1.Simultaneous Determination of 30 Compounds Illegally Added in Chinese Patent Medicine for Promoting Blood Circulation and Removing Blood Stasis Medicine by UHPLC-MS/MS
Linlin ZHANG ; Zheng LI ; Huan YANG ; Cheng ZHENG ; Dengfeng TANG ; Bilian CHEN
Chinese Journal of Modern Applied Pharmacy 2024;41(3):359-365
OBJECTIVE
To establish an ultra-performance liquid chromatography-tandem mass spectrometry method for the simultaneous determination of 30 compounds(including antianginal drugs, anticoagulant, anti-platelet aggregators and anti-inflammatory analgesics) illegally added in Chinese patent medicine for promoting blood circulation and removing blood stasis.
METHODS
The sample was extracted by ultrasonication with 60% methanol. The analysis was performed on Phenomenex Kinetex C18 column (2.1 mm×100 mm, 2.6 μm) with gradient elution using 0.1% formic acid solution and acetonitrile as the mobile phase at the flow rate of 0.3 mL·min–1, and the column temperature was 40 ℃. Mass spectrometry was collected using electrospray ionization (ESI), simultaneous scanning of positive and negative ions, and multiple reaction monitoring mode.
RESULTS
The linearity of the 30 compounds was good in the mass range examined, with the correlation coefficients all >0.999. The limits of detection of each compound ranged from 1.3 to 238.4 ng·g–1 and the average recoveries ranged from 63.7% to 108.2% with the RSDs of 1.0% to 6.7%. The method was used to test 90 batches of Shujin Huoxue tablets. Paracetamol was detected in 3 batches, while the rest of the compounds were not detected. The amount of paracetamol detected ranged from 0.16 to 0.93 μg per tablet, which was much lower than the minimum daily dose of the corresponding drug, excluding intentional addition. The probable explanation was the residues caused by incomplete cleaning validation of the enterprise’s collinear production.
CONCLUSION
This method is rapid, accurate, highly sensitive, and highly selective, and can be used for qualitative screening and quantitative determination of 30 chemical compounds illegally added in Chinese patent medicine for promoting blood circulation and removing blood stasis.
2.Application value of CT radiomics in differentiating malignant and benign sub-centimeter solid pulmonary nodules
Jianing LIU ; Linlin QI ; Jiaqi CHEN ; Fenglan LI ; Shulei CUI ; Sainan CHENG ; Yawen WANG ; Zhen ZHOU ; Jianwei WANG
Chinese Journal of Radiological Health 2024;33(3):340-345
Objective To investigate the application efficiency and potential of CT radiomics in differentiating malignant and benign sub-centimeter solid pulmonary nodules. Methods A retrospective study was performed on the sub-centimeter ( ≤ 10 mm) solid pulmonary nodules detected by enhanced CT in our hospital from March 2020 to January 2023. Malignancy was confirmed by surgical pathology, and benignity was confirmed by surgical pathology or follow-up. Lesions were manually segmented and radiomic features were extracted. The feature dimension was reduced via feature correlation analysis and least absolute shrinkage and selection operator (LASSO). The 5-fold cross validation was used to validate the model. Support vector machine, logistic regression, linear classification support vector machine, gradient boosting, and random forest models were established for CT radiomics. Receiver operating characteristic curves were drawn. Delong test was used to compare the diagnostic performance of the five classifiers. The optimal model was selected and compared to radiologists with medium and high seniority. Results A total of 303 nodules, 136 of which were malignant, were examined. Radiomics models were established after feature extraction and selection. On test set, the areas under the receiver operating characteristic curves of support vector machine, logistic regression, linear classification support vector machine, random forest, and gradient boosting models were 0.922 (95%CI: 0.893, 0.950), 0.910 (95%CI: 0.878, 0.942), 0.905 (95%CI: 0.872, 0.938), 0.899 (95%CI: 0.865, 0.933), and 0.896 (95%CI: 0.862, 0.930), respectively. Delong test indicated no significant differences in the performance of the five radiomics models, and the support vector machine model showed the highest accuracy and F1 score. The support vector machine model showed significantly higher diagnostic accuracy as compared to radiologists (83.8% vs. 55.4%, P < 0.001). Conclusion The radiomics models achieved high diagnostic efficiency and may help to reduce the uncertainty in diagnosis of malignant and benign sub-centimeter solid nodules by radiologists.
