1.LC-MS Analysis on Material Basis of Famous Classical Formula Xuefu Zhuyutang
Shujing ZHONG ; Zhaoyue LIU ; Mengge WANG ; Lan MIAO ; Changying REN ; Mingqian SUN ; Li LIN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(6):188-196
ObjectiveTo systematically identify the chemical constituents of Xuefu Zhuyutang(XFZY) and quantitatively determine its main components, aiming to elucidate its pharmacodynamic material basis and provide a scientific foundation for improving its quality control standards. MethodsUltra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS/MS) was employed for qualitative analysis of XFZY, and the identification of compounds was accomplished by comparing their retention times, secondary MS fragment ion information, 52 reference standards and relevant databases, followed by attribution of their herbal sources. A total of 22 representative compounds were screened out, and UPLC-quadrupole-linear ion trap mass spectrometry(UPLC-Q-TRAP-MS/MS) was applied for quantitative analysis of the compounds in the formula. ResultsA total of 77 compounds were identified in XFZY, including 31 flavonoids mainly derived from Aurantii Fructus, Glycyrrhizae Radix et Rhizoma, Persicae Semen, Carthami Flos, Bupleuri Radix, Paeoniae Radix Rubra and Achyranthis Bidentatae Radix, 24 terpenoids mainly derived from Platycodonis Radix, Glycyrrhizae Radix et Rhizoma, Paeoniae Radix Rubra and Rehmanniae Radix, 9 phenylpropanoids and their derivatives mainly derived from Chuanxiong Rhizoma, Angelicae Sinensis Radix and Rehmanniae Radix, 4 phenolic acids mainly derived from Chuanxiong Rhizoma, Angelicae Sinensis Radix and Paeoniae Radix Rubra, 3 saccharides mainly derived from Rehmanniae Radix and Achyranthis Bidentatae Radix, and 6 other compounds mainly derived from Persicae Semen, Rehmanniae Radix and Angelicae Sinensis Radix. The results of quantitative analysis showed that the contents of protocatechuic acid, hydroxypaeoniflorin, amygdalin, vanillic acid, paeoniflorin, liquiritin apioside, liquiritin, isoquercitrin, naringin, cosmosiin, hesperidin, neohesperidin, isoliquiritin, liquiritigenin, naringenin, benzoylpaeoniflorin, hesperetin, isoliquiritigenin, formononetin, glycyrrhizic acid, nobiletin and ligustilide in XFZY were determined to be 0.12, 1.57, 54.53, 0.29, 36.17, 4.29, 4.84, 0.09, 46.67, 0.04, 3.44, 31.95, 0.82, 0.10, 0.11, 0.43, 0.07, 0.03, 0.01, 8.24, 0.13, 1.81 mg·g-1. ConclusionThe qualitative method established in this study enables rapid and sensitive analysis of the chemical constituents in XFZY. Among the identified compounds, 52 are confirmed by reference standards, ensuring the accuracy of identification. The quantitative analysis of 22 key components provides a reliable experimental basis for the pharmacodynamic material basis research and quality control standard improvement of XFZY.
