Abstract:Objective To perform a systematic review to evaluate the impact of deprescribing interventions on the clinical outcomes in the elderly patients with polypharmacy. Methods A thorough search was made in the databases of the literature related to deprescribing interventions in the elderly patients with polypharmacy. The studies were screened according to the inclusion and the exclusion criteria. I² test for heterogeneity among studies was performed using Review Manager 5.3. Fixed effect model or random effect model was employed to analyze the impact of deprescribing interventions in the elderly patients with polypharmacy. Results A total of 18 studies were selected for the final randomized controlled trials (RCT), with overall quality of the literature being good. Meta-analysis showed that deprescribing interventions were not able to decrease all-cause mortality among elderly patients with polypharmacy [OR=0.86, 95%CI (0.67-1.09)]. The comparison between different intervention methods showed that patient-specific interventions decreased all-cause mortality [OR=0.68, 95%CI (0.51-0.92)]. The comparison of the follow-up length showed that long follow-up (>6 months) outperformed shorter follow-up (≤6 months) in decreasing all-cause mortality [OR=0.58,5%CI (0.39-0.86) vsOR=1.02, 95%CI (0.76-1.36); P＜0.05]. The comparison between different age groups showed no change in all-cause mortality [OR=0.63,5% CI (0.40-1.02) vs OR=0.95,5%CI (0.72-1.25); P＞0.05]. The comparison of cognitive status showed that deprescribing interventions in the groups of different cognitive statuses did not alter all-cause mortality [OR=0.63,5%CI(0.37-1.07) vs OR=0.93, 95%CI (0.71-1.22); P>0.05]. Deprescribing interventions did not decrease the number of patients with[JP+1]falls [OR=0.98, 95%CI (0.74-1.27)] but were able to significantly decrease the average falls they experienced [MD=-0.11,95%CI (-0.21--0.02)] and the length of hospital stay [MD=-0.49,5%CI (-0.76--0.22)]. Conclusion The analysis of data available suggested that deprescribing interventions did not decrease all-cause mortality in elderly patients with polypharmacy, but patient-specific or long-term follow-up seemed to have an advantage in decreasing it; that deprescribing interventions did not decrease the number of patients with falls but reduced the number of falls they experienced and the length of hospital stay. Patient-specific deprescribing interventions seem to be safe and feasible in decreasing inappropriate polypharmacy.

Abstract:Objective To observe the effect of acupuncture maneuver featuring “harmonizing qi and blood and nourishing mind” on cognitive function of people with subjective cognitive decline (SCD). Methods A total of 26 SCD patients were recruited for the studyvia the online bulletin board of Beijing Chinese Medicine Hospital affiliated to Capital Medical University or at gratuitous medical consultation in multiple communities in Beijing from December 2017 to September 2018. They were divided into acupuncture group (n=14) and control group (n=12). For a period of 3 months, both groups received conventional medical therapy, with acupuncture maneuver featuring “harmonizing qi and blood and nourishing mind” being added to the acupuncture group but not to the control group. A comparison was made between the two groups before and after the treatment for subjective cognitive decline questionnaire (SCD-Q), mini-mental state examination (MMSE), animal fluency test (AFT), auditory verbal learning test-Huashan version (AVLT-H), trail-making test A-B (TMT A-B) and Z-composite score. SPSS statistics 22.0 was used for data processing. Depending on the data type, comparison between groups was conducted by Student′s t test or Chi-square test. Results Acupuncture group scored significantly better after the treatment than before the treatment in SCD-Q [(7.35±1.32) vs (3.46±1.63)], MMSE [(27.00±1.66) vs (28.32±1.56)], [JP+1]AVLT-H immediate recall [(14.85±2.03) vs (19.14±2.31)], AVLT-H short delay recall [(4.28±1.58) vs (6.64±1.15)],AVLT-H long delay recall [(4.14±1.56) vs (6.57±1.08)], AFT[(15.64±4.19) vs (19.36±3.75), P < 0.05] and Z-composite score [0.03(-0.22, 0.24) vs 0.04(-0.30, 0.49)] and the control group showed declining MMSE scores [(27.16±1.40) vs(26.16±1.52)](P<0.05). Improvement in the acupuncture group was more significant than the control group in SCD-Q [(3.46±1.63) vs (7.20±1.33) score], MMSE[(28.32±1.56) vs (26.16±1.52) score], AFT[(19.36±3.75) vs (15.33±5.17) score] and Z-composite score [0.04(-0.03, 0.49) vs -0.06(-0.37, 0.30)] (P<0.05). Conclusion Acupuncture maneuver featuring “harmonizing qi and blood and nourishing mind” can significantly reduce the complaints in the SCD patients, exerting positive effects on their memory function and speech function but no obvious effects on their executive function.