3.Single-cell transcriptomics reveals cell atlas and identifies cycling tumor cells responsible for recurrence in ameloblastoma
Xiong GAN ; Xie NAN ; Nie MIN ; Ling RONGSONG ; Yun BOKAI ; Xie JIAXIANG ; Ren LINLIN ; Huang YAQI ; Wang WENJIN ; Yi CHEN ; Zhang MING ; Xu XIUYUN ; Zhang CAIHUA ; Zou BIN ; Zhang LEITAO ; Liu XIQIANG ; Huang HONGZHANG ; Chen DEMENG ; Cao WEI ; Wang CHENG
International Journal of Oral Science 2024;16(2):251-264
Ameloblastoma is a benign tumor characterized by locally invasive phenotypes,leading to facial bone destruction and a high recurrence rate.However,the mechanisms governing tumor initiation and recurrence are poorly understood.Here,we uncovered cellular landscapes and mechanisms that underlie tumor recurrence in ameloblastoma at single-cell resolution.Our results revealed that ameloblastoma exhibits five tumor subpopulations varying with respect to immune response(IR),bone remodeling(BR),tooth development(TD),epithelial development(ED),and cell cycle(CC)signatures.Of note,we found that CC ameloblastoma cells were endowed with stemness and contributed to tumor recurrence,which was dominated by the EZH2-mediated program.Targeting EZH2 effectively eliminated CC ameloblastoma cells and inhibited tumor growth in ameloblastoma patient-derived organoids.These data described the tumor subpopulation and clarified the identity,function,and regulatory mechanism of CC ameloblastoma cells,providing a potential therapeutic target for ameloblastoma.
4.Consistency evaluation of the Kimura-Takemoto classification and operative link for gastritis assessment in risk stratification of gastric cancer after Helicobacter pylori eradication
Chengyao WANG ; Linlin SHAO ; Wenkun LI ; Rui CHENG ; Xi ZHANG ; Zheng ZHANG ; Peng LI ; Shutian ZHANG ; Jing WU
Chinese Journal of Digestion 2024;44(5):308-313
Objective:To assess the correlation and consistency between the cancer risk-oriented endoscopic Kimura-Takemoto classification and the operative link for gastritis assessment (OLGA) in risk stratification of gastric cancer in patients with chronic gastritis after Helicobacter pylori ( H. pylori) eradication. Methods:From January 1, 2018 to October 31, 2021, 97 patients with chronic gastritis who successfully underwent H. pylori eradication at Beijing Friendship Hospital affiliated to Capital Medical University were selected. During the follow-up period, all patients underwent standardized magnifying endoscopy to assess gastric mucosal atrophy with the Kimura-Takemoto classification, which was classified as no or mild atrophy, moderate atrophy, and severe atrophy. Additionally, according to the new Sydney staging system, endoscopic biopsies were conducted at 5 sites of the patients to classify into OLGA stages 0, Ⅰ, Ⅱ, Ⅲ, or Ⅳ. Spearman rank correlation analysis and Kappa consistency test were performed to evaluate the correlation and consistency between the 2 evaluation systems, respectively. Area under the curve (AUC) of the receiver operating characteristic curve was used to calculate the predictive ability of the grading of gastric mucosal atrophy under endoscopy in high-risk histological staging. Furthermore, multivariate logistic regression analysis was used to assess factors influencing the consistency of the 2 evaluation systems. Chi-square test or Fisher′s exact test were used for statistical analysis. Results:Longitudinal follow-up was completed in 97 cases, with a follow-up time of (37.38±13.18) months after H. pylori eradication. The proportion of OLGA stage Ⅲ to Ⅳ in patients with no or mild atrophy (21.7%, 10/46) was lower than that in patients with moderate and severe atrophy (63.0%, 29/46 and 5/5, respectively), and the differences were statistically significant( χ2=16.07 and 13.30, both P<0.001). However, there