Objective:To summarize the clinical features of primary pulmonary lymphoepithelioma-like carcinoma by performing a literature review of case reported in the last 30 years.Methods:Using "primary pulmonary lymphoepithelioma-like carcinoma" as the key word, CNKI (China National Knowledge Infrastructure), Wanfang Database, Viper database, and PubMed were searched for cases reported from January 1988 to June 2020.Results:A total of 44 articles involving 179 patients were included in this study. There were 83 male and 96 female patients women, and 132 patients had no smoking history. Cough and expectoration were the most common clinical manifestations. Some patients were asymptomatic and were discovered in the physical examination. Among the 179 LELC patients, 173 had a single lesion. There were 93 cases of left lung involvement and 82 cases of right lung involvement. Tumors occurred more frequently in the right middle lobe (24.6%) and left lower lobe (31.8%). The serological positive rate of EB virus was 82.4%, and the genetic positive rate was low. Pathology showed nests of tumor cells with large vacuolated nuclei with abundant lymphocytic infiltrates. The positive rate for CK was 100% (75/75). The positive rates for CK5/6, P63, and P40 were 94.4% (68/72), 88.6% (62/70), and 83.9% (26/31), respectively. The positive rate of EBER in situ hybridization (ISH) was 95.5% (127/133). Surgery and chemoradiotherapy were recommended. The longest survival was 134 months.Conclusion:PPLELC occurs mostly in middle-aged people and non-smokers. The most common manifestations are cough and sputum, with some patients being asymptomatic. Tumors occur more frequently in the right middle lobe and left lower lobe, which are not easy to differentiate from common lung cancer types. The diagnosis of PPLELC depends on pathology, and immunohistochemistry may result in confusion with squamous cell carcinoma easily. The serological detection rate of EBV is high. Positive EBER ISH is helpful to diagnosis. The main therapeutic methods are surgery and chemoradiotherapy. Targeted therapy has little benefit and the efficacy of immunotherapy remains to be studied.

目的 提高对混合型肺曲霉病(MTPA)的认识和诊治水平.方法 回顾性分析2013年1月至2021年7月广西医科大学第一附属医院呼吸与危重症医学科收治的21例MTPA的临床资料.结果 21例MTPA分别为变应性支气管肺曲霉病(ABPA)+侵袭性肺曲霉病(IPA)或曲霉球+IPA重叠类型,95.2％有肺内结构性病变;ABPA+IPA重叠3例,平均年龄(38.0±14.4)岁,有哮喘病史66.7％;曲霉球+IPA重叠18例,平均年龄(54.8±11.5)岁,均无哮喘病史(0％),2组年龄、哮喘病史差异有统计学意义(P<0.05).临床症状:ABPA+IPA组,咳嗽咳痰(100％),呼吸困难(66.7％);曲霉球+IPA组,咳嗽咳痰(100％),咯血(61.1％).11例(11/19)血GM检测阳性,10例(10/12)BALF GM检测阳性.影像学表现:ABPA+IPA组,肺内结节、肿块、高密度影(100％),牙膏征、指套征(66.7％),支气管扩张(100％),晕轮征(33.3％);曲霉球+IPA组,肺内结节、肿块、高密度影(94.4％),空气新月征(44.4％),支气管扩张(50.0％),空洞(88.9％),晕轮征(22.2％),2组比较,仅牙膏征、指套征差异有统计学意义(P<0.05).治疗及转归:ABPA+IPA组,3例(100％)均经抗真菌联合全身激素治疗后好转;曲霉球+IPA组,单纯抗真菌治疗9例(50.0％),单纯肺叶切除术2例(11.1％),肺叶切除术联合抗真菌治疗7例(38.9％),好转16例(88.9％),恶化2例(11.1％).结论 MTPA较罕见,肺内结构性基础疾病是其主要宿主因素之一;ABPA与IPA重叠主要症状为咳嗽咳痰、呼吸困难,曲霉球与IPA重叠主要症状为咳嗽咳痰、咯血;GM检测有助于诊断重叠IPA类型的MTPA;胸部影像学对MTPA的诊断有重要意义;抗真菌联合全身激素治疗是治疗ABPA重叠IPA的有效手段;曲霉球与IPA重叠患者的治疗需个体化,单纯抗真菌治疗或手术联合抗真菌治疗效果好.