Abstract:Objective To compare the effects of 2 different goal-directed therapies on cerebral oxygen metabolism and S100β level in patients with sepsis-induced hypoperfusion. Methods From May 2017 to August 2018, a total of 60 patients with sepsis-induced hypoperfusion, who required mechanical ventilation and were admitted to the Intensive Care Unit of the Affiliated Hospital of Xuzhou Medical University were randomly divided into modified early goal-directed therapy group (group M) and standard therapy group (group S), with 30 patients in each group. In group M, fluid resuscitation was guided by 2016 Surviving Sepsis Campaign Interna-tional Guidelines for Management of Sepsis and Septic Shock combined with stroke volume variation (SVV) monitored by FloTrac/Vigileo system, and then the following goals were required to reach during the first 6 h of therapy:SVV ≤13%, mean arterial pressure (MAP) ≥65 mmHg(1 mmHg=0.133 kPa), and lactate clearance rate ≥10% or lactic acid (Lac) <2.0 mmol/L. In group S, the first 6 h of fluid resuscitation was directed by the goals of systolic blood pressure (SBP) ≥100 mmHg and shock index (SI) <0.8. The regional oxygen saturation (rSO₂), serum S100β level, jugular venous oxygen saturation (SjvO₂), arteriovenous blood oxygen content difference (Da-jvO₂), cerebral extraction rate of oxygen (CERO₂), hemodynamic parameters, serum Lac level, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were compared between the 2 groups at pre-resuscitation (T1), first 6 h of resuscitation (T2), 24 h of resuscitation (T3), and 48 h of resuscitation (T4). Meanwhile, the volume of intravenous fluid infusion within 48 h, proportion of the patients receiving vasopressor, incidence rate of adverse cardiac and cerebral vascular events, length of intensive care unit (ICU) and hospital stay, and hospital mortality were recorded and compared between the 2 groups. Results The levels of rSO₂ and SjvO₂ were significantly increased, and those of Da-jvO₂, CERO₂ and S100β were obviously decreased at T2-T4 than at T1 in both groups (P<0.05). In the group M, the rSO₂ level was significantly higher [(66.7±2.6) % vs (63.4±1.8)%] and S100β level was notably lower [(0.29±0.04) vs (0.34±0.04)μg/L)] at T2, the level of SjvO₂ [(68.5±2.5) % vs (65.7±1.2)%, (71.3±2.3)% vs (68.0±2.6)%] was remarkably increased and those of Da-jvO₂ [(51.8±3.8)% vs (54.3±2.6)%, (44.5±2.6)% vs (48.3±3.9)%] and CERO₂ [(31.7±2.2)% vs (33.2±1.4)%, (27.6±1.6)% vs (33.0±2.5)%] were significantly lower at T3-T4 when compared with the group S (all P<0.05). Compared with the values at T1, those of MAP and central venous pressure (CVP) were significantly increased and those of heart rate (HR), Lac level and APACHE Ⅱ score decreased at T2-T4 in both groups (P<0.05). At T2, the group M had significantly lower CVP [(8.5±1.0) vs (10.0±1.3)cmH₂O] and less amount of intravenous fluid infusion [(2 783±307) vs (3 087±382)ml] than the other group (P<0.05). There were no statistical differences in the length of ICU and hospital stay, incidence rate of adverse cardiac and cerebral vascular events, and hospital mortality between the 2 groups (P>0.05). Conclusion The modified early goal-directed therapy based on SVV and lactate clearance rate is superior to the standard therapy not only in optimization of cerebral oxygen metabolism balance, but also in improvement of cerebral perfusion and attenuation of brain injury during the early resuscitation.