2.CRTC2 attenuates cardiomyocyte hypertrophy by inhibiting cardiomyocyte ferroptosis
Zhaoyue WANG ; Hongyu ZHENG ; Yanxia WANG ; Yuanqin ZHAO ; Wei DENG ; Kun ZHOU ; Qian XU ; Huiting LIU ; Shao OUYANG ; Miao JIANG ; Zhongzhou YANG ; Zhisheng JIANG
Chinese Journal of Arteriosclerosis 2025;33(10):849-858
Aim To investigate the role and regulatory mechanism of CREB regulated transcription coactivator 2(CRTC2)in cardiomyocyte hypertrophy.Methods A pathological cardiomyocyte hypertrophy model was established in C57BL/6 mice by intraperitoneal injection of isoproterenol(ISO),the expression of CRTC2 in cardiac tissue was detec-ted by Western blot.The CRTC2 knockout mice model was constructed,the cardiac function of mice was detected by small animal echocardiography,the collagen fiber content in mice cardiac tissue was detected by Masson staining,the car-diomyocyte hypertrophy related proteins:skeletal muscle α1-actin(ACTA1)and brain natriuretic peptide(BNP),as well as ferroptosis related proteins:acyl-CoA synthetase long chain family member 4(ACSL4),solute carrier family 7 member 11(SLC7A11)and glutathione peroxidase 4(GPX4)in mice cardiac tissue were detected by Western blot,the iron ion content in mice cardiac tissue was detected by iron ion kit,to evaluate the correlation between CRTC2 and cardiomyocyte hypertrophy and ferroptosis.H9c2 cells were induced by ISO to construct an in vitro model of cardiomyocyte hypertrophy,the protein expressions of CRTC2,ACTA1,BNP,ACSL4,SLC7A11 and GPX4 were detected after intervention with fer-roptosis inhibitor ferrostatin-1(Fer-1).H9c2 cells with CRTC2 overexpression induced by ISO were used to construct an in vitro model of cardiomyocyte hypertrophy,the related indicators of cardiomyocyte hypertrophy and ferroptosis were detec-ted to explore the mechanism of CRTC2 in cardiomyocyte hypertrophy.Results Compared with the control group,the expression of CRTC2 protein in the cardiac tissue of ISO induced cardiomyocyte hypertrophy mice was increased(P<0.05).Compared with wild-type mice,CRTC2-/-mice showed worsened cardiac function,manifested as increased left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall thickness(LVPWT),heart weight/tibia length(HW/TL)and heart weight/body weight(HW/BW),decreased short axis shortening(FS)and ejection fraction(EF),increased collagen fiber content in cardiac tissue,upregulated ex-pression of cardiomyocyte hypertrophy-related proteins ACTA1 and BNP,increased mRNA and protein expression of ferrop-tosis-related protein ACSL4,decreased mRNA and protein expression of SLC7A11 and GPX4,and elevated iron ion content in cardiac tissue(P<0.05 or P<0.01).In vitro experiments showed that compared with ISO group,the ISO+Fer-1 group had no significant change in CRTC2 protein expression(P>0.05),the expression of ACTA1 and BNP protein decreased,the surface area of cardiomyocyte reduced,the expression of ACSL4 protein decreased,and the expression of SLC7A11 and GPX4 proteins increased(P<0.05 or P<0.01).Compared with the ISO group,the LV-CRTC2+ISO group showed a decrease in surface area of cardiomyocytes(P<0.01),a decrease in ACTA1,BNP and ACSL4 protein ex-pression,an increase in SLC7A11 and GPX4 protein expression,and a decrease in ROS and iron ion content(P<0.05 or P<0.01).Conclusion CRTC2 alleviates cardiomyocyte hypertrophy and protect cardiac function by suppressing fer-roptosis in cardiomyocytes.
3.CRTC2 attenuates cardiomyocyte hypertrophy by inhibiting cardiomyocyte ferroptosis
Zhaoyue WANG ; Hongyu ZHENG ; Yanxia WANG ; Yuanqin ZHAO ; Wei DENG ; Kun ZHOU ; Qian XU ; Huiting LIU ; Shao OUYANG ; Miao JIANG ; Zhongzhou YANG ; Zhisheng JIANG
Chinese Journal of Arteriosclerosis 2025;33(10):849-858