was no significant difference in distribution of OLGA staging between patients with moderate atrophy and patients with severe atrophy (all P>0.05). The consistency rate of high-risk assessment for gastric cancer between the 2 evaluation systems was 73.2% (71/97). The correlation between the Kimura-Takemoto classification and OLGA staging was moderate ( r=0.47, 95% confidence interval(95% CI) 0.30 to 0.61, P<0.001). The result of consistency test indicated that the consistency of the 2 evaluation systems was moderate, and the Kappa value was 0.46 (95% CI 0.29 to 0.64, P<0.001). For patients with chronic gastritis after H. pylori eradication, the sensitivity of Kimura-Takemoto classification of moderate to severe atrophy under endoscopy in identifying high-risk of OLGA stages was 77.21% (95% CI 62.16% to 88.53%), the specificity was 69.81% (95% CI 55.66% to 81.66%), and the AUC was 0.735 (95% CI 0.636 to 0.820, P<0.01). As the time after H. pylori eradication increased (post- H. pylori eradication less than 18, 18 to 36, and more than 36 months), the consistency of atrophy assessment between the Kimura-Takemoto classification and OLGA staging reduced (7/8, 84.4% (27/32), 64.9% (37/57), respectively), and the difference was statistically significant ( χ2=4.36, P=0.037). The result of multivariate logistic regression analysis revealed that the time after H. pylori eradication more than 36 months ( OR=3.443, 95% CI 1.117 to 10.614, P=0.031) and gastric ulcer ( OR=3.928, 95% CI 1.177 to 13.110, P=0.026) were independent factors influencing the consistency between the Kimura-Takemoto classification and OLGA staging. Conclusions:The endoscopic and histological changes of chronic gastritis after eradication of H. pylori are consistent. Within short period after H. pylori eradication (no more than 36 months), the sensitivity of high-risk classification under endoscopy is high and the specificity is moderate, which can predict high-risk histological staging to a certain degree.
5.Letter 2 regarding “Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma”
Yiwen ZHANG ; Liwei WU ; Zepeng MU ; Linlin REN ; Ying CHEN ; Hanyun LIU ; Lili XU ; Yangang WANG ; Yaxing WANG ; Susan CHENG ; Yih Chung THAM ; Bin SHENG ; Tien Yin WONG ; Hongwei JI
Clinical and Molecular Hepatology 2024;30(1):113-117
6.Modified Wuhutang Alleviates Airway Inflammation and Down-regulates Expression of Muc5AC, STAT3, NF-κB, and NLRP3 in Lung Tissues of RSV-infected Asthmatic Mice
Linlin YU ; Jing WANG ; Ya ZOU ; Weiwei CHENG ; Xiaoping JING
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(19):108-115
ObjectiveTo explore effect of modified Wuhutang on airway inflammation and expression of mucin (Muc) 5AC, signal transducer and activator of transcription 3 (STAT3), nuclear factor kappa B (NF-κB), and NOD-like receptor thermal protein domain associated protein 3 (NLRP3) in respiratory syncytial virus (RSV)-infected asthmatic mice. MethodSeventy male BALB/c mice of 6-8 weeks old were randomized into normal control (CON), asthma (ovalbumin, OVA), RSV infection-induced asthma (OVA+RSV), high-, medium-, and low-dose (4.08, 2.04, 1.02 g·kg-1·d-1, respectively) modified Wuhutang, and dexamethasone (Dxms, 0.1 g·kg-1d-1) groups (n=10). The model of asthma was established by sensitization and atomization inhalation with OVA. The RSV infection-induced asthma model was established by three consecutive RSV nasal infusions (1.0 × 106 PFU·mL-1, 50 μL). Wuhutang was administrated by gavage, and Dxms by intraperitoneal injection. The CON group was given the same amount of normal saline by gavage. The mice were anesthetized with 2.5% pentobarbital sodium 24 h after the last administration, and then the lung tissue was stained by hematoxylin-eosin (HE) and Van Gieson (VG) for observation of airway inflammation. The immunohistochemical assay was employed to detect the expression of Muc5AC. Western blot was employed to determine the protein levels of phosphorylated (p)-STAT3, STAT3, p-NF-κB, NF-κB, and NLRP3. ResultCompared with the CON group, the OVA group presented airway inflammatory cell infiltration, tissue hyperemia and edema, and collagen fiber deposition. The OVA+RSV group showed severer airway inflammatory cell infiltration and tissue hyperemia and edema than the OVA group. Compared with the OVA+RSV group, modified Wuhutang alleviated the airway inflammatory cell infiltration, tissue hyperemia and edema, and collagen fiber deposition, and the high-dose group had the best performance. Compared with the CON group, the OVA group and the OVA+RSV group showed increased expression level of Muc5AC (P<0.01). Compared with the OVA+RSV group, modified Wuhutang reduced the expression level of Muc5AC, and the reduction was significant in the high-dose group (P<0.05). Compared with the high-dose modified Wuhutang group, Dxms lowered the expression level of Muc5AC (P<0.05). Compared with the CON group, the OVA and OVA+RSV groups showed up-regulated protein levels of p-STAT3, p-NF-κB, and NLRP3 (P<0.05, P<0.01). Compared with the OVA+RSV group, modified Wuhutang down-regulated the protein levels of p-STAT3, p-NF-κB, and NLRP3 (P<0.01). Compared with the high-dose modified Wuhutang group, the Dxms group showed up-regulated levels of p-STAT3, p-NF-κB proteins (P<0.01). ConclusionModified Wuhutang can reduce airway inflammation and down-regulate the expression of Muc5AC, p-STAT3, p-NF-κB, and NLRP3 in RSV-infected asthmatic mice, which suggests that Wuhutang reduces airway inflammation in RSV-infected asthma by regulating the STAT3/NF-κB signaling pathway.
7.Protective Effect of Flos Puerariae,Hoveniae Semen, and Their Compatibility on Acute Alcoholic Gastric Mucosal Injury in Mice and Mechanism
Wenyong LIAO ; Muyun LI ; Xiao DONG ; Can CAO ; Min HUO ; Yuna REN ; Haiyan LIU ; Linlin XIU ; Cheng HE ; Angran FAN ; Shaohong CHEN ; Gansheng ZHONG
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(10):39-47
ObjectiveTo explore the improvement effect of Flos Puerariae, Hoveniae Semen, and their compatibility on acute alcoholic gastric mucosal injury, and lay a foundation for further development of Flos Puerariae, Hoveniae Semen, and their compatibility in the prevention and treatment of alcohol-induced multiple organ injury. MethodThe acute alcohol-induced gastric mucosal injury model of mice was established by multiple intragastric administration of 56% Hongxing Erguotou liquor (15 mL·kg-1). A total of 120 male ICR mice were randomly divided into 8 groups, namely, the blank group, model group, omeprazole group (0.026 g·kg-1), Flos Puerariae-Hoveniae Semen (compatibility) high, medium, and low-dose groups (29.2,14.6, 7.3 g·kg-1), Flos Puerariae group (19.5 g·kg-1), and Hoveniae Semen group (19.5 g·kg-1), with 15 mice in each group. After one week of adaptive feeding, the animals were pre-administrated with the corresponding drug at the rate of 10 mL·kg-1 for 3 d. From the 4th day, after 1 h of administration, Erguotou liquid was administrated at the rate of 15 mL·kg-1 and the blank group was administrated with the same volume of deionized water to record the drunkenness and sober up time. The administration was lasted for 3 d. One hour after the last administration, the eyeballs were removed and the mice were sacrificed. The concentration of ethanol in serum was determined by gas chromatograph, and the activity of ethanol dehydrogenase (ADH) in gastric mucosa was determined by ultraviolet-vis spectrophotometer. Hematoxylin-eosin (HE) staining was used to observe the pathological changes in gastric