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Objective: The objective of this study was to investigate the validity and reliability of a the Chronic Oral Mucosal Diseases Questionnaire in a UK populationMethods: Two hundred patients with chronic oral mucosal disease (oral lichen planus, recurrent aphthous stomatitis, mucous membrane pemphigoid, pemphigus vulgaris) were enrolled in this study from the Oral Medicine Department of University College London Hospitals Trust (UCLHT) Eastman Dental Hospital. Individuals were interviewed using Oral Health Impact Profile (OHIP-14), Visual Analogue Scale (VAS) and Chronic Oral Mucosal Diseases Questionnaire (COMDQ), and the construct validity and internal reliability were examined.Results: Of the 200 study participants, 100 respondents had oral lichen planus, 42 had recurrent aphthous stomatitis and 58 had vesiculobullous conditions (mucous membrane pemphigoid or pemphigus vulgaris). With regard to construct validity, a moderate to good degree of convergent validity was found between OHIP-14 and VAS and most subscales and the total COMDQ score except the patient support subscale of COMDQ (0.21-0.37).Conclusion: COMDQ is a valid and reliable patient-reported outcome measure for patients with chronic oral mucosal diseases in a UK population. It can be considered a valuable instrument in both clinical practice and in oral medicine research. [ABSTRACT FROM AUTHOR]

Introduction: Pyridostigmine is an acetylcholinesterase inhibitor commonly used in the treatment of myasthenia gravis. We describe a patient who developed a rash after recently being started on pyridostigmine and give a general review of leukocytoclastic vasculitis. Case Presentation: A 91-year-old man was diagnosed with ocular myasthenia gravis. He was started on pyridostigmine, and 2 weeks later he developed a rash. The rash was biopsied and found to be secondary to leukocytoclastic vasculitis; the pyridostigmine was stopped, loratadine was started, and the rash resolved. Discussion: Leukocytoclastic vasculitis is commonly caused by a hypersensitivity reaction to medications, or it can be associated with certain medical conditions. We present a brief review of the most common medications and medical conditions known to cause this reaction, but to our knowledge this is the first description of pyridostigmine causing this reaction. [ABSTRACT FROM AUTHOR]

Introduction: Pyridostigmine is an acetylcholinesterase inhibitor commonly used in the treatment of myasthenia gravis. We describe a patient who developed a rash after recently being started on pyridostigmine and give a general review of leukocytoclastic vasculitis. Case Presentation: A 91-year-old man was diagnosed with ocular myasthenia gravis. He was started on pyridostigmine, and 2 weeks later he developed a rash. The rash was biopsied and found to be secondary to leukocytoclastic vasculitis; the pyridostigmine was stopped, loratadine was started, and the rash resolved. Discussion: Leukocytoclastic vasculitis is commonly caused by a hypersensitivity reaction to medications, or it can be associated with certain medical conditions. We present a brief review of the most common medications and medical conditions known to cause this reaction, but to our knowledge this is the first description of pyridostigmine causing this reaction. [ABSTRACT FROM AUTHOR]

Analytical philosophy has been challenged by experimental approaches that make use of, among other things, cognitive science methods. In this paper we illustrate the benefits of merging philosophy with neuroscience, using an example of research in the foundations of social science. We argue that designing novel experiments to answer specific philosophical questions has several advantages compared to relying passively on neuroscientists' data. In this particular case, the data redirect attention towards topics - such as inductive reasoning - that are relatively overlooked by mainstream social neuroscience. [ABSTRACT FROM AUTHOR]

Eye movements were measured during the performance of a computerized Tower of London task to specify the source of planning abnormalities in patients with 1st-episode schizophrenia or schizoaffective disorder. Subjects viewed 2 arrays of colored balls in the upper and lower parts of the screen. They were asked to plan the shortest sequence of moves required to rearrange the balls in the lower screen to match the upper arrangement. Compared with healthy controls, patients made more planning errors, and decision times were longer. However, the patients showed the same gaze biases as controls prior to making a response, indicating that they understood the requirements of the task, approached the task in a strategic manner by identifying the nature of the problem, and used appropriate fixation strategies to plan and elaborate solutions. The patients showed increased duration of long-gaze periods toward both parts of the screen. This suggests that the patients had difficulty in encoding the essential features of the stimulus array. This finding is compatible with slowing of working memory consolidation. [ABSTRACT FROM AUTHOR]

The article presents case study of a 66-year old male presented with a history of nausea, lethargy and polyuria associated with steatorrhoea along a background of prior extensive alcohol intake. It mentions that urine examination and ultrasound imaging were unhelpful beyond dilatation of the pancreatic duct. It also mentions that exocrine pancreatic insufficiency emerged due to failure of pancreas to secrete appropriate amount of digestive enzymes, presenting with steatorrhoea and weight loss.

