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El Alaoui O, Jelti O, Lachkar A, Najib A, Yacoubi H. Megaprosthesis Total Knee Replacement Following Resection of Extensive Osteoblastic Osteosarcoma in the Distal Femur: A Case Report. Cureus 2024; 16:e56971. [PMID: 38665714 PMCID: PMC11045034 DOI: 10.7759/cureus.56971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Osteosarcoma is the most common type of primary bone cancer, which usually appears in the distal femur. The diagnosis of this condition typically involves advanced imaging and tissue biopsy, as well as taking into account characteristic clinical and radiographic indicators. The treatment approach for distal femoral osteosarcoma is multidisciplinary and involves initial chemotherapy, followed by limb-sparing surgery, reconstruction of bone and soft tissue, and subsequent adjuvant chemotherapy. We present a case study of a 25-year-old male admitted with a blastic lesion in the distal femur, confirmed via open biopsy to be osteoblastic osteosarcoma. Further evaluation revealed multiple pulmonary nodular lesions, managed with chemotherapy. After four months, regression of the lesion was observed. Due to malignant clinical and imaging features, excision of the lesion and subsequent reconstruction were performed, utilizing a custom-made total knee arthroplasty. The excision encompassed the removal of the distal 14 cm of the femur, with histological examination confirming central osteoblastic osteosarcoma. Satisfactory outcomes were observed during a one-year follow-up, indicating promising results. Vigilance is crucial, especially in young patients with surface-type bone tumors, as this neoplasm requires consideration.
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Affiliation(s)
- Oussama El Alaoui
- Orthopedics and Traumatology, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda - CHU Mohammed VI Oujda, Oujda, MAR
| | - Ousama Jelti
- Orthopedics, Traumatology and Orthopedic, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Adnane Lachkar
- Orthopedic Trauma, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Abdeljaouad Najib
- Traumatology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Hicham Yacoubi
- Orthopedic Trauma, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
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Ruggieri P. CORR Insights®: Proximal Femur Replacements for an Oncologic Indication Offer a Durable Endoprosthetic Reconstruction Option: A 40-year Experience. Clin Orthop Relat Res 2023; 481:2244-2246. [PMID: 37707538 PMCID: PMC10567026 DOI: 10.1097/corr.0000000000002849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Pietro Ruggieri
- Head, Department of Orthopedics and Orthopedic Oncology, University of Padua, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
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Babazadeh-Naseri A, Li G, Shourijeh MS, Akin JE, Higgs Iii CF, Fregly BJ, Dunbar NJ. Stress-shielding resistant design of custom pelvic prostheses using lattice-based topology optimization. Med Eng Phys 2023; 121:104012. [PMID: 37985018 DOI: 10.1016/j.medengphy.2023.104012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/20/2023] [Accepted: 06/22/2023] [Indexed: 11/22/2023]
Abstract
Endoprosthetic reconstruction of the pelvic bone using 3D-printed, custom-made implants has delivered early load-bearing ability and good functional outcomes in the short term to individuals with pelvic sarcoma. However, excessive stress-shielding and subsequent resorption of peri‑prosthetic bone can imperil the long-term stability of such implants. To evaluate the stress-shielding performance of pelvic prostheses, we developed a sequential modeling scheme using subject-specific finite element models of the pelvic bone-implant complex and personalized neuromusculoskeletal models for pre- and post-surgery walking. A new topology optimization approach is introduced for the stress-shielding resistant (SSR) design of custom pelvic prostheses, which uses 3D-printable porous lattice structures. The SSR optimization was applied to a typical pelvic prosthesis to reconstruct a type II+III bone resection. The stress-shielding performance of the optimized implant based on the SSR approach was compared against the conventional optimization. The volume of the peri‑prosthetic bone predicted to undergo resorption post-surgery decreased from 44 to 18%. This improvement in stress-shielding resistance was achieved without compromising the structural integrity of the prosthesis. The SSR design approach has the potential to improve the long-term stability of custom-made pelvic prostheses.
