.0001, 0.0001 for left and right sides, respectively) and theta (P = 0.0001, 0.0001 for left and right sides, respectively) bands revealed significantly increased activities. Our findings support that internalized attention manifested as theta activity continuingly enhances significantly in sequential phases of meditation, while relaxation manifested as alpha activity is significant only after the advanced meditative phase is reached.

The relationship between antihypertensive combination therapies comprising diuretics and/or beta-blockers and the risk of new-onset diabetes: a retrospective longitudinal cohort study.

We investigate the associations of antihypertensive drugs in double and triple combination regimens comprising diuretics and/or beta-blockers on the development of new-onset diabetes (NOD). This study was a retrospective cohort study carried out using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance (BNHI) in Taiwan from January 2001 to December 2006. We estimated the odds ratios (ORs) of NOD associated with antihypertensive combination therapy use; non-NOD individuals served as the reference group. A total of 2361 NOD cases were identified among the 12,386 hypertensive patients (6143 men and 6243 women, aged 28-86 years (mean age: 68+11)) during the study period. The risk of NOD was higher after adjusting for age and sex among users of double combinations of diuretics plus beta-blockers (adjusted OR, 1.25; 95% confidence interval (CI): 1.12-1.58), diuretics plus calcium channel blockers (CCBs; adjusted OR: 1.14; 95% CI: 1.06-1.26) and beta-blockers plus calcium channel blockers (adjusted OR: 1.12; 95% CI: 1.04-1.29) than that among non-users. Patients who took angiotensin-converting enzyme (ACE) inhibitors, or alpha-blockers as part of a double-drug regimen were at a lower risk of developing NOD than were non-users. Double- or triple-drug combinations comprising angiotensin receptor blockers (ARBs) and vasodilators were not associated with risk of NOD. The results of this study suggest that users of double-drug combination therapies containing diuretics and/or beta-blockers and an ACE inhibitor or alpha-blocker are at a significantly lower risk of developing NOD than are other classes.