Abstract:Objective To explore the influencing factors for greater tricuspid regurgitation after the implantation of cardiovascular implantable electronic devices (CIEDs), and investigate its possible mechanism. Methods Clinical data of 198 patients who undergoing implantation of CIEDs (including single- or dual-chamber permanent pacemakers, embedded cardioverter-defibrillators and cardiac resynchronisation therapy) in our department from January 2014 to December 2016 were collected in this study. According to the changes of tricuspid regurgitation observed by echocardiography before and after implantation, the selected patients were divided into unaggravated tricuspid regurgitation group (n=146) and aggravated tricuspid regurgitation group (n=52). Clinical data and preoperative echocardiographic data were compared between the 2 groups. SPSS statistics 17.0 was used to perform the statistical analysis. Mann-Whitney U test, unpaired Chi-square test or Fisher exact probability test was employed for comparison between groups. Multivariate logistic stepwise regression was applied to analyze the risk factors for tricuspid regurgitation. Results Compared with the unaggravated group, the proportions of male, preoperative creatinine clearance rate, hyperlipidemia and implantation time >12 months were significantly higher, while the proportions of smaller preoperative right atrial diameter and mitral and tricuspid regurgitation were obvious lower in the aggravated group (P<0.05). Multiple logistic regression analysis showed that implantation time (OR=1.000,5%CI 1.001-1.003; P=0.013) and hyperlipidemia (OR=2.024,5%CI 6.728-22.360; P=0.022) were independent risk factors for aggravation of tricuspid regurgitation, and mild tricuspid regurgitation before CIED implantation ( OR=0.018,5%CI 0.049-0.133; P<0.001) was independent protective factor for the aggravation. Conclusion CIED implantation time and hyperlipidemia can aggravate tricuspid regurgitation, and the severity of tricuspid regurgitation before operation is correlated with the aggravation after implantation. Attention should be paid to follow-up observation.

Abstract:Objective To investigate the status quo and etiology of anemia in the elderly. Methods A retrospective analysis was made of 10 307 patients aged ≥60 years, who were treated in Chinese PLA General Hospital between January 1,3 and March 31,3. Their clinical data were collected. They were stratified based on the age for the analysis of the incidence of anemia across age groups and influence of gender, age, population category and model of medical consultation on the incidence of anemia. According to the clinical diagnosis and indicators of the patients, distribution of causes was analyzed. SPSS statistics 22.0 was used for data processing, and according to data types, Chi-square test for comparison between groups. Results The overall incidence of anemia was 23.4% (2 412/10 307). The incidence of anemia increased with age (P<0.01). The model of medical consultation had a significant influence on the incidence (P<0.01), but category of population did not (P>0.05). Etiologic analysis found that unexplained anemia (1 119/2 412,6.4%) topped the list, followed by chronic disease (835/2 412,4.6%) and nutritional anemia (458/2 412, 19.0%). Conclusion The elderly patients are susceptible to anemia and the causes are complex, warranting special attention by the clinicians.

Abstract:Objective To investigate the value of cathepsin S in bronchoalveolar lavage fluid (BALF) in comprehensive assessment of the patients with chronic obstructive pulmonary disease (COPD). Methods A total of 46 patients with stable COPD were included as the study (COPD) group, who paid follow-up visits at the Department of Respiratory Medicine of our Hospital from April 2014 to April 2017. They were divided, based on COPD assessment test (CAT) results, into group A(n=11), B(n=7), C(n=13), and D(n=15). Group A was assigned as CAT scored <10, the ratio of forced expiratory volume in the first second (FEV1) to the expected value ≥50%, and the frequency of acute exacerbations during last year less than twice. Group B as CAT scored ≥10, the ratio ≥50%, and the frequency less than twice. Group C as CAT scored <10, the ratio <50%, or the frequency more than twice. Group D as CAT scored ≥10, the ratio < 50%, or the frequency more than twice. As the control group, 29 healthy volunteers were taken from the same frame with normal lung function. The levels of cathepsin S in BALF were determined with enzyme-linked immunosorbent assay (ELISA). High-resolution CT (HRCT) was used to measure the percentage ratio of low-attenuation area (LAA) to total lung area (LAA%). Results BALF cathepsin S levels in the COPD group were significantly higher than that of the control group. BALF cathepsin S levels related to the severity of the disease as group D > group C > group B > group A (P<0.01) and to the degree of emphysema as LAA grade 3 > LAA grade 2 > LAA grade 1 > LAA grade 0 (P<0.01). The results of univariate analysis showed that LAA classification significantly affected the level of cathepsin S (F＝5.141,P<0.001). Correlation analysis indicated that BALF cathepsin S level in COPD patients correlated positively to the frequency of acute exacerbation in the previous year (r=0.142, P=0.003), CAT score (r=0.309, P=0.017) and LAA% (r=0.497, P<0.001). Conclusion The BALF cathepsin S level reflects the severity of COPD and can be used as a biomarker in the assessment and treatment of COPD.

