Recognising risk,influencing reality and mental healthcare in a regional emergency department

Mental health presentations to EDs continue to rise with associated challenges increasingly understood and well documented. Despite growing evidence of current and ongoing systemic issues contributing to this increase, there continues to be a lack of administrative engagement to address ED attendance, with avoidance and diversion strategies initiated during the COVID-19 pandemic no longer prioritised, despite growing need. Clear and well-documented reports of ED overcrowding and bed boarding is evidence that things need to change. Moreover, if innovative action is not taken, the risk and reality is that long waits, poor outcomes and exposure to unsafe conditions will continue. This is broadly unacceptable to consumers, their carers and the broader ED network. Delayed action in seeking alternative solutions only reinforces the risk and reality that people experiencing mental health concerns have ‘Nowhere Else To Go’.     

hCG和LHRH-A对人早孕和孕终末期胎盘绒毛分泌孕酮作用的体外研究

在妊娠的不同时期,胎盘中黄体生成素释放激素(LHRH)的含量不同。离体培养的绒毛组织实验也发现,相同剂量的外源性LHRH对妊娠中期和终末期胎盘绒毛组织分泌hCG和孕酮作用强度也不同。本实验室曾发现,LHRH类似物(LHRH-A)对体外培养孕早期(10～12周)和孕终末期(38～40周)绒毛组织分泌hCG均有兴奋作用,但对分泌孕酮的作用不同,即LHRH-A对早孕绒毛分泌孕酮有抑制作用,而对终末期分泌孕酮     

Oral Langerhans cell histiocytosis in Malaysian children: a 40-year experience

Background.  Oral Langerhans cell histiocytosis is generally seen in children.
Objective.  To determine the clinicopathological features of oral LCH in Malaysian paediatric patients.
Methods.  A retrospective study was carried out to determine the clinicopathological features of Langerhans cell histiocytosis (LCH), Letterer–Siwe disease, Hand–Schuller–Christian disease, eosinophilic granuloma, and histiocytosis X occurring in the oral cavity in children, diagnosed histologically in the main oral histopathology laboratory in Malaysia from 1967 to 2007.
Result.  There were 17 cases (eight girls and nine boys) with age ranging from 1 to 7 years. There were ten Malays, four Chinese, two Indians, and one of other ethnicity. Thirteen cases presented as gingival swellings with six of these cases accompanied with mobility of the teeth. Nine cases involved the mandible, two in the maxilla, and two cases in both the maxilla and mandible. The radiographic findings were mentioned only in nine cases with presence of bony erosion or destruction of the jaw bones. Four cases had punched-out radiolucencies of the skull. The patients also had other systemic signs and symptoms: skin lesions ( n  = 5), hepatosplenomegaly ( n  = 2), prolonged fever ( n  = 2), diabetes insipidus ( n  = 1), and exophthalmos ( n  = 1). Two cases were known cases of systemic LCH.
Conclusion.  The histopathologic features of LCH are easily recognized; however, with the development of immunostaining, the use of CD1a helps in confirming the diagnosis.