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Affiliation(s)
| | - Geng Li
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | | | - John E Akin
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | - C Fred Higgs Iii
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | - Nicholas J Dunbar
- Department of Orthopedic Surgery, University of Texas Health Science Center, Houston, TX 77030, USA.
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Trikha R, Greig DE, Olson TE, Kendal JK, Geiger EJ, Wessel LE, Eckardt JJ, Bernthal NM. Proximal Femur Replacements for an Oncologic Indication Offer a Durable Endoprosthetic Reconstruction Option: A 40-year Experience. Clin Orthop Relat Res 2023; 481:2236-2243. [PMID: 37458708 PMCID: PMC10566928 DOI: 10.1097/corr.0000000000002765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/22/2023] [Accepted: 06/08/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Proximal femur replacements (PFRs) are an effective surgical option to treat primary and metastatic tumors causing large bony defects in the proximal femur. Given the relative rarity of these indications, current studies on PFR for oncologic indications are generally limited by patient volume or relatively short-term follow-up. Because recent advances in systemic therapy have improved the prognosis of patients who undergo limb salvage surgery for musculoskeletal tumors, data on the long-term durability of endoprosthetic reconstructions have become increasingly important. QUESTIONS/PURPOSES (1) How does the long-term survival of cemented bipolar PFRs compare with patient survival in patients who underwent PFR for benign, aggressive, and metastatic tumors? (2) What are common reasons for revisions of primary PFRs? (3) Which factors are associated with survival of primary PFRs? (4) What is the survivorship free from conversion of bipolar PFRs to THA? METHODS Between January 1, 1980, and December 31, 2020, we treated 812 patients with an endoprosthetic reconstruction for an oncologic indication. All patients who underwent a primary PFR for an oncologic indication were included in this study. The study cohort consisted of 122 patients receiving a primary PFR. Eighteen patients did not reach a censored endpoint such as death, revision, or amputation within 2 years. Thirty-three patients died within 2 years of their surgery. Of the 122 patients with primary PFRs, 39 did not reach a censored endpoint and have not been seen within the past 5 years. However, the mean follow-up time for these patients was longer than 10 years. The Social Security Death Index was queried to identify any patients who may have died but might not have been captured by our database To allow for adequate follow-up, endoprosthetic reconstructions performed after December 31, 2020 were excluded. The mean age at the time of the index surgery was 48 ± 22 years. The mean follow-up time of surviving patients was 7 ± 8 years. All PFRs were performed using a bipolar hemiarthroplasty with a cemented stem, and all implants were considered comparable. Demographic, oncologic, procedural, and outcome data including prosthesis survival, patient survival, complication rates, and rates of conversion to THA were analyzed. Patient, prosthesis, and limb salvage survival rates were generated, with implant revision as the endpoint and death as a competing risk. Statistical significance was defined as p < 0.05. RESULTS Generally, patients with benign or low-grade (Stage I) disease outlived their implants (100% patient survival through 30 years; p = 0.02), whereas the opposite was true in patients with high-grade, localized Stage II disease (64% patient survival at 5 years [95% CI 49% to 76%]; p = 0.001) or widespread Stage III metastatic disease (6.2% patient survival at 5 years [95% CI 0.5% to 24%]; p < 0.001). Primary PFR implant survival at 5, 10, 20, and 30 years was 97% (95% CI 90% to 99%), 81% (95% CI 67% to 90%), 69% (95% CI 46% to 84%), and 51% (95% CI 24% to 73%), respectively. Eight percent (10 of 122) of primary PFRs were revised for any reason. The most common causes of revision were aseptic loosening (3% [four of 122]), infection (3% [three of 122]), breakage of the implant (2% [two of 122]), and tumor progression (1% [one of 122]). Follow-up time was the only factor that was associated with revision of primary PFRs. Neither segment length nor stem length were associated with revision of primary. Six percent (seven of 122) of PFRs were converted to THA at a mean 15 ± 8 years from the index procedure. Survivorship free from conversion to THA (accounting for death as a competing risk) was 94% (95% CI 85% to 99%), 86% (95% CI 68% to 94%). and 77% (95% CI 51% to 91%) at 10, 20, and 30 years, respectively. CONCLUSION Cemented bipolar PFRs for an oncologic indication are a relatively durable reconstruction technique. Given the relative longevity and efficacy of PFRs demonstrated in our study, especially in patients with high-grade or metastatic disease where implant survival until all-cause revision was longer than patient survival, surgeons should continue to seriously consider PFRs in appropriate patients. The relative rarity of these reconstructions limits the number of patients in this study as well as in current research; thus, further multi-institutional collaborations are needed to provide the most accurate prognostic data for our patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Rishi Trikha
