Effect of RBP2 gene silencing on proliferation, migration and invasion of ovarian epithelial cancer SKOV3/DDP cells and its mechanism / 中华肿瘤杂志

Objective: To explore the effect of down-regulation of retinol binding protein 2 (RBP2) expression on the biological characteristics of ovarian cancer cells and its mechanism. Methods: Knockdown of RBP2 and cisplatin (DDP)-resistant ovarian cancer cell line SKOV3/DDP-RBP2i was established, the negative control group and blank control group were also set. Cell counting kit 8 (CCK-8) was used to detect the cell proliferation ability, flow cytometry was used to detect cell apoptosis, scratch test and Transwell invasion test were used to detect cell migration and invasion ability, real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) and western blot were used to detect the expressions of molecular markers related to epithelial-mesenchymal transition (EMT). The effect of RBP2 on the growth of ovarian cancer was verified through experiment of transplanted tumors in nude mice, and the relationships between RBP2 expression and tumor metastasis and patient prognosis were analyzed using the clinical data of ovarian cancer in TCGA database. Results: After down-regulating the expression of RBP2, the proliferation ability of SKOV3/DDP cell was significantly reduced. On the fifth day, the proliferation activities of SKOV3/DDP-RBP2i group, negative control group and blank control group were (56.67±4.16)%, (84.67±3.51) and (87.00±4.00)% respectively, with statistically significant difference (P<0.001). The apoptosis rate of SKOV3/DDP-RBP2i group was (14.19±1.50)%, higher than (8.77±0.75)% of the negative control group and (7.48±0.52)% of the blank control group (P<0.001). The number of invasive cells of SKOV3/DDP-RBP2i group was (55.20±2.39), lower than (82.60±5.18) and (80.80±7.26) of the negative control group and the blank control group, respectively (P<0.001). The scratch healing rate of SKOV3/DDP-RBP2i group was (28.47±2.72)%, lower than (50.58±4.06)% and (48.92±4.63)% of the negative control group and the blank control group, respectively (P<0.001). The mRNA and protein expressions of E-cadherin in the SKOV3/DDP-RBP2i group were higher than those in the negative control group (P=0.015, P<0.001) and the blank control group (P=0.006, P<0.001). The mRNA and protein expression of N-cadherin in SKOV3/DDP-RBP2i group were lower than those in the negative control group (P=0.012, P<0.001) and the blank control group (P=0.005, P<0.001). The mRNA and protein expressions of vimentin in SKOV3/DDP-RBP2i group were also lower than those in the negative control group (P=0.016, P=0.001) and the blank control group (P=0.011, P=0.001). Five weeks after the cells inoculated into the nude mice, the tumor volume of SKOV3/DDP-RBP2i group, negative control group and blank control group were statistically significant different. The tumor volume of SKOV3/DDP-RBP2i group was smaller than those of negative control group and blank control group (P=0.001). Bioinformatics analysis showed that the expression of RBP2 in patients with metastatic ovarian cancer was higher than that without metastasis (P=0.043), and the median overall survival of ovarian cancer patients with high RBP2 expression was 41 months, shorter than 69 months of low RBP2 expression patients (P<0.001). Conclusion: Downregulation of the expression of RBP2 in SKOV3/DDP cells can inhibit cell migration and invasion, and the mechanism may be related to the inhibition of EMT.

Clinical Significance of Truncated Mutant ΔJBP of TET2 Gene in Patients with Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To the clinical characteristics and prognostic value of the patients with complete deletion of TET_JBP domain (ΔJBP) in TET2 acute myeloid leukemia (AML).@*METHODS@#Next Generation Sequencing technology was used to determine the mutations of 34 AML-related genes (including TET2 gene). The I-TASSER tool was used to predict the tertiary structure of the full-length TET2 protein and TET_JBP structure deletion.@*RESULTS@#Among 38 AML patients with TET2 mutations, 22(57.9%) showed truncation mutations, of which 16 (72.7%) produced TET2ΔJBP truncation mutants. Protein structure prediction showed that the deletion of TET_JBP domain lead to the significant changes of tertiary structure in TET2 protein. Compared with the patients in non-ΔJBP group, the age of patients in ΔJBP group were older (63 vs 54 years old, P=0.047), and the occurrence rate of CEBPA double mutation (CEBPA@*CONCLUSION@#AML patients with TET2ΔJBP truncation mutant shows lower CR rate, shorter EFS and OS after induction chemotherapy, which may be related to the poor prognosis, and co-mutation with CEBPA