Aim To investigate the role and regulatory mechanism of CREB regulated transcription coactivator 2(CRTC2)in cardiomyocyte hypertrophy.Methods A pathological cardiomyocyte hypertrophy model was established in C57BL/6 mice by intraperitoneal injection of isoproterenol(ISO),the expression of CRTC2 in cardiac tissue was detec-ted by Western blot.The CRTC2 knockout mice model was constructed,the cardiac function of mice was detected by small animal echocardiography,the collagen fiber content in mice cardiac tissue was detected by Masson staining,the car-diomyocyte hypertrophy related proteins:skeletal muscle α1-actin(ACTA1)and brain natriuretic peptide(BNP),as well as ferroptosis related proteins:acyl-CoA synthetase long chain family member 4(ACSL4),solute carrier family 7 member 11(SLC7A11)and glutathione peroxidase 4(GPX4)in mice cardiac tissue were detected by Western blot,the iron ion content in mice cardiac tissue was detected by iron ion kit,to evaluate the correlation between CRTC2 and cardiomyocyte hypertrophy and ferroptosis.H9c2 cells were induced by ISO to construct an in vitro model of cardiomyocyte hypertrophy,the protein expressions of CRTC2,ACTA1,BNP,ACSL4,SLC7A11 and GPX4 were detected after intervention with fer-roptosis inhibitor ferrostatin-1(Fer-1).H9c2 cells with CRTC2 overexpression induced by ISO were used to construct an in vitro model of cardiomyocyte hypertrophy,the related indicators of cardiomyocyte hypertrophy and ferroptosis were detec-ted to explore the mechanism of CRTC2 in cardiomyocyte hypertrophy.Results Compared with the control group,the expression of CRTC2 protein in the cardiac tissue of ISO induced cardiomyocyte hypertrophy mice was increased(P<0.05).Compared with wild-type mice,CRTC2-/-mice showed worsened cardiac function,manifested as increased left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall thickness(LVPWT),heart weight/tibia length(HW/TL)and heart weight/body weight(HW/BW),decreased short axis shortening(FS)and ejection fraction(EF),increased collagen fiber content in cardiac tissue,upregulated ex-pression of cardiomyocyte hypertrophy-related proteins ACTA1 and BNP,increased mRNA and protein expression of ferrop-tosis-related protein ACSL4,decreased mRNA and protein expression of SLC7A11 and GPX4,and elevated iron ion content in cardiac tissue(P<0.05 or P<0.01).In vitro experiments showed that compared with ISO group,the ISO+Fer-1 group had no significant change in CRTC2 protein expression(P>0.05),the expression of ACTA1 and BNP protein decreased,the surface area of cardiomyocyte reduced,the expression of ACSL4 protein decreased,and the expression of SLC7A11 and GPX4 proteins increased(P<0.05 or P<0.01).Compared with the ISO group,the LV-CRTC2+ISO group showed a decrease in surface area of cardiomyocytes(P<0.01),a decrease in ACTA1,BNP and ACSL4 protein ex-pression,an increase in SLC7A11 and GPX4 protein expression,and a decrease in ROS and iron ion content(P<0.05 or P<0.01).Conclusion CRTC2 alleviates cardiomyocyte hypertrophy and protect cardiac function by suppressing fer-roptosis in cardiomyocytes.
4.Angiotensin Ⅱ activates p53/SAT1 signaling pathway to induce ferroptosis in white adipocytes
Wei DENG ; Xiyan LIU ; Liyuan GUO ; Qian XU ; Kun ZHOU ; Yuanqin ZHAO ; Zhaoyue WANG ; Xiang LI ; Xin-mei DENG ; Xinyi QIN ; Zhong REN ; Zhisheng JIANG
Chinese Journal of Arteriosclerosis 2025;33(5):385-394
Aim To investigate the effect and mechanism of angiotensin Ⅱ(Ang Ⅱ)on ferroptosis in white adi-pocytes.Methods The 3T3-L1 preadipocytes were differentiated into white adipocytes by inducer stimulation.The experiment was divided into control group,Ang Ⅱ group,Ang Ⅱ+Fer-1(ferroptosis inhibitor)group and Ang Ⅱ+PFT-α(p53 inhibitor)group.Ang Ⅱ was used to treat cells.RT-qPCR and Western blot were used to detect the expression levels of ferroptosis factors and adipokines.JC-1 kit was used to detect mitochondrial membrane potential(MMP)level.Iron ion kit was used to detect intracellular iron content.Glutathione(GSH)kit was used to detect GSH content.Fer-1 and Ang Ⅱ were added to treat cells to detect the the changes of ferroptosis level.The expression of p53 and spermidine/spermine N1-acetyltransferase 1(SAT1)protein was detected.Subsequently,PFT-α and Ang Ⅱ were added to co-treat cells to detect the changes of p53 and SAT1 protein expression,and to observe the effect of inhibiting p53 expression on the expression levels of ferroptosis factors and adipokines.Results 3T3-L1 cells were successfully differentiated into white adipocytes by stimulator-induced differentiation.Ang Ⅱ induced ferroptosis in white adipocytes.RT-qPCR results showed that compared with control group,the mRNA expression of anti-ferroptosis