Abstract:Objective To investigate the bacterial spectrum and drug resistance of chronic periprosthetic-joint infection (PJI) in the elderly and to provide reference for its clinical prevention and treatment. Methods A retrospective analysis was made of 76 elderly patients with PJI who underwent hip and knee arthroplasty in Guangzhou First people′s Hospital from January 2013 to October 2018. The bacterial spectrum and drug resistance were analyzed using French Automated Microbial Identification and Susceptibility Test System (VITEK2-Compact, BioMérieux, France). Results Among 76 patients, 64 were infected for the first time after the initial replacement and 12 after revision, 18 being mixed infection (with at least two bacteria) and 58 being single infection. Knee arthroplasty were performed in 51 patients, hip arthroplasty in 23, and femoral head replacement in 2. A total of 108 strains of bacteria were isolated, of which 72.22%(78/108) were gram-positive, mainly Staphylococcus aureus and Staphylococcus epidermidis, and 27.78%(30/108) gram-negative, mainly Escherichia coli and Pseudomonas aeruginosa. Bacteria varied in their resistance to antimicrobial agents. Over 60% Staphylococcus aureus and Staphylococcus epidermidis were resistant to clindamycin, erythromycin, gentamicin and penicillin, and less than 5% to vancomycin, linezolid, tigecycline, quinupeptine/dafolopin; over 70% Escherichia coli and Pseudomonas aeruginosa were resistant to cefazolin sodium, ceftazidime, compound sulfamide and ampicillin and less than 15% to piperacillin/tazobactam and imipenem. Conclusion Staphylococcus aureus and Staphylococcus epidermidis are the main pathogens of chronic PJI in the elderly, the bacterial spectrum of chronic infection different from that of acute infection, and antibiotics should be selected based on the results of drug sensitivity test.

Abstract:Objective To determine the effect of early heparin therapy on blood flow of infarct-related arteries and heart function in patients with acute anterior myocardial infarction. Methods One hundred patients suffering from acute anterior myocardial infarction admitted to our hospital from April 2017 to November 2018 were enrolled in this study. They were randomly divided into observation group and control group, with 50 cases in each group. The patients of the observation group were given intravenous injection of 4 000 U unfractionated heparin immediately after diagnosis of ST-segment elevation myocardial infarction (STMEI). While the same dose of heparin was injected intravenously to the patients from the control group after insertion of sheath. Then all of the patients underwent percutaneus coronary intervention (PCI). The heparin administration time, activated coagulation time (ACT), blood flow of infarct-related arteries by coronary angiography, hospital door to balloon (D-to-B) time, vessel opening time, peak high-sensitive troponin T (hs-TnT) value, peak pro-brain natriuretic peptide (pro-BNP) value, pump failure during hospital stay, left ventricular ejection fraction, and length of hospital stay were observed and recorded in the 2 groups. SPSS statistics 13.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between the groups based on different data types. Results The observation group had significantly shorter heparin administration time [(7.5±1.8) vs (47.4±8.6)min], lower ratio of TIMI flow grade 0(28% vs 38%), shorter D-to-B time [58.4±13.0) vs (63.9±12.9)min], shorter vessel opening time [(29.2±5.9) vs (32.5±5.4)min], lower ratio of high thrombosis burden (30% vs 52%), lower value of peak hs-TnT [(2 915.4±1 845.9) vs (3 987.4±2 018.8)ng/ml], lower value of peak pro-BNP [(3 096.4±1 965.2) vs (4 770.5±2 073.5)pg/ml], lower ratio of pump failure (4% vs 16%), and shorter length of hospital stay [(9.0±1.8) vs (10.1±2.0)d] when compared with the control group (P<0.05). What′s more, longer activated coagulation time [(213.2±13.7) vs (67.7±5.1) s], higher ratio of TIMI flow grade 2-3(40.0% vs 18.0%), and higher LVEF [(56.5±7.7)% vs (51.3±7.0)%] were observed in the observation group (P<0.05). Conclusion Early heparin therapy promotes recanalization of infarct-related arteries, shortens vessel opening time, and improves heart function in acute anterior myocardial infarction patients.