Forensic Analysis of 133 Cases of Knee Injuries / 法医学杂志

Objective To discuss the types, characteristics, and the evaluation of disability of knee injuries. Methods The data of 133 cases of knee injury from 2017 to 2019 were collected and statistically analyzed according to the region of injury, the degree of disability, etc. Results One hundred and twenty-five cases of injury were compound, and 8 cases were simple. The incidences of ligament injury, meniscus injury and fracture were 88.72%, 75.19% and 57.89%, respectively. Of the cruciate ligament injuries, 12 cases were posterior cruciate ligament injury while 51 cases were anterior cruciate ligament injury, and the differences between the two kinds of injury had statistical significance （P<0.05）; 32 cases were secondary traumatic arthritis. The rates of disability of knee injuries were 38.35% （Grade Ⅸ and Ⅹ）. Conclusion Compound knee injuries are common, and traumatic arthritis has a relatively high rate. Multiple injuries can affect the stability and weight-bearing of the knee joint. It is suggested that in addition to evaluating the range of motion of knee joint, multiple factors should be considered to assess disability.

Clinical characteristics of small cell lung cancer with distant metastasis: A SEER-based study / 第二军医大学学报

Objective: To investigate the effect of different organ metastases on clinical prognosis in patients with small cell lung cancer (SCLC). Methods: A total of 10 347 SCLC patients with distant metastases (M1) obtained from the surveillance, epidemiology, and end results (SEER) database between 2010 and 2013 were enrolled in this study. The median duration of follow-up was 4 months and the median age was 67 years. According to metastatic sites, the patients were divided into six groups: bone metastasis group, brain metastasis group, liver metastasis group, lung metastasis group, none group (no metastasis found in the bone, brain, liver or lung) and multi-organ metastasis (MOM) group (2 or more organ metastases found in the bone, brain, liver or lung). The effects of different organ metastases on clinical prognosis in SCLC patients were analyzed. Results: MOM was the most common pathway of metastasis, accounting for 32.8% (3 396/10 347), followed by liver metastasis (19.0%, 1 971/10 347), brain metastasis (12.1%, 1 251/10 347) and bone metastasis (10.0%, 1 033/10 347). The mortality rates associated with bone, brain, liver and lung metastases and MOM were 77.2% (797/1 033), 74.1% (927/1 251), 82.4% (1 625/1 971), 73.4% (504/687), and 81.6% (2 770/3 396), respectively. Compared with the none group, the MOM and liver metastasis groups had higher hazard ratio (HR) (95% confdence interval [CI] of 1.80 (1.66-1.96) and 1.69 (1.54-1.85), respectively, followed by bone and brain metastasis groups with HR (95% CI) of 1.24 (1.12-1.39) and 1.28 (1.16-1.42) (all P<0.001). Lung metastasis group had a lowest HR (95% CI) of 1.07 (0.95-1.21) (P = 0.27). Conclusion: MOM and liver metastases are associated with the worst prognosis and the highest mortality in SCLC patients, followed by bone, brain and lung metastases. Therefore, for the SCLC patients with distant metastasis, different treatments should be carried out according to involved organs, and treatment should be strengthened in patients with liver metastasis and MOM.

Exercise training for bone and lipid metabolisms: exercise intensity and duration are important factors / 中国组织工程研究