factor glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11)and iron regulatory protein 1(IRP-1)was down-regulated in Ang Ⅱ group,and the mRNA expression of pro-ferroptosis factor acyl-CoA synthetase of long-chain family member 4(ACSL4)was up-regulated.Western blot results showed that compared with control group,the protein expression of SLC7A11 and GPX4 was down-regulated in Ang Ⅱ group,and the protein expression of ACSL4 was up-regulated.Ang Ⅱ treatment increased the content of intracellular iron ions and decreased the levels of GSH and MMP.Compared with Ang Ⅱ group,the mRNA expression of IRP-1 and SLC7A11 was up-regulated in Ang Ⅱ+Fer-1 group.Ang Ⅱ induced changes in the expression profile of adipokines in white adipocytes.Western blot results showed that compared with control group,the protein ex-pression of pro-inflammatory adipokine leptin(LEP),resistin(RETN),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)was up-regulated in Ang Ⅱ group,and the protein expression of anti-inflammatory adipokine adiponectin(AD-PN)and omentin 1(ITLN1)was down-regulated.In addition,Ang Ⅱ increased the protein expression of p53 and SAT1.Inhibition of p53 expression can improve the level of ferroptosis and adipokine expression in white adipocytes trea-ted with Ang Ⅱ.Western blot results showed that compared with Ang Ⅱ group,the protein expression of p53 and SAT1 was down-regulated in Ang Ⅱ+PFT-α group,the protein expression of SLC7A11 and GPX4 was up-regulated,and the protein expression of ACSL4 was down-regulated.The protein expression of ADPN was up-regulated in Ang Ⅱ+PFT-αgroup,and the protein expression of TNF-α,LEP and RETN was down-regulated.Conclusion Ang Ⅱ induces fer-roptosis in white adipocytes through activating the p53/SAT1 signaling pathway.
5.Angiotensin Ⅱ activates p53/SAT1 signaling pathway to induce ferroptosis in white adipocytes
Wei DENG ; Xiyan LIU ; Liyuan GUO ; Qian XU ; Kun ZHOU ; Yuanqin ZHAO ; Zhaoyue WANG ; Xiang LI ; Xin-mei DENG ; Xinyi QIN ; Zhong REN ; Zhisheng JIANG
Chinese Journal of Arteriosclerosis 2025;33(5):385-394
Aim To investigate the effect and mechanism of angiotensin Ⅱ(Ang Ⅱ)on ferroptosis in white adi-pocytes.Methods The 3T3-L1 preadipocytes were differentiated into white adipocytes by inducer stimulation.The experiment was divided into control group,Ang Ⅱ group,Ang Ⅱ+Fer-1(ferroptosis inhibitor)group and Ang Ⅱ+PFT-α(p53 inhibitor)group.Ang Ⅱ was used to treat cells.RT-qPCR and Western blot were used to detect the expression levels of ferroptosis factors and adipokines.JC-1 kit was used to detect mitochondrial membrane potential(MMP)level.Iron ion kit was used to detect intracellular iron content.Glutathione(GSH)kit was used to detect GSH content.Fer-1 and Ang Ⅱ were added to treat cells to detect the the changes of ferroptosis level.The expression of p53 and spermidine/spermine N1-acetyltransferase 1(SAT1)protein was detected.Subsequently,PFT-α and Ang Ⅱ were added to co-treat cells to detect the changes of p53 and SAT1 protein expression,and to observe the effect of inhibiting p53 expression on the expression levels of ferroptosis factors and adipokines.Results 3T3-L1 cells were successfully differentiated into white adipocytes by stimulator-induced differentiation.Ang Ⅱ induced ferroptosis in white adipocytes.RT-qPCR results showed that compared with control group,the mRNA expression of anti-ferroptosis factor glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11)and iron regulatory protein 1(IRP-1)was down-regulated in Ang Ⅱ group,and the mRNA expression of pro-ferroptosis factor acyl-CoA synthetase of long-chain family member 4(ACSL4)was up-regulated.Western blot results showed that compared with control group,the protein expression of SLC7A11 and GPX4 was down-regulated in Ang Ⅱ group,and the protein expression of ACSL4 was up-regulated.Ang Ⅱ treatment increased the content of intracellular iron ions and decreased the levels of GSH and MMP.Compared with Ang Ⅱ group,the mRNA expression of IRP-1 and SLC7A11 was up-regulated in Ang Ⅱ+Fer-1 group.Ang Ⅱ induced changes in the expression profile of adipokines in white adipocytes.Western blot results showed that compared with control group,the protein