Abstract:Objective To investigate the effect of ulinastatin on serum levels of microribonucleic acid-23b (miR-23b) and infla-mmatory factors in elderly patients with sepsis and evaluate its clinical efficacy for sepsis. Methods A single-blind randomized controlled trial was devised on 64 sepsis patients admitted in the Emergency Department of our hospital from March 2017 to January 2018. They were randomly divided into the control group (n=32, conventional treatment) and the observation group (n=32, intravenous injection of 300 000 U ulinastatin, one time/8 h, on the basis of conventional therapy). The serum levels of inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high sensitivity C-reactive protein (hs-CRP), and the expression of miR-23b were detected in the 2 groups before and 7 d after treatment. Acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ), sequential organ failure estimation (SOFA) score, and multiple organ dysfunction syndrome (MODS) score were used to evaluate the patients′ health status, and the clinical efficacy were compared between the 2 groups. SPSS statistics 17.0 was used for data analysis, and Student′s t test, Chi-square test or rank sum test was employed for comparison between groups. Results The expression levels of miR-23b were (0.87±0.10) and (0.86±0.09) ng/ml, respectively, in the control group and observation group before treatment, and the levels were increased to (1.73±0.21) and (1.91±0.26) ng/ml in 7 d after treatment (P<0.05). The increase was more significant in the observation group than in the control group (t=2.112, P=0.037). Compared with before treatment,the levels of TNF-α, IL-6 and hs-CRP, and the scores of APACHE Ⅱ, SOFA and MODS in the 2 groups were obviously decreased after 7 d of treatment (P<0.05); and the decreases of the above indices were more remarkable in the observation group (P<0.05). The total effective rate was 75.0%(24/32) in the control group, and 90.6%(29/32) in the observation group, with statistical difference between them (Z=-2.375, P=0.018). Conclusion Ulinastatin effectively alleviates inflammatory responses and improves the prognosis in sepsis patients, which may be through regulating miR-23b expression, and it is worthy of clinical promotion.

Abstract:Objective To observe the change of serum neutrophil gelatinase-associated lipocalin (NGAL) level before and after coronary angiography (CAG) and percutaneous coronary intervention (PCI) in patients with coronary heart disease, and to investigate its predictive value of NGAL for contrast-induced nephropathy (CIN). Methods A total of 136 patients who underwent CAG and PCI in the Department of Cardiology and Emergency Center of our hospital from April 2017 to April 2018 were recruited, and their clinical data were collected and retrospectively analyzed. According to the occurrence of CIN, they were assigned into CIN group (n=10) and non-CIN group (n=126). The serum creatinine (SCr), blood urea nitrogen (BUN) and NGAL levels before and at 24 h and 48 h after operation were compared between 2 groups, and the predictive value of NGAL for CIN was analyzed by receiver operating characteristic (ROC) curve. The data were analyzed by SPSS statistics 22.0. Student′s t test, ANOVA or Chi-square test was used for comparison between 2 groups. Results The CIN group had significantly increased levels of 48 h SCr, 24 h BUN, 48 h BUN and 24 h NGAL than those indices before operation (P<0.05). Compared with the non-CIN group, the CIN group had obviously higher 48 h SCr [(174.95±15.77) vs (97.69±9.33)μmol/L], 24 h BUN [(7.75±1.75) vs (5.07±1.35)mmol/L], 48 h BUN [(8.92±2.03) vs (5.17±1.31)mmol/L], and 24 h NGAL [(457.68±220.69) vs (185.82±51.41)ng/ml](all P<0.05). ROC curve showed that the cut-off value of 24 h NGAL for predicting CIN was 40.325 ng/ml, and the area under the curve was 0.852, with a sensitivity of 70% and a specificity of 100%. Conclusion The serum level of NGAL is significantly increased in coronary heart disease patients at 24 h after PCI and CAG, and the index shows early predictive value for CIN.