BACKGROUND: Rational exercise training promotes bone and lipid metabolisms, while over-trained exercise makes negative effect. There are many biomarkers and pathways in the progress of bone and lipid metabolisms, which have been explored in different suitable studies. OBJECTIVE: To summarize the indexes and pathways of bone and lipid metabolisms, especially the common biomarkers and pathways, and to explore the effects of exercise on bone and lipid metabolisms. METHODS: PubMed and CNKI databases were retrieved with the keywords of "exercise training, bone metabolism, lipid metabolism, index, pathway" in English and Chinese, respectively. Finally, 52 eligible articles were enrolled for result analysis. RESULTS AND CONCLUSION: Bone metabolic indexes include 25-hydroxy-vitamin-D, calcitonin, parathyroid hormone, tumor necrosis factor, interleukin 1, 2, 4, 6 and 11, insulin-like growth factor 1, transforming growth factor-beta, bone morphogenetic protein, interferon, macrophage colony-stimulating factor, fibroblast growth factor, platelet fireworks growth factor, tartrate-resistant acid phosphatase, collagen Ⅰ telopeptide, pyridinoline, urinary deoxypyridinoline, alkaline phosphatase, osteocalcin, osteoporogeterin, carboxyterminal propeptide of type Ⅰ procollagen and so on. While lipid metabolic indexes contain triacylglycerol, serum total cholesterol, high density lipoprotein, low density lipoprotein, leptin, adiponectin, apolipoprotein, oxidized low density lipoprotein, and low density lipoprotein receptor related protein. Exercise intensity and duration are important factors for bone and lipid metabolisms. While a long-term high-intensity exercise will do harm to bone and lipid metabolisms, and a short-time high-intensity exercise is beneficial for bone metabolism. The interaction of exercise intensity and duration on bone and lipid metabolisms still needs to be further studied.

Efficacy and safety of orthokeratology to control myopia in Asia children: A Meta-analysis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To assess the efficacy and safety of orthokeratology for reducing the progression of myopia in Asia children.?METHODS: Seven databases, including the Cochrane Library, Medline, EMbase, CBM, CNKI, VIP, and WanFang Data, were searched. The published languages were limited to English and Chinese. The risk bias tool provided by Cochrance cooperation and methodological index for non-randomized studies ( MINORS) scale were used to assess the risk bias of included studies (randomized controlled trials and controlled trials). The published biases of included studies were assessed with funnel plot. Meta-analysis was performed with Review Manager 5. 3.? RESULTS: Seven eligible studies, including 478 children, were included, 250 cases in ortho-k group, 228 cases in control group. The Meta-analysis indicated that change in axial length of ortho-k group was significantly less than the control group [WMD=-0. 31, 95％CI(-0. 35,-0. 26), P<0. 001]. Five studies observed adverse effects which all included the effect of positive staining of corneal fluorescein. One study reported chalazion in one child. None of the studies reported severe adverse events.? CONCLUSION: The overall findings suggested that orthokeratology might slow the progression of myopia in children of Asia.

Effects of Fengshi Bitong Prescription on Cytokines in Serum and Synovial Fas/FasL mRNA Expression in Rats with Collagen-Induced Arthritis / 中国中医药信息杂志

Objective To observe the effects of Fengshi Bitong Prescription (FSBT) on cytokines in serum and Fas/FasL mRNA expression system in synovium; To discuss relevant mechanism of action. Methods Rats were given foot intradermal injection of bovine type Ⅱ collagen emulsion to establish collagen-induced arthritis (CIA) model. After successful modeling, they were randomly divided into 6 groups: normal control group, CIA model group, tripterygium glycosides group, FSBT high-, medium-, and low-dose groups. Each medication group was given relevant medicine for gavage for 14 d. The weight and arthritis scores of CIA rats were observed. Serum levels of IL-1β, IL-15, and TGF-β1 were detected by ELISA. Expressions of Fas and FasL mRNA in synovium of CIA rats were detected by real-time PCR. Results Compared with model group, the foot arthritis score and serum levels of IL-15 in FSBT high- and medium-dose groups significantly decreased (P<0.01), and the serum level of TGF-β1 significantly increased (P<0.05). Expression of Fas significantly decreased and FasL significantly increased in FSBT high-dose group (P<0.05). Conclusion FSBT may have certain immune regulation effects on rheumatoid arthritis. Its mechanism may be in regulating Fas/FasL apoptosis system, thereby inducing apoptosis of synovial cells and inhibiting synovial hyperplasia.