The article offers information on the World Workshop on Oral Medicine (WWOM) VII is designed to capitalize upon rich legacy and further strategically advance the field of Oral Medicine; and mentions the goal of this workshop was to bring together a group of international experts in oral medicine to review the literature on important topics in this field and propose future directions.

Objective: To preliminary evaluate the clinical effects of probiotics in individuals with symptomatic oral lichen planus and the possible mechanisms of action. Subjects and Methods: A group of 30 individuals with symptomatic oral lichen planus were recruited in a randomised double‐blind parallel group controlled (1:1) proof‐of‐concept pilot trial of probiotic VSL#3 vs placebo. Efficacy outcomes included changes in pain numeric rating scale, oral disease severity score and the chronic oral mucosal disease questionnaire. Adverse effects, home diary and withdrawals were assessed as feasibility outcomes. Mechanistic outcomes included changes in salivary and serum levels of CXCL10 and IFN‐γ and in oral microbial composition. Results: The probiotic VSL#3 was safe and well tolerated. We observed no statistically significant change in pain, disease activity, quality of life, serum/salivary CXCL10 or oral microbial composition with respect to placebo. Salivary IFN‐γ levels demonstrate a trend for a reduced level in the active group (p = 0.082) after 30 days of probiotic consumption. Conclusions: The present proof‐of‐concept study provides some weak not convincing indication of biological and clinical effects of probiotic VSL#3 in individuals with painful oral lichen planus. Further research in this field is needed, with the current study providing useful information to the design of future clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: To validate the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) for measuring pain intensity in chronic oral mucosal diseases. Methods: Secondary analyses of data including the VAS, NRS, demographic, clinical and quality‐of‐life outcomes at baseline and 4‐month follow‐up were retrieved from a clinical study of chronic oral mucosal diseases. Construct and criterion validity and responsiveness of the VAS and NRS were assessed through testing hypotheses based upon strength of Spearman's correlation coefficients. Results: Data of 500 and 290 patients with chronic oral mucosal diseases were used for the assessment of validity and responsiveness, respectively. Moderate‐to‐high correlations between both pain scores and scores of clinical and quality‐of‐life outcomes were observed, supporting construct validity of the VAS and NRS. Their criterion validity was confirmed by significantly strong association between scores of both scales. Responsiveness of both scales was adequate based on moderate association between their change scores and global rating of change scale. Conclusion: The present results provide evidence supporting validity and responsiveness of the VAS and NRS for pain intensity assessment in patients with chronic oral mucosal diseases. Future research examining other pain intensity domains and standardizing composite scores for pain intensity in this population is required. [ABSTRACT FROM AUTHOR]

Rationale Attentional bias towards smoking-related cues is increased during abstinence and can predict relapse after quitting. Exercise has been found to reduce cigarette cravings and desire to smoke during temporary abstinence and attenuate increased cravings in response to smoking cues. Objective To assess the acute effects of exercise on attentional bias to smoking-related cues during temporary abstinence from smoking. Method In a randomized cross-over design, on separate days regular smokers ( n = 20) undertook 15 minutes of exercise (moderate intensity stationary cycling) or passive seating following 15 hours of nicotine abstinence. Attentional bias was measured at baseline and post-treatment. The percentage of dwell time and direction of initial fixation was assessed during the passive viewing of a series of paired smoking and neutral images using an Eyelink II eye-tracking system. Self-reported desire to smoke was recorded at baseline, mid- and post-treatment and post-eye-tracking task. Results There was a significant condition × time interaction for desire to smoke, F(1,18) = 10.67, P = 0.004, eta2 = 0.36, with significantly lower desire to smoke at mid- and post-treatment following the exercise condition. The percentage of dwell time and direction of initial fixations towards smoking images were also reduced significantly following the exercise condition compared with the passive control. Conclusion Findings support previous research that acute exercise reduces desire to smoke. This is the first study to show that exercise appears to also influence the salience and attentional biases towards cigarettes. [ABSTRACT FROM AUTHOR]