ex-pression of pro-inflammatory adipokine leptin(LEP),resistin(RETN),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)was up-regulated in Ang Ⅱ group,and the protein expression of anti-inflammatory adipokine adiponectin(AD-PN)and omentin 1(ITLN1)was down-regulated.In addition,Ang Ⅱ increased the protein expression of p53 and SAT1.Inhibition of p53 expression can improve the level of ferroptosis and adipokine expression in white adipocytes trea-ted with Ang Ⅱ.Western blot results showed that compared with Ang Ⅱ group,the protein expression of p53 and SAT1 was down-regulated in Ang Ⅱ+PFT-α group,the protein expression of SLC7A11 and GPX4 was up-regulated,and the protein expression of ACSL4 was down-regulated.The protein expression of ADPN was up-regulated in Ang Ⅱ+PFT-αgroup,and the protein expression of TNF-α,LEP and RETN was down-regulated.Conclusion Ang Ⅱ induces fer-roptosis in white adipocytes through activating the p53/SAT1 signaling pathway.
6.Analysis of Influencing Factors of Negative Defensive Medicine from the Perspective of Multidimensional Configuration
Yaping LIU ; Junping LIU ; Dandan ZOU ; Juan ZHAO ; Huanyu ZHANG ; Zhaoyue LIU ; Xinle YIN ; Libo LIANG
Chinese Hospital Management 2024;44(7):11-15
Objective By exploring the conditional configuration effect of negative defensive medicine behavior,the formation mechanism and causal path of negative defensive medicine are explained,and systematic suggestions are provided for negative defensive medicine behavior,so as to improve the rational utilization of health resources.Methods NCA and fsQCA are used to conduct configuration analysis on factors influencing passive defensive medical behavior,output the conditional configuration,and further analyze the configuration effects among the influencing factors.Results The antecedent conditions of negative defensive medicine include systemic mechanisms,institutional norms,social culture,doctor-patient relationships,and self-efficacy.Ultimately,two paths contributing to passive defensive medical behavior emerge:environment conduction type and efficiency-environment joint conduction type,their consistency is 0.830.Conclusion To reduce the negative defensive medical behavior,it should pay atten-tion to improving the institutional environment and improving doctors'self-efficacy,establish a fair and reasonable external institutional environment,create an honest and harmonious cultural atmosphere,strengthen the training of doctors'professional ability and improve the doctor-patient relationship,so as to improve the rational use of health resources.
7.Analysis of Influencing Factors of Negative Defensive Medicine from the Perspective of Multidimensional Configuration
Yaping LIU ; Junping LIU ; Dandan ZOU ; Juan ZHAO ; Huanyu ZHANG ; Zhaoyue LIU ; Xinle YIN ; Libo LIANG
Chinese Hospital Management 2024;44(7):11-15
Objective By exploring the conditional configuration effect of negative defensive medicine behavior,the formation mechanism and causal path of negative defensive medicine are explained,and systematic suggestions are provided for negative defensive medicine behavior,so as to improve the rational utilization of health resources.Methods NCA and fsQCA are used to conduct configuration analysis on factors influencing passive defensive medical behavior,output the conditional configuration,and further analyze the configuration effects among the influencing factors.Results The antecedent conditions of negative defensive medicine include systemic mechanisms,institutional norms,social culture,doctor-patient relationships,and self-efficacy.Ultimately,two paths contributing to passive defensive medical behavior emerge:environment conduction type and efficiency-environment joint conduction type,their consistency is 0.830.Conclusion To reduce the negative defensive medical behavior,it should pay atten-tion to improving the institutional environment and improving doctors'self-efficacy,establish a fair and reasonable external institutional environment,create an honest and harmonious cultural atmosphere,strengthen the training of doctors'professional ability and improve the doctor-patient relationship,so as to improve the rational use of health resources.