Lamotrigine monotherapy in children with epilepsy: a systematic review / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of lamotrigine monotherapy in children with epilepsy via a systematic review.</p><p><b>METHODS</b>PubMed, Cochrane, CNKI, VIP, CBM, Wanfang Data were searched for randomized controlled trials (RCTs) of lamotrigine monotherapy in children with epilepsy. Literature screening, data extraction, and quality assessment were performed according to the method recommended by Cochrane Collaboration. RevMan 5.2 software was used to conduct the Meta analysis.</p><p><b>RESULTS</b>A total of 9 RCTs involving 1 016 participants were included. Lamotrigine yielded a significantly lower complete control rate of seizure than ethosuximide, but the complete control rate of seizure showed no significant differences between lamotrigine and carbamazepine/sodium valproate. Patients treated with lamotrigine had a significantly lower incidence rate of adverse events than those treated with carbamazepine, but the incidence rate of adverse events showed no significant differences between patients treated with lamotrigine and sodium valproate/carbamazepine. The drop-out rate showed no significant differences between the three treatment groups.</p><p><b>CONCLUSIONS</b>Lamotrigine is an ideal alternative drug for children who do not respond to traditional antiepileptic medication or experience significant adverse reactions; however, more high-quality RCTs with a large sample size and a long follow-up time are needed to confirm these conclusions.</p>

Research progress on antioxidation effect of traditional Chinese medicine polysaccharides and sports for diabetes prevention and treatment / 中国中药杂志

Researchers found that oxidative stress was closely related to the development of diabetes, and hyperglycemia was a main cause for oxidative stress. Many researchers have proved that oxidative stress, present in diabetes, can aggravate diabetes. Now, traditional Chinese medicines have certain treatment and relief effects for oxidative stress in diabetes, but there are no scientific and systematic conclusions on the efficacy of different Chinese medicines for diabetes and complications. Tomakea scientific and systematic review on the recent years' researches on antioxidation effects of traditional Chinese medication polysaccharides for diabetes, analyze the antioxidation effects of sports in treatment of diabetes, and provide the reference and basis for medications and sports in diabetic patients, as well as prevention and treatments of diabetes and complications from aspects of "internal nursing and external workouts". Databases of CNKI and PubMed were retrieved with key words of "diabetes, oxidative stress, antioxidant, traditional Chinese medication, polysaccharide, sports" in both Chinese and English from Jan 2000 to Apr 2016.Finally 118 papers were included in for analysis and review. Polysaccharides of traditional Chinese medications as well as sports have antioxidation effects for diabetes and its complications, and the combination of these two would produce huge significance for relieving oxidative stress in diabetes, as well as for the prevention and treatment of diabetes and its complications. We need further researches on the levels of oxidative stress markers, doses of Chinese medicines, and the time of taking medications.

Comparison of Forefinger Tapping between Hemiplegics and Normal Controls / 中国康复理论与实践

@#Objective To measure the tapping frequency of hemiplegic unaffected forefinger and normal control's forefinger. Methods The tapping frequency of 27 left hemiplegic patients and 32 healthy controls were measured by finger oscillating frequency tester. Results The oscillation frequency of hemiplegic patients was lower than that of the healthy controls (P<0.001). Conclusion Hand function of hemiplegic patients weakened.

The significance of contribution degree of hurting factors in mental injury and the research progress / 法医学杂志

In forensic psychiatric evaluation, experts frequently need to assess the contribution degree of hurting factors to the victims. The contribution degree reflects the extent of hurt caused by the injurer and is the quantitative index of the responsibility which should be undertaken by the injurer. It is also important evidence for the judgement. Presently, there is no accepted and practicable quantitative tool to reflect the objective contribution degree. This article reviews domestic and international researches on the contribution degree of hurting factors in mental injury, including the concept, connotation, related assessment methods, problems in assessment and its future study trend.

Progress of transcranial magnetic stimulation-motor evoked potential and its forensic application / 法医学杂志

Transcranial magnetic stimulation-motor evoked potential (TMS-MEP) test is one of the electrophysiological examination methods to evaluate the function of central nervous system. The value of the TMS-MEP has been recognized by some clinical forensic workers recently. This article reviews the principle and advantages of TMS-MEP and its application in functional evaluation of central nervous system and clinical treatment. The value of TMS-MEP in forensic medicine, especially in objective assessment of muscle strength after injury of central nervous system is also discussed.