Substances of misuse (such as nicotine) are associated with increases in activation within the mesocorticolimbic brain system, a system thought to mediate the rewarding effects of drugs of abuse. Pharmacological treatments have been designed to reduce cigarette cravings during temporary abstinence. Exercise has been found to be an effective tool for controlling cigarette cravings. The objective of this study is to assess the effect of exercise on regional brain activation in response to smoking-related images during temporary nicotine abstinence. In a randomized crossover design, regular smokers ( n = 10) undertook an exercise (10 min moderate-intensity stationary cycling) and control (passive seating for same duration) session, following 15 h of nicotine abstinence. Following treatments, participants entered a functional Magnetic Resonance Imaging (fMRI) scanner. Subjects viewed a random series of smoking and neutral images for 3 s, with an average inter-stimulus-interval (ISI) of 10 s. Self-reported cravings were assessed at baseline, mid-, and post-treatments. A significant interaction effect (time by group) was found, with self-reported cravings lower during and following exercise. During control scanning, significant activation was recorded in areas associated with reward (caudate nucleus), motivation (orbitofrontal cortex) and visuo-spatial attention (parietal lobe, parahippocampal, and fusiform gyrus). Post-exercise scanning showed hypo-activation in these areas with a concomitant shift of activation towards areas identified in the ‘brain default mode’ (Broadmanns Area 10). The study confirms previous evidence that a single session of exercise can reduce cigarette cravings, and for the first time provides evidence of a shift in regional activation in response to smoking cues. [ABSTRACT FROM AUTHOR]

Right-hemisphere patients with left neglect often demonstrate abnormal visual search, re-examining stimuli to the right while ignoring those to the left. But re-fixations alone do not reveal if patients misjudge whether they have searched a location before. Here, we not only tracked the eye movements of 16 neglect patients during search, but also asked them to click a response button only when they judged they were fixating a target for the very first time. ''Re-clicking'' on previously found targets would indicate that patients erroneously respond to these as new discoveries. Lesions were mapped with high-resolution MRI. Neglect patients with damage involving the right intraparietal sulcus or right inferior frontal lobe ''re-clicked'' on previously found targets on the right at a pathological rate, whereas those with medial occipito-temporal lesions did not. For the intraparietal sulcus patients, the probability of erroneous re-clicks on an old target increased with time since first discovering it; whereas for frontal patients it was independent of search time, suggesting different underlying mechanisms in these two types of patient. Re-click deficits correlated with degree of leftward neglect, mainly due to both being severe in intraparietal cases. These results demonstrate that misjudging previously searched locations for new ones can contribute to pathological search in neglect, with potentially different mechanisms being involved in intraparietal versus inferior frontal patients. When combined with a spatial bias to the right, such deficits might explain why many neglect patients often re-examine rightward locations, at the expense of items to their left. [ABSTRACT FROM AUTHOR]

Objectives: To establish thresholds of pain and quality of life scores corresponding to patient acceptable symptom state (PASS) in patients with oral lichen planus (OLP) and to assess demographic and clinical factors associated with achieving the PASS. Methods: Prospective data from baseline and 4-month follow-up including Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), 14-item Oral Health Impact Profile (OHIP-14) and 15-item and 26-item Chronic Oral Mucosal Disease Questionnaire (COMDQ-15; COMDQ-26) were collected from 281 patients with OLP. An anchoring approach based upon the patient's opinion on acceptability of OLP status was applied. Associated factors for achieving the PASS were analysed using multivariate logistic regression. Results: About two-thirds (68.7%) of participants rated their OLP status as acceptable. Cut-off thresholds for PASS were as follows: ≤ 28 mm for VAS, ≤ 3 for NRS, ≤ 18 for total OHIP-14, ≤ 26 for total COMDQ-15 and ≤ 48 for total COMDQ-26. Based upon results of multivariate logistic analysis, factors associated with being in PASS were lower pain intensity, lower depressive symptoms and lower disease activity of OLP. Conclusion: The present study established PASS cut-off thresholds as a tool facilitating interpretation of pain and quality of life outcomes relevant to individuals with OLP. Clinical relevance: Identified PASS estimates could be utilised as clinically important endpoints in clinical practice of OLP as well as eligibility criteria for recruiting participants in clinical trials assessing effectiveness of symptomatic intervention of OLP. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the responsiveness of measures of pain and oral health‐related quality of life (OH‐QoL) in patients with oral lichen planus (OLP) and to determine thresholds for minimal important change (MIC) and minimal important difference (MID) for use in this patient population. Methods: Data from baseline and 4‐month follow‐up including Visual Analog Scale (VAS), Numerical Rating Scale (NRS), 14‐item Oral Health Impact Profile (OHIP‐14), 15‐item and 26‐item Chronic Oral Mucosal Disease Questionnaire (COMDQ‐15; COMDQ‐26) were collected from 157 patients with OLP. Responsiveness was assessed by testing hypotheses and calculating the area under the curve. MIC and MID were established based on triangulation of distribution‐based and anchor‐based estimates. Results: The results supported adequate responsiveness of VAS, NRS, COMDQ‐15 and COMDQ‐26 for use in OLP, while the OHIP‐14 demonstrated relatively low sensitivity to detect improvement in the OLP status. Recommended meaningful improvement thresholds were as follows: VAS (MIC 16 mm; MID 18 mm), NRS (MIC/MID 2 points), OHIP‐14 (MIC/MID 5 points), COMDQ‐15 (MIC 5 points; MID 6 points) and COMDQ‐26 (MIC/MID 9 points). Conclusion: This study provides some evidence of responsiveness as well as establishing meaningful improvement thresholds in scores of pain and OH‐QoL measures in OLP. [ABSTRACT FROM AUTHOR]