8.Analysis of Influencing Factors of Negative Defensive Medicine from the Perspective of Multidimensional Configuration
Yaping LIU ; Junping LIU ; Dandan ZOU ; Juan ZHAO ; Huanyu ZHANG ; Zhaoyue LIU ; Xinle YIN ; Libo LIANG
Chinese Hospital Management 2024;44(7):11-15
Objective By exploring the conditional configuration effect of negative defensive medicine behavior,the formation mechanism and causal path of negative defensive medicine are explained,and systematic suggestions are provided for negative defensive medicine behavior,so as to improve the rational utilization of health resources.Methods NCA and fsQCA are used to conduct configuration analysis on factors influencing passive defensive medical behavior,output the conditional configuration,and further analyze the configuration effects among the influencing factors.Results The antecedent conditions of negative defensive medicine include systemic mechanisms,institutional norms,social culture,doctor-patient relationships,and self-efficacy.Ultimately,two paths contributing to passive defensive medical behavior emerge:environment conduction type and efficiency-environment joint conduction type,their consistency is 0.830.Conclusion To reduce the negative defensive medical behavior,it should pay atten-tion to improving the institutional environment and improving doctors'self-efficacy,establish a fair and reasonable external institutional environment,create an honest and harmonious cultural atmosphere,strengthen the training of doctors'professional ability and improve the doctor-patient relationship,so as to improve the rational use of health resources.
9.Analysis of Influencing Factors of Negative Defensive Medicine from the Perspective of Multidimensional Configuration
Yaping LIU ; Junping LIU ; Dandan ZOU ; Juan ZHAO ; Huanyu ZHANG ; Zhaoyue LIU ; Xinle YIN ; Libo LIANG
Chinese Hospital Management 2024;44(7):11-15
Objective By exploring the conditional configuration effect of negative defensive medicine behavior,the formation mechanism and causal path of negative defensive medicine are explained,and systematic suggestions are provided for negative defensive medicine behavior,so as to improve the rational utilization of health resources.Methods NCA and fsQCA are used to conduct configuration analysis on factors influencing passive defensive medical behavior,output the conditional configuration,and further analyze the configuration effects among the influencing factors.Results The antecedent conditions of negative defensive medicine include systemic mechanisms,institutional norms,social culture,doctor-patient relationships,and self-efficacy.Ultimately,two paths contributing to passive defensive medical behavior emerge:environment conduction type and efficiency-environment joint conduction type,their consistency is 0.830.Conclusion To reduce the negative defensive medical behavior,it should pay atten-tion to improving the institutional environment and improving doctors'self-efficacy,establish a fair and reasonable external institutional environment,create an honest and harmonious cultural atmosphere,strengthen the training of doctors'professional ability and improve the doctor-patient relationship,so as to improve the rational use of health resources.
10.Analysis of Influencing Factors of Negative Defensive Medicine from the Perspective of Multidimensional Configuration
Yaping LIU ; Junping LIU ; Dandan ZOU ; Juan ZHAO ; Huanyu ZHANG ; Zhaoyue LIU ; Xinle YIN ; Libo LIANG
Chinese Hospital Management 2024;44(7):11-15
Objective By exploring the conditional configuration effect of negative defensive medicine behavior,the formation mechanism and causal path of negative defensive medicine are explained,and systematic suggestions are provided for negative defensive medicine behavior,so as to improve the rational utilization of health resources.Methods NCA and fsQCA are used to conduct configuration analysis on factors influencing passive defensive medical behavior,output the conditional configuration,and further analyze the configuration effects among the influencing factors.Results The antecedent conditions of negative defensive medicine include systemic mechanisms,institutional norms,social culture,doctor-patient relationships,and self-efficacy.Ultimately,two paths contributing to passive defensive medical behavior emerge:environment conduction type and efficiency-environment joint conduction type,their consistency is 0.830.Conclusion To reduce the negative defensive medical behavior,it should pay atten-tion to improving the institutional environment and improving doctors'self-efficacy,establish a fair and reasonable external institutional environment,create an honest and harmonious cultural atmosphere,strengthen the training of doctors'professional ability and improve the doctor-patient relationship,so as to improve the rational use of health resources.

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