Abstract:Objective To investigate the expression of macrophage subtypes in mouse model of unilateral ureter obstruction (UUO) and its role in renal fibrosis. Methods A total of 39 male C57/BL mice were divided into sham group (n=9), UUO-3d group (n=10), UUO-7d group (n=10) and UUO-14d group (n=10). Unilateral ureter separation was performed on the mice in the sham group, and unilateral ureteral ligation in the UUO groups. The kidney was obtained at 3,7 and 14 days after operation. Pathological staining was used to observe renal interstitial fibrosis and infiltration of inflammatory cells, and immunofluorescence to observe renal interstitial macrophage infiltration. Flow cytometry was performed to detect changes in the proportion of renal macrophage subtypes (CD86 and CD206). SPSS statistics 20.0 was used for data analysis, and SNK-q test for comparison. Results In the sham group, the renal tubules were structurally intact, and the renal interstitium was clear without infiltration of the inflammatory cells and collagen deposition and with infiltration of a small number of macrophages. Compared with sham group, all UUO groups (UUO-3d, -7d, -14) had larger collagen protein areas [(7.8±1.5) % vs (14.1±2.7)%, (27.4±3.1)%, (39.3±2.7)%] and more inflammatory cells [(169±16) vs (1068±164), (2159±432), (3536±318)] in renal interstitium (P<0.05). Prolonged obstruction time in the model group resulted in significantly increased infiltration of macrophages [(20.8±2.7)% vs (31.1±1.3)%, (49.5±2.1)%, (69.6±1.8)%; P<0.05]. The expression of M2 macrophage marker (CD206) also increased with prolonged UUO [(3.2±1.9)%, (34.1±2.1)%, (52.6±1.6)%, (76.7±2.3)%; P<0.05], but no significant difference was found between UUO groups in the expression of M1 macrophage marker (CD86) [(76.4±3.6)%, [JP+2](81.8±2.8)%, (80.6±4.4)%, (85.5±2.6)%; P>0.05].Conclusion Increased M2 macrophage may contribute to renal fibrosis in the mice with unilateral ureteral ligation.

Abstract:Exosomes, as the key mediators of intercellular communication, are extracellular vesicles derived from intracellular sources. They play various physiological roles in apoptosis regulation, immune responses, inflammation and other processes via their containing proteins and genetic materials, such as microRNAs. Stem cell therapy shows unique advantages in the repairing of myocardial cell injury. Evidence indicates that mesenchymal stem cell (MSC)-derived exosomes improve the viability of myocardial cells after ischemia/reperfusion injury, which suggests that the beneficial effects of the stem cells in the recovery may be associated with their secretion of exosomes. Therefore, exosome therapy might be a new direction for cell-free therapy strategy in myocardial repair. In this review, we summarized the roles of stem cell-derived exosomes in the repair of myocardial injury.

Abstract:Skeletal muscle mass and function mostly decrease with age in the elderly, and age-related loss of skeletal muscle mass and function is closely associated with increased readmissions and overall mortality. This review summarizes the research on age-related muscle loss and dysfunction, focusing on the measurement of muscle protein synthesis and decomposition, affecting factors and molecular regulatory mechanisms in the process of aging. It is aimed for an understanding of the research on sarcopenia in the elderly and promotion of its further research.

Abstract:Epidemiological surveys show that the incidence of atrial fibrillation has been increasing year by year, especially in the elderly, and the morbidity and mortality increase with age. Several clinical trials report that warfarin remains the main drug for the treatment of atrial fibrillation. The international normalized ratio (INR) is recommended as between 2.0 and 3.0 in European and American guidelines; however, there are racial differences between Asian and European and American populations. Warfarin anti-coagulation should be appropriately reduced, especially in the elderly patients with non-valvular atrial fibrillation who have high risks of stroke and bleeding. INR of 1.5-2.5 is safe and effective for them, which warrants a large number of clinical trials and evidence basis.

Abstract:Myeloid neoplasms and acute leukemia are categorized as early/prefibrotic primary myelofibrosis (Pre-PMF) and overt primary myelofibrosis (Overt PMF) in the revised World Health Organization classification in 2016. Thrombocytosis is a common manifestation in the patients with Pre-PMF and is similar to the essential thrombocythemia (ET) at onset. However, Pre-PMF and ET differ in survival rate, leukemic evolution and rates of progression to Overt PMF, and accurate differentiation is of vital importance. The diagnosis of Pre-PMF is mainly based on histopathological features of bone marrow biopsy, fibrosis grade and clinical parameters(leukocytosis, anemia, elevated lactate dehydrogenase and splenomegaly). The current article summarizes the latest advances in Pre-PMF diagnosis and compares its clinical features,morphological changes,molecular genetics and prognosis with those of ET.