Taizhou Enze Medical Center (Group) made worthwhile attempts in the decentralized and centralized financial management,in an effort to build a centralized mode featuring department setup,information management,funding management,centralized accouting,and cost-performance settlement.Centralized financial management is a trend change in the management of large medical groups,but the changes in the financial management of its complexity and long-term,are associated with the group's overall reform needs,which need to be amended and improved constantly in practice.

BACKGROUND:Adipose-derived stem cells discovered recently are a new kind of adult stem cells, and have a strong multi-differentiation capacity. However, there are rare studies concerning in vivo osteogenic capacity of adipose-derived stem cells.
OBJECTIVE:To investigate the effect of adipose-derived stem cells combined with gelatin sponge on repairing bone defects.
METHODS:Adipose-derived stem cells from rabbit inguinal fat pads were isolated and cultured, and then
induced using an osteogenic medium containing bone morphogenetic protein 2 fol owed by injection of gelatin sponge. Radial defect models of rabbits were prepared. Compound of adipose-derived stem cel s and gelatin sponge was implanted into the lesion side, while gelatin sponge alone was implanted into the contralateral side. Rabbits were kil ed at weeks 6 and 12 after bone defect repair for X-ray examination, CT scan, and hematoxylin-eosin staining.
RESULTS AND CONCLUSION:Lane-Sandhu X-ray and Lane-Sandhu histological scores after compound implantation were significantly higher than those after repair with gelatin sponge alone. It indicates that
adipose-derived stem cel s combined with gelatin sponge can promote bone defect healing of rabbits, showing an obvious osteogenic capacity in vivo.

Objective To study the effects of angiotensin Ⅱ (AngⅡ) on insulin signal transduction pathway in skeletal myoblast of L6 rats,and further to explore the possible mechanism of AngⅡ on glucose utilization.Methods Myoblast cells of L6 rats were cultured and induced to differentiate.They were divided into 4 groups according to different treatment by AngⅡ or JAK2-PKA inhibitor H89:normal control group ( NC group),insulin group,insulin + AngⅡ group and insulin + AngⅡ + H89 group.Expression of IRS1 and GLUT4 mRNA was detected by RT-PCR.Expression of IRS1,Ptyr-IRS1 and GLUT4 (total and membrane protein) were detected by Western blot.Results The difference of GLUT4 mRNA expression in the 4 groups detected by RT-PCR had no statistical significance(P ＞ 0.05).The difference of IRS1 mRNA expression among the latter 3 groups had no statistical significance(P ＞ 0.05),however,IRS1 expression in the latter 3 groups was higher than that in NC group(P ＜ 0.05).Western blot results showed expression of IRS1,Ptyr-IRS1 and GLUT4 (membrane protein)was higher in the latter 3 groups than in NC group(P ＜0.05).The difference of IRS1 expression among the latter 3 groups(P ＞ 0.05 ) and GLUT4 (total protein) expression among the 4 groups had no statistical significance (P ＞ 0.05).The expression of of ptyr-IRS1 and GLUT4 membrane protein in Ins + AngⅡ + H89 group was much higher than that in Ins + AngⅡ group,and lower than that in insulin group(P ＜0.05).Conclusion AngⅡ inhibits IRS1's tyrosine phosphorylation and GLUT4's transfer from cytoplasm to plasma membrane in skeletal muscle cells through JAK2-PKA signaling pathway,and therefore induces insulin resistance.

Objective:To explore the influencing and prognosis factors of emphysematous urinary tract infection (EUTI).Methods:The baseline clinical data of the patients admitted to Shandong University Qilu Hospital (Qingdao) from December 2013 to June 2020 and diagnosed with EUTI were analyzed retrospectively. The patients with non-EUTI (NEUTI) during the same period were selected as the control group. The baseline characteristics between the two groups were compared. Logistic regression analysis method was used to analyze the influencing factors of EUTI.Results:(1) 24 EUTI patients and 53 NEUTI patients were included in the present study. Compared with the NEUTI group, the hemoglobin level was lower ( t=-5.245, P<0.001) and the levels of blood urine nitrogen ( Z=-4.361, P<0.001), serum creatinine (Scr, Z=-4.543, P<0.001), blood glucose ( Z=-2.608, P=0.009), and triacylglycerol ( Z=-2.408, P=0.016) were higher in the EUTI group. The proportions of diabetes mellitus ( χ2=13.453, P<0.001) and chronic kidney disease ( χ2=17.936, P<0.001) in the EUTI group were higher than those in the NEUTI group. Increasing Scr was the risk factor of EUTI in patients with urinary tract infection ( OR=1.011, 95% CI 1.001-1.020, P=0.025). (2) Escherichia coli ( E.coli, 14 cases, 58.3%) was the most common causative organism. The other causative organisms included Klebsiella pneumoniae (2 cases, 8.3%), Enterococcus faecium (1 case, 4.2%), Pantoea (1 case, 4.2%), and mixed bacteria of E.coli and Enterococcus faecium (1 case, 4.2%). Ten cases of E.coli were extended-spectrum β-lactamases (ESBL)-positive. (3) Of the 24 patients with EUTI, 4 patients had adverse outcomes. The length of stay ( Z=-2.457, P=0.014), blood urea nitrogen ( t=2.432, P=0.024), shock ( P=0.002), autoimmune disease ( P=0.022), and white blood cell count ( Z=-2.091, P=0.036) were statistically different between good prognosis group ( n=20) and poor prognosis group ( n=4). However, logistic regression analysis results showed that neither was the influencing factor of poor prognosis of EUTI. Conclusions:The elevated Scr level is the independent influencing factor of EUTI among urinary infection patients. E.coli is the most common pathogenic bacteria, and ESBL-positive bacteria are common.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.