Healthcare costs attributable to the treatment of patients with spinal metastases:a cohort study with up to 8 years follow-up

BACKGROUND: Cancer treatment, and in particular end-of-life treatment, is associated with substantial healthcare costs. The purpose of this study was to analyse healthcare costs attributable to the treatment of patients with spinal metastases. METHODS: The study population (n = 629) was identified from clinical databases in Denmark. Patients undergoing spinal metastasis treatment from January 2005 through June 2012 were included. Clinical data were merged with national register data on healthcare resource use, costs and death date. The analytic period ranged from treatment initiation until death or administrative censoring in October 2013. Analysis of both survival and costs were stratified into four treatment regimens of increasing invasiveness: radiotherapy (T1), decompression (T2), decompression + instrumentation (T3) and decompression + instrumentation + reconstruction (T4). Survival was analysed using Kaplan-Meier curves. Costs were estimated from a healthcare perspective. Lifetime costs were defined as accumulated costs from treatment initiation until death. The Kaplan-Meier Sampling Average method was used to estimate these costs; 95% CIs were estimated using nonparametric bootstrapping. RESULTS: Mean age of the study population was 65.2 years (range: 19-95). During a mean follow-up period of 9.2 months (range: 0.1-94.5 months), post treatment survival ranged from 4.4 months (95% CI 2.5-7.5) in the T1 group to 8.7 months (95% CI 6.7-14.1) in the T4 group. Inpatient hospitalisation accounted for 65% and outpatient services for 31% of the healthcare costs followed by hospice placements 3% and primary care 1%. Lifetime healthcare costs accounted for €36,616 (95% CI 33,835-39,583) per T1 patients, €49,632 (95% CI 42,287-57,767) per T2 patient, €70997 (95% CI 62,244-82,354) per T3 patient and €87,814 (95% CI 76,638-101,528) per T4 patient. Overall, 45% of costs were utilised within the first month. T1 and T4 patients had almost identical distributions of costs: inpatient hospitalisation averaged 59% and 36% for outpatient services. Costs of T2 and T3 were very similarly distributed with an average of 71% for inpatient hospitalisation and 25% for outpatient services. CONCLUSION: The index treatment accounts for almost half of lifetime health care costs from treatment initiation until death. As expected, lifetime healthcare costs are positively association with invasiveness of treatment

Lowest instrumented vertebra selection for Lenke 5C scoliosis

Study Design. A radiographical follow-up and analysis. Objective. To investigate the postoperative curve change in Lenke 5C scoliosis, and to discuss how to select lowest instrumented vertebra (LIV). Summary of Background Data. 5C curves are relatively rare in adolescent idiopathic scoliosis, and few studies have focused on this type of adolescent idiopathic scoliosis. Such questions as "How does the curve change over time in the postoperative period?" "Is LIV selection correlated with final correction and balance?" and "How should we select LIV for Lenke 5C curves?" need to be answered. Methods. We reviewed all the adolescent idiopathic scoliosis cases surgically treated in an institution from 2002 through 2008. Inclusion criteria were as follows: (1) patients with Lenke 5C curves who were treated with selective lumbar fusion; (2) minimum 2-year radiographical follow-up. All image data were available and all measurements were performed in picture archiving and communication systems. Standing posteroanterior and lateral digital radiographs were reviewed at 4 junctures: preoperative, immediate postoperative, 3 months, and 2 years postoperatively. Results. Thirty patients met the inclusion criteria. The following results were observed: (1) From the perspectives of both Cobb angle and vertebral translation, significant correction was achieved; (2) The correction obtained by surgery was well retained in the postoperative period; (3) Although preoperative spinal imbalance was common in this group of patients, the majority eventually attained balance at 2 years; (4) LIV selection was significantly correlated with the 2-year correction and balance; (5) In the literature as well as in this study, the overall preoperative LIV-center sacral vertical line distance is 28 mm and the overall preoperative LIV tilt is 25 degrees. Conclusion. In Lenke 5C scoliosis, preoperative spinal imbalance is common, although the majority of patients attain balance at 2 years. Signifi cant correction loss is not common in the postoperative period. LIV selection signifi cantly correlates with 2-year correction and balance. A translation of 28 mm and a tilt of 25 degrees may be used as a general criterion for selecting LIV.Clinical NeurologyOrthopedicsSCI(E)5ARTICLE14E894-E9003

Statistical evaluation of nano-structured hydroxyapatite mechanical characteristics by employing the Vickers indentation technique

In this study, the mechanical characteristics of hydroxyapatite (HA) against the Vickers indenter under different loads were investigated. For this purpose, the HA powders were first synthesized by a one-pot solvothermal method. The powders were then subjected to consolidating by the spark plasma sintering (SPS) method for mechanical evaluation. Characterization methods used in this study included X-rays diffraction, field emission scanning electron microscopy, transmission electron microscopy, inductively coupled plasma, energy dispersive X-ray spectroscopy, and Vickers indentation technique. The findings of this study showed that the morphology of the synthesized powders by solvothermal method were rod-shaped and nanometer-sized. As the applied load increased to 2 N, the elastic modulus increased but the hardness did not change much. At a constant force, the contact depth increased with decreasing elastic modulus and hardness. Also, increasing contact depth increased the stiffness and contact area. The results of this study will be useful for investigating the mechanical properties of HA based materials

Comparison of the effect of argon, hydrogen, and nitrogen gases on the reduced graphene oxide-hydroxyapatite nanocomposites characteristics

In this study, the effect of the argon, nitrogen, and hydrogen gases on the final properties of the reduced graphene oxide-hydroxyapatite nanocomposites synthesized by gas injected hydrothermal method was investigated. Four samples were synthesized, which in the first sample the pressure was controlled by volume change at a constant concentration. In subsequent samples, the pressure inside the autoclave was adjusted by the injecting gases. The initial pressure of the injected gases was 10 bar and the final pressure considered was 25 bar. The synthesized powders were consolidated at 950 °C and 2 MPa by spark plasma sintering method. The final samples were subjected to Vickers indentation analysis. The findings of this study indicate that the injection of argon, hydrogen, and nitrogen gases improved the mechanical properties of the nanocomposites. Injection of gases increased the crystallinity and particle size of hydroxyapatite, and this increase was greater for nitrogen gas than for others. Injection of these gases increased the rate of graphene oxide reduction and in this case the effect of nitrogen gas was greater than the others. [Figure not available: See fulltext.]There is no official funding. XRD and FTIR were performed at Tarbiat Modares University (Iran). Raman spectroscopy and Indentation testing were performed at ICV-CSIC (Spain), and the SEM and TEM analyses were performed at Aarhus University (Denmark)