Analysis on influences of guardians on behavior of left-behind children aged 3 to 7 years in countryside / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the influences of guardians on emotion and behavior of rural left-behind children aged 3 to 7 years.</p><p><b>METHODS</b>A self-designed questionnaire of children's condition and Children Strengths and Difficulties Questionnaire (the edition for parents, SDQ) were used to investigate 805 left-behind children aged 3 to 7 years in countryside.</p><p><b>RESULTS</b>The prevalence of difficulty among left-behind children was 3.5%, in male it was 4.1% and in female 2.7%, the difference was not significant (chi(2) = 1.154, P > 0.05) between male and female. The scores of peer communication problems among associate the left-behind children were (2.30 +/- 1.86), which was significantly higher than that (2.09 +/- 1.74) of not left-behind children (P < 0.05). The score of emotion symptom was (2.76 +/- 1.84) and the total score of difficulty was (11.41 +/- 4.77) among left-behind children was significantly higher than those of left-behind children with one parent stayed out (2.29 +/- 1.64) and (10.41 +/- 5.18), were significantly different (t = -2.489 - 2.006, P < 0.05), the score of social behavior (6.39 +/- 2.26) was significantly lower than that of left-behind children with father or mother stayed out (7.34 +/- 2.18, P < 0.001). The score of social behavior of children whose guardians had higher education level (7.02 +/- 2.21) was significantly higher than those with guardians who were illiterate or semiliterate (6.20 +/- 2.44, P < 0.01).</p><p><b>CONCLUSIONS</b>There are evident problems in emotion and behavior among left-behind children with parents staying out. One of parents should stay home to care for children. To improve educational level of guardian will be beneficial to development of physical and mental health among left-behind children.</p>

Levetiracetam therapy for childhood epilepsy: a systematic review / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Levetiracetam has been widely used for childhood epilepsy, but there is no high quality evidence to support its use. This study performed a systematic review to evaluate the effectiveness and safety of levetiracetam therapy for childhood epilepsy.</p><p><b>METHODS</b>The papers related to levetiracetam therapy for childhood epilepsy published up to March, 2009 were retrieved electronically from the PubMed, Embase, the Cochrane Library, Chinese Biomedical Database, Wanfang and Weipu Chinese Journals Full-text Database. The relevant papers on randomized control trials (RCTs) or quasi-RCTs were studied by meta analysis.</p><p><b>RESULTS</b>Two papers that met the inclusion criteria were included. The first paper involved 198 patients, including 108 cases in the levetiracetam therapy group and 97 cases in the placebo group. Seven cases (6.9%) were seizure free in the levetiracetam therapy group compared with 1 case (1%) in the placebo group (p<0.01) 14 weeks after treatment. Levetiracetam therapy decreased significantly the frequency of seizures compared with the placebo treatment. The second paper involved 39 patients, including 21 cases in the levetiracetam therapy group and 18 cases in the oxcarbazepine therapy group. Nineteen cases (90.5%) were seizure-free in the levetiracetam therapy group compared with 13 cases (72.2%) in the oxcarbazepine therapy group (P=0.410) during a follow-up of 12-24 months. The adverse effects in the levetiracetam therapy group were not significantly different from the placebo and the oxcarbazepine therapy groups.</p><p><b>CONCLUSIONS</b>The current evidence shows that levetiracetam therapy is effective for childhood epilepsy. However, it needs to be proved by the multi-centre, large sample RCTs.</p>

Study on emotional, behavioral problems and related determinants among stranded children aged 4 to 7 years in the rural areas of China / 中华流行病学杂志

Objective To understand emotional, behavioral problems and related determinants among rural stranded children and to provide evidence for further psychological support. Methods A total of 3944 caregivers of children in the rural areas and aged 4 to 7 years but without parents around, were randomly selected. Data were collected through Strengths and Difficulties Questionnaires (the edition for parents, SDQ). Results The overall prevalence of children with behavioral/emotional problems was 43.6% among those stranded children including 8.3% having experienced emotional symptoms, 9.5% reported to be displaying 'conduct' problems, 8.7% exhibited significant hyperactivity/inattention, 18.9% experienced peer relationship problems and 16.8% having prosocial behaviors. The prevalence of behavioral/emotional problems was significantly higher in boys than those in girls and in lower age groups. Significant differences were also found in conduct problems, hyperactivity/inattention and prosocial behaviors (P<0.01). The result from logistic regression analysis showed that factors as education level and motivation of the caregivers as well as financial support from the parents were related to emotional/ behavioral problems among the stranded children. Conclusion The prevalence of emotional and behavioral problems was high among children living the rural areas but without their parents around which should call for psychological intervention.