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Danielle E. Greig
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Thomas E. Olson
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Joseph K. Kendal
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Erik J. Geiger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Lauren E. Wessel
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeffrey J. Eckardt
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA
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Kendal JK, Slawaska-Eng D, Gazendam A, Schneider P, Wessel LE, Ghert M, Bernthal NM. Risk Factors for All-Cause Early Reoperation Following Tumor Resection and Endoprosthetic Reconstruction: A Secondary Analysis from the PARITY Trial. J Bone Joint Surg Am 2023; 105:4-9. [PMID: 37466573 DOI: 10.2106/jbjs.22.00815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Oncologic resection and endoprosthetic reconstruction of lower-extremity musculoskeletal tumors are complex procedures fraught with multiple modes of failure. A robust assessment of factors contributing to early reoperation in this population has not been performed in a large prospective cohort. The aim of the present study was to assess risk factors for early reoperation in patients who underwent tumor excision and endoprosthetic reconstruction, with use of data from the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. METHODS Baseline characteristics were assessed, including age, sex, tumor type, tumor location, presence of a soft-tissue mass, diabetes, smoking status, chemotherapy use, and neutropenia. Operative factors were recorded, including operative time, topical antibiotics, silver-coated prosthetics, endoprosthetic fixation, extra-articular resection, length of bone resected, margins, tranexamic acid, postoperative antibiotics, negative-pressure wound therapy, and length of stay. Univariate analysis was utilized to explore the differences between patients who did and did not undergo reoperation within 1 year postoperatively, and a multivariate Cox proportional hazards regression model was utilized to explore the predictors of reoperation within 1 year. RESULTS A total of 155 (25.7%) of 604 patients underwent ≥1 reoperation. In univariate analysis, tumor type (p < 0.001), presence of a soft-tissue mass (p = 0.045), operative time (p < 0.001), use of negative-pressure wound therapy (p = 0.010), and hospital length of stay (p < 0.001) were all significantly associated with reoperation. On multivariate assessment, tumor type (benign aggressive bone tumor versus primary bone malignancy; hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.63; p = 0.01), operative time (HR per hour, 1.15; 95% CI, 1.10 to 1.23; p < 0.001), and use of negative-pressure wound therapy (HR, 1.93; 95% CI, 1.30 to 2.90; p = 0.002) remained significant predictors of reoperation within 1 year. CONCLUSIONS Independent variables associated with reoperation within 1 year in patients who underwent tumor resection and endoprosthetic reconstruction included tumor type (benign aggressive bone tumor versus primary bone malignancy), operative time, and use of negative-pressure wound therapy. These results will help to inform patients and surgeons regarding the risk of reoperation by diagnosis and reinforce operative time as a factor influencing reoperation. These results also support further investigation into the use of negative-pressure wound therapy at the time of surgery in this patient population. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph K Kendal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Schneider
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Wessel
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
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Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
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Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
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The First FDA Approved Early Feasibility Study of a Novel Percutaneous Bone Anchored Prosthesis for Transfemoral Amputees: A Prospective One-year Follow-up Cohort Study. Arch Phys Med Rehabil 2022; 103:2092-2104. [DOI: 10.1016/j.apmr.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
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Rajasekaran RB, Ashford R, Stevenson JD, Pollock R, Rankin KS, Patton JT, Gupta S, Cosker TDA. Reconstruction after resection of a proximal humeral tumour : what challenges remain? Bone Joint J 2022; 104-B:3-5. [PMID: 34969269 DOI: 10.1302/0301-620x.104b1.bjj-2021-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Raja B Rajasekaran
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Robert Ashford
- East Midlands Sarcoma Service, Nottingham University Hospitals, Nottingham, UK
| | | | - Rob Pollock
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Kenneth S Rankin
- North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne University Hospitals, Newcastle upon Tyne, UK
