Objective To investigate the impact of various distribution of bone cement on the early clinical outcomes in osteoporotic vertebral compression fracture (OVCF) patients treated with percutaneous kyphoplasty (PKP).Methods A total of 312 patients (54 males and 258 females,mean age 69.37 years) who diagnosed as OVCF and received PKP treatment from January 2015 to July 2017 were enrolled in the present study.All subjects were divided into two groups according to different distribution of bone cement:the shaped "O" distribution (group O,113 cases),in which bone cement in the vertebral body presented whole crumb,no separation or loss of bone cement,and the shaped "H" distribution (group H,199 cases),in which bone cement in the vertebral body presented two briquettes,connected with or without a small amount of bone cement.Demographic data,surgical details,radiographic data,and clinical outcomes (at preoperatively,two-days and one-year follow-up) were compared between the two groups.Results There was no significant difference in bone mineral density (BMD),operation duration,blood loss,and occurrence of leakage of bone cement between two groups.In comparison with group O,group H was accompanied with higher volume of injected bone cement and higher proportion of bilateral approach (P＜0.05).Both groups achieved significant improvement of VAS scores after surgery,while the group H had a dramatical reduction of VAS scores at one-year follow-up compared with two-days follow-up (P＜0.05).In addition,group H had a better restoration of VAS scores at one-year follow-up than group O (P＜0.05),though no significant difference was observed at preoperative and two-days follow-up.Both groups achieved significant improvement of radiographic data after surgery (P＜0.05) with similar effects of correction.Conclusion Either shaped "H" or shaped"O" distribution of bone cement can obtain satisfied early clinical effects of PKP for the treatment of OVCF.Compared with shaped "O" distribution,shaped "H" distribution can achieve better pain relief at early follow-up.

ObjectiveTo explore the current status and issues regarding the application of ancient books in clinical practice guidelines and expert consensus of traditional Chinese medicine （TCM） published in China， and to provide methodological recommendations for the incorporation of ancient books in the development of TCM guidelines. MethodsWe searched China National Knowledge Infrastructure （CNKI）， WanFang Data， VIP， SinoMed， PubMed， Embase， as well as six industry websites including China Association of Chinese Medicine， National Group Standards Information Platform， and Chinese Association of the Integration of Traditional and Western Medicine，etc. TCM clinical practice guidelines or expert consensus issued during January 1st， 2017， to November 26th， 2022 were searched. Clinical practice guidelines or expert consensus that explicitly referred to ancient books were included， and the content regarding the searching for ancient books， sources of access to ancient books， methods of evaluating the level of evidence， methods of evaluating the level of recommendation， and methods of evaluating the evidence for the ancient books were analysed. ResultsA total of 1,215 TCM clinical practice guidelines or expert consensus were retrieved， with 442 articles explicitly mentioning the application of ancient books， including 300 （67.87%） clinical practice guidelines and 142 （32.13%） expert consensus. Sixty of the 442 publications explicitly reported that ancient books searching had been conducted （13.57%）； among these 60 publications 27 （45.00%） explicitly reported ancient books searching strategies， and the most frequent method was manual searching with a total of 24 articles （40.00%）. The most popular search source was Chinese Medical Dictionary， a TCM classics database， with a total of 18 articles. 197 articles （44.57%） explicitly reported the evaluation criteria for the level of evidence， of which 141 articles （71.57%） involved the evaluation criteria for the ancient books； 413 articles （93.44%） mentioned ancient books in the recommendations， and only the source of formula name was mentioned in 409 （99.03%） of the publications. ConclusionThe current application of ancient books in TCM clinical practice guidelines and expert consensus is limited， with issues of non-standard searching and evaluation methods. Standar-dization and uniformity are needed in evidence grading and recommendation standards. Future research should clarify the scope and methods of applying ancient book， emphasize their integration with modern research evidence， and enhance their value and quality in the development of TCM clinical practice guidelines.

This study delves into the pivotal factors influencing the consensus process within traditional Chinese medicine guideline development, with the objective of augmenting the quality of this process through methodological recommendations aimed at elevating standardization.