Objective:To explore the application of the mandarin Chinese version of the Leicester cough questionnaire (LCQ-MC) in the chronic disease management of adult patients with severe asthma.Methods:Thirty patients with severe asthma without a smoking history who received treatment and chronic disease management in the First Affiliated Hospital of Guangxi Medical University from December 2018 to December 2020 and met the inclusion criteria were selected as the research subjects. Their clinical symptoms, LCQ-MC, asthma control test (ACT), mini asthma quality of life questionnaire (MiniAQLQ), visual analogue scale (VAS) and lung function test were recorded. The reliability of LCQ-MC and its correlation with ACT, MiniAQLQ, VAS and lung function were analyzed.Results:Among the 30 patients, there were 14 males and 16 females, with an average age of (50.5±10.5) years old and a medical history of (38.3±15.5) years. The main manifestations were cough which was observed in 29 cases (96.7%), wheezing in 25 cases (83.3%), nasal symptoms in 14 cases (46.7%) and chest tightness in 11 cases (36.7%). All lung functions were consistent with the diagnosis of asthma. The total score of LCQ-MC was (16.1±4.2), in which the physiological, psychological and social dimensions were (5.0±1.2), (5.6±1.6), (5.5±1.7), respectively; and ACT (18.9+5.5), MiniAQLQ (4.9±1.4), VAS (33.5±32.4). The Cronbach′s α for the questionnaire was more than 0.70, and the results were positively correlated with ACT and MiniAQLQ ( r=0.553, 0.593, P=0.002, 0.001), negatively correlated with VAS ( r=-0.762, P<0.001). The correlations between LCQ-MC and these scores were consistent with the results after 6 months. Conclusion:Cough is an important symptom of severe asthma, and LCQ-MC can be effectively used for evaluation and chronic disease management of adult patients with severe asthma.

Pulmonary lymphangiomyomatosis is a rare lung disease that occurs in women of reproductive age. Main clinical manifestations are repeated pneumothorax, chylothorax, dyspnea and so on. Typical imaging manifestation is diffuse cystic lesions of both lungs. Clinical treatment is difficult, and prognosis is poor. Treatments for PLAM includes drugs treatment, managment of pneumothorax and chylothorax, and lung transplantation. Among them, Sirolimus is the main therapeutic drug. This article reviews the progress in treatment of PLAM to provide references for clinical treatment and future research of this disease.

Hospital infrastructure is the material basis of hospital to carry out medical treatment, scientific research, education services, etc. The proportion of infrastructure spending accounts for hospitals total expenditure increased year by year. Strengthen the hospital infrastructure financial management, effective use construction funds become more important in the hospital management.

1997年3月1日中华人同共和国卫生部颁布的第51号令即<卫生系统内部审计工作规定>明确指出,二级乙等以上的医院应设置独立的与本单位财务机构相同级别的内部审计机构.事实证明,医院内部审计部门的设立,确实提高了医院的社会效益和经济效益,合理利用卫生资源,促进医院管理水平更上新台阶.但也存着许多亟待解决的问题.

结合三项制度改革,分析工程造价管理中存在的问题。从工程造价管理体制及制度两方面探讨工程造价管理存在的问题,提出改进工程造价管理的对策,具体内容包括:规范工程造价管理主体;规范工程造价管理主体的职责;完善工程造价体制;改革现行定额制度。

一、虚假利润的识别 在现实经济中,有许多企业的资产规模很大,账面利润也很丰厚,但却没有充裕的现金来支付相应的支出,甚至于不能够按时偿还企业到期的债务;换言之,企业有很多的"利润",但手头现钱却不足--这是一个非常重要而又危险的信号,而要洞察这一信号,现金流量指标无疑有着至关重要的作用.而在实际的具体工作中,我们可以从以下几个方面去识别虚假的利润.