Knowledge, attitude, practice and related determinants on nutrition among caregivers of rural stranded children under 7-year-olds in China / 中华流行病学杂志

Objective To explore knowledge, attitude, practice (KAP) and related determinants on nutrition among caregivers of those rural stranded children under 7 years of age in China and to provide evidence for setting up relevant health education program. Methods 1691 caregivers of the stranded children randomly selected were surveyed by a standard questionnaire. Logistic regression models were used to screen the determinants on KAP regarding nutrition. Results Rates on awareness, positive attitude and approprite behavior were lower in caregivers of children whose parents both left (47.8%, 55.4%, 41.8%, respectively) the countryside, when compared with those only one parent was away from home (59.9%, 59.5%, 38.0%, respectively). Data from multivariable logistic regression models showed that caregivers' KAP on nutrition was related to age, educational background, average family income, and willingness on the job as well as the age of the child. Conclusion Improving caregivers' KAP on nutrition and setting up appropriate health education program were in urgent need.

Relationship between P300 and intelligence quotient in severe head injury patients / 法医学杂志

OBJECTIVE@#To explore the change of brain cognition function in severe head injury and the correlation between P300 in event-related potential (ERP) and intelligence quotient (IQ).@*METHODS@#Auditory P300 was measured and intelligence quotient was tested by Wechsler Adult Intelligence Scale Revised in China (WAIS-RC) in 40 severe head injury patients. Auditory P300 was measured in 40 normal healthy people as control group.@*RESULTS@#The latencies of P300 in severe head injury patients group were longer than in control group. There was a significant difference between the two groups (P< 0.01). There were significant negative correlations between P300 latency and VIQ and FIQ respectively (r=-0.335,-0.344, P<0.05).@*CONCLUSION@#ERP might be taken as an objective index for measuring the change of the brain cognition function in patients with severe head injury.

Relationship between event-related potentials and brain injury / 法医学杂志

Event-related potentials (ERPs) develop promptly as one kind of special evoked potentials. And it is one of the most effective methods to investigate human's cognition function in these years. P300 is the component of ERPs which is widely and maturately researched and has intimate relation with attention, memory and other high psychological activity. The evaluation of recognition change after brain injury is the focus of the research. With the development of relatively research, it is deemed that this technique has wide application perspective in many aspects such as forensic clinical medicine and forensic psychiatry.

Dissection of cavernous nerves in rat and model of neurological erectile dysfunction / 法医学杂志

OBJECTIVES@#To identify rat cavernous nerve and establish a rat model of erectile dysfunction caused by injury of cavernous nerve.@*METHODS@#Ten rats were undergone dissections. 30 experimental rats were randomized into 2 groups, cavernous nerve were identified by electrical stimulation. One month after surgery, rat models were evaluated by electrical stimulation.@*RESULTS@#The anatomic structure of cavernous nerve in rats are highly similar to human beings, the erection can be evoked by stimulating cavernous nerves, and after cavernous nerve injury it can not be evoked (P < 0.05).@*CONCLUSION@#Because of the highly similarity of cavernous nerve between rats and human beings, so as the suitable price, rat should be used as the ideal ED experimental animal. The model of ED caused by cavernous nerve injury is reliable.

Analysis and consider of technical identification for 32 cases medical tangle in medical association / 法医学杂志

OBJECTIVE@#To analyze cause of medical accidents and actuality of technical identification in medical tangle.@*METHODS@#32 cases (17 death, 15 survive) of medical tangle by technical identification (according to sex, age, mostly diseases, sequel) and identified results (whether or not mistake, cause and effect connection, duty degree) have been studied.@*RESULTS@#13 cases of 32 medical accidents have been determined.19 cases have been attributed to no medical accidents. Causes of medical accidents were most due to negligence of sense of duty.@*CONCLUSION@#The incidence rate of medical accidents can be decreased by strengthen colligated stuff of medical affairs personnal. We suggest that our state bring out more perfect legislation of autopsy in order to gain positive effect of technical identification in medical tangle. The medical mistake among grade of medical accidents should be added so that justice of identification could be improved.