mucosa. Serum inflammatory factors were determined by enzyme-linked immunosorbent assay (ELISA). The mRNA expression of nuclear transcription factor-κB (NF-κB) p65 and NF-κB inhibitory protein α (IκBα) were detected by real-time polymerase chain reaction (Real-time PCR). ResultAs compared with the normal group, the content of interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in serum of mice in the model group was increased (P<0.05), the mRNA expression of NF-κB p65 in gastric mucosa tissues was increased (P<0.01), and the mRNA expression of IκBα was decreased (P<0.01). As compared with the model group, the drunkenness time of the omeprazole group, high and medium-dose compatibility groups, and Flos Puerariae group was prolonged (P<0.05), the sober up time of the high and medium-dose compatibility groups was shortened (P<0.05), the ethanol concentration in the serum of the high-dose compatibility group was decreased (P<0.05), the ADH activity in the gastric mucosa of the omeprazole group and high and medium-dose compatibility groups was increased (P<0.05), the macroscopic injury score of the high, medium, and low-dose compatibility groups and Flos Puerariae group was decreased (P<0.05), the score of pathological injury in the omeprazole group, high, medium, and low-dose compatibility groups, and Flos Puerariae group was decreased (P<0.01), the expression of IL-6 in serum of all drug groups was decreased (P<0.05), the expression of IL-1β in serum of the omeprazole group, high, medium, and low-dose Flos Puerariae groups, and Hoveniae Semen group was decreased (P<0.05), the expression of TNF-α in serum of high and medium-dose groups was decreased (P<0.05), the mRNA expression of NF-κB p65 in gastric mucosa tissues of all drug groups was decreased (P<0.05), and the mRNA expression of IκBα in gastric mucosa tissues of the omeprazole group and high, medium, and low-dose compatibility groups was increased (P<0.05). As compared with the high-dose compatibility group, the drunkenness time in the low-dose compatibility group and Hoveniae Semen group was shortened (P<0.01), the sober up time in the Flos Puerariae and Hoveniae Semen groups was prolonged (P<0.01), the concentration of ethanol in the serum of the medium and low-dose compatibility groups, Flos Puerariae group, and Hoveniae Semen group increased (P<0.05), the macroscopic injury score of the medium and low-dose compatibility groups and Hoveniae Semen group was increased (P<0.05), the pathological injury score of the medium and low-dose compatibility groups, Flos Puerariae group, and Hoveniae Semen group was increased (P<0.01), the content of IL-1β in serum of low-dose compatibility group, Flos Puerariae group, and Hoveniae Semen group was increased (P<0.01), and the mRNA expression of IκBα in gastric mucosa of the Flos Puerariae group and Hoveniae Semen group was decreased (P<0.05). As compared with the medium-dose compatibility group, the drunkenness time in the Hoveniae Semen group was shortened (P<0.05), the sober up time in the Flos Puerariae group was prolonged (P<0.05), the pathological injury score in the Flos Puerariae group and Hoveniae Semen group was increased (P<0.01), and the content of IL-1β in serum of the low-dose compatibility group, the Flos Puerariae group, and Hoveniae Semen group was increased (P<0.05). As compared with the low-dose compatibility group, the pathological injury score of the Hoveniae Semen group was increased (P<0.05). ConclusionFlos Puerariae, Hoveniae Semen, and their compatibility play a role in preventing and treating acute alcoholic gastric mucosal injury in mice, which may be related to the inhibition of the expression of NF-κB signal pathway in gastric mucosa, and the high-dose compatibility group has the optimal effect.