| | | | - Sanjay Gupta
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Thomas D A Cosker
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
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Variability in the reported surgical techniques and methods for intercalary reconstruction following tumor resection. Surg Oncol 2021; 38:101610. [PMID: 34091268 DOI: 10.1016/j.suronc.2021.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is currently no consensus regarding the best techniques or surgical strategies with which to maximize intercalary allograft reconstruction outcomes. The purpose of the current study was to assess which techniques and methods are being utilized by North American orthopaedic oncologists. METHODS Members of the Musculoskeletal Tumor Society (MSTS) were invited to complete an anonymous online questionnaire. The survey presented participants with two clinical scenarios and interrogated them on their preferred type of allograft, method of compression and fixation, and additional techniques used. RESULTS One hundred and twenty-six physicians completed the questionnaire. The majority studied in the United States (82%) and worked at an academic medical center (71%). Over half (54%) reported seeing over 10 primary bone tumors every year. Respondents were split between preferring a structural allograft alone or using a combined allograft-vascularized fibular graft. A majority indicated a preference for plate(s) and screw fixation but were divided between the use of two compression plates with a spanning plate, a single compression plate with a spanning plate, and two compression plates with an intramedullary nail. Screw fixation preferences were split between the use of unicortical locking only, bicortical locking only, and a combination of unicortical and bicortical locking. Almost equal percentages of respondents reported they would have used two, three, or four screws in both scenarios. Respondents were split between placing screws equidistantly and placing them peripherally within the allograft, adjacent to the allograft-host junction. DISCUSSION There is no clear surgical preference for intercalary reconstruction following tumor extirpation within this sample of orthopaedic oncologists. The current survey demonstrates variability across nearly every aspect of allograft reconstruction, which may, in part, explain the wide spectrum of outcomes reported within the literature. Prospective studies are warranted to better evaluate technique-specific outcomes in an effort to maximize reconstructive longevity and minimize allograft related complications.
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War AR, Dang K, Jiang S, Xiao Z, Miao Z, Yang T, Li Y, Qian A. Role of cancer stem cells in the development of giant cell tumor of bone. Cancer Cell Int 2020; 20:135. [PMID: 32351329 PMCID: PMC7183664 DOI: 10.1186/s12935-020-01218-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
The primary bone tumor is usually observed in adolescence age group which has been shown to be part of nearly 20% of the sarcomas known today. Giant cell tumor of bone (GCTB) can be benign as well as malignant tumor which exhibits localized dynamism and is usually associated with the end point of a long bone. Giant cell tumor (GCT) involves mononuclear stromal cells which proliferate at a high rate, multinucleated giant cells and stromal cells are equally present in this type of tumor. Cancer stem cells (CSCs) have been confirmed to play a potential role in the development of GCT. Cancer stem cell-based microRNAs have been shown to contribute to a greater extent in giant cell tumor of bone. CSCs and microRNAs present in the tumors specifically are a great concern today which need in-depth knowledge as well as advanced techniques to treat the bone cancer effectively. In this review, we attempted to summarize the role played by cancer stem cells involving certain important molecules/factors such as; Mesenchymal Stem Cells (MSCs), miRNAs and signaling mechanism such as; mTOR/PI3K-AKT, towards the formation of giant cell tumor of bone, in order to get an insight regarding various effective strategies and research advancements to obtain adequate knowledge related to CSCs which may help to focus on highly effective treatment procedures for bone tumors.
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Affiliation(s)
- Abdul Rouf War
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
| | - Kai Dang
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
| | - Shanfen Jiang
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
| | - Zhongwei Xiao
- Department of Neurology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399 People’s Republic of China
| | - Zhiping Miao
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
| | - Tuanmin Yang
- Honghui Hospital, Xi’an, Jiaotong University College of Medicine, Xi’an, Shaanxi China
| | - Yu Li
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
| | - Airong Qian
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
- NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an, 710072 Shaanxi China
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