8.Porphyromonas gingivalis Inhibits Ferroptosis in Esophageal Squamous Cell Carcinoma via Upregulation of HIF-1α
Ran GUO ; Linlin SHI ; Yueyue CHENG
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong 2023;52(6):749-755
Objective To investigate the mechanism underlying the suppressive effect of Porphyromonas gingivalis(P.gingivalis)on ferroptosis in esophageal squamous cell carcinoma(ESCC).Methods ESCC cells infected with P.gingivalis and uninfected control cells were treated with ferroptosis inducer RSL3 followed by measurements of cell viability,malondialde-hyde(MDA),reactive oxygen species(ROS),and the expression of glutathione peroxidase 4(GPX4).Moreover,the expression of hypoxia-inducible factor-1α(HIF-1α)and its target genes were detected by qPT-PCR,Western blotting or immunohistochem-istry in ESCC tissue and cells under the condition of P.gingivalis infection.The effect of P.gingivalis infection combined with the HIF-1α inhibitors LW6 and RSL3 on ferroptosis in ESCC was detected in vitro and in vivo.Results P.gingivalis infection of the ESCC cells resulted in an increase of the cell viability(P<0.05),decreased levels of intracellular ROS(P<0.05)and MDA(P<0.05)and increased the expression of GPX4 compared with RSL3 treatment alone.In ESCC tissues,the increased a-bundance of P.gingivalis was correlated with upregulation of HIF-1α.Furthermore,P.gingivalis infection induced upregula-tion of HIF-1α and its target genes.LW6 promoted ferroptosis via inhibiting the HIF-1α upregulation induced by P.gingivalis infection in vitro and in vivo.Conclusion HIF-1α renders resistance to ferroptosis in P.gingivalis infected ESCC.Combination of HIF-1α inhibitory agents and ferroptosis inducing agents might be a novel therapeutic strategy in ESCC care.
9.Identification and Expression Analysis of NBS-LRR Family Genes in Codonopsis pilosula Based on Transcriptome
Guanghui ZHAO ; Linlin DONG ; Kang NING ; Hao HUAI ; Yufei CHENG ; Juan ZHANG ; Xiaotong GUO
World Science and Technology-Modernization of Traditional Chinese Medicine 2023;25(6):1961-1971
Objective To analyze the NBS-LRR disease resistance gene family of Codonopsis pilosula(Franch.)Nannf.and explore the disease resistance mechanism,so as to solve the problem of root rot disease of C.pilosula and promote the breeding and industrial development of C.pilosula.Methods Based on the transcriptome data of C.pilosula in response to root rot pathogen,gene structure,phylogeny,gene interaction and expression pattern of C.pilosula NBS-LRR family genes were analyzed by using bioinformatics methods.Results 88 NBS-LRR family genes were successfully identified.Including N,NL,CN,CNL,TN,TNL and PN,there are 50,14,1,14,4,3 and 2 genes respectively.Their physical and chemical properties,gene structure,phylogeny,gene interaction and expression pattern were analyzed.The results showed that CNL subfamily genes of C.pilosula were amplified during evolution;CNL and TNL gene structures ar-relatively conservative;Expression pattern analysis showed that there were differences in temporal expression patterns of C.pilosula NBS-LRR family genes under F.oxysporum infection.The highly expressed genes DN64786c1g6,DN64786c1g5,DN48234c0g2,DN54844c1g2,DN59747c0g3,DN56071c1g8,DN64591c1g1,DN48464c1g1,DN59886c0g1 play an important role in regulating the disease resistance of C.pilosula.The DN54844c1g2 may interact with GLR family,and then participate in immune regulation by regulating Ca2+ influx;DN64786c1g5 may interact with cytc-1 and cytc-2,and then participate in the response of C.pilosula to root rot by participating in redox reaction;DN59747c0g3 may interact with MPK3 and play an important role in the response of C.pilosula to root rot by participating in map signal cascade,phosphorylating WRKY transcription factor and participating in hypersensitivity reaction(HR).Conclusion The identification and expression analysis of NBS-LRR family genes of C.pilosula is of great significance to explore the mechanism of root rot resistance and gene function of C.pilosula..
10.Study on the construction of the perceived service quality evaluation index system for Internet hospitals
Yurong BAO ; Yue LOU ; Yinghui BAO ; Linlin JIANG ; Cheng CHEN
Chinese Journal of Hospital Administration 2022;38(4):285-289
Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.


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