Objectives: To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in clinical studies of recurrent aphthous stomatitis (RAS) and to provide cross-sectional assessment of anxiety, depressive, and distress symptoms and perceived stress in patients with RAS.Methods: The validity and reliability of the HADS and PSS-10 were evaluated in 120 individuals with RAS through confirmatory factor analysis and calculation of Cronbach's alpha and omega coefficients. The prevalence of comorbid anxiety, depression, distress, and moderate-to-high perceived stress, and their association with demographics and clinical factors were assessed through cutoff scores of the HADS and PSS-10 and bivariate analyses, respectively.Results: A bi-factor model, with all items loading onto general factor with two group factors, provides the best fit to the HADS and PSS-10 data of this RAS cohort. While omega values suggested adequate reliability of total score of both scales, relatively low ranges of coefficient omega hierarchical limit utility of their subscale scores. The prevalence of anxiety, depression, distress, and moderate-to-high perceived stress was 42.5%, 18.33%, 28.33%, and 71.67%, respectively. Ethnicity, alcohol consumption, disease comorbidities, clinical type of RAS, ulcer size, pain, and RAS disease activity were found to be associated with negative psychological symptoms.Conclusion: The HADS and PSS-10 are valid and reliable as general scales of psychological distress and stress in patients with RAS. Significant mental burden among RAS patients makes the use of these validated instruments a sensible and prudent practice for psychological assessment of this patient group. [ABSTRACT FROM AUTHOR]

Objectives: To validate the Hospital Anxiety and Depression Scale (HADS) and the 10‐item Perceived Stress Scale (PSS‐10) for use in patients with oral lichen planus (OLP) and to provide cross‐sectional analysis of anxiety, depressive and distress symptoms in patients with OLP. Methods: Validity and reliability of both instruments were assessed in 260 participants with OLP in one tertiary oral medicine centre through confirmatory factor analysis and calculation of reliability coefficients. Prevalence, clinical and demographic predictors of the presence of psychological symptoms in OLP were calculated and identified using multivariated logistic regression. Results: Factor analysis results demonstrated that a bifactor model described the underlying structure of both scales better than other models. Values of omega indicated adequate reliability of total HADS and PSS‐10 score while low coefficient omega hierarchical values limit clinical applicability of their subscale scores. The prevalence of anxiety, depressive and distress symptoms in OLP was 39.23%, 20.77% and 27.69%, respectively. Pain intensity, disease comorbidities, age, smoking and alcohol consumption were found to be independent predictors of the presence of psychological symptoms in OLP. Conclusion: The HADS and PSS‐10 are appropriate to use as general measures of psychological distress and perceived stress in patients with OLP. [ABSTRACT FROM AUTHOR]

Background: The adoption of the Chronic Oral Mucosal Disease Questionnaire (COMDQ) into clinical practice has been low, despite its rigorous development process. A potential limitation of the COMDQ is the high response burden to patients. Therefore, the aim of the present study was to develop and validate a short version of the 26-item COMDQ.Methods: The COMDQ data of 520 patients with chronic oral mucosal diseases were randomly divided into two subsamples. Descriptive item analysis and exploratory factor analysis (EFA) were performed using data from the first subsample for item reduction and development of the shortened COMDQ. The resulting short version was then validated using confirmatory factor analysis (CFA) on the other subsample. Internal consistency reliability of the short-form COMDQ was assessed using Cronbach's alpha. Criterion validity of this new scale was examined against its original version.Results: Based upon item analysis, 11 items were dropped. EFA results on the remaining 15 items extracted four factors consistent with the original COMDQ, and CFA results displayed acceptable goodness-of-fit indices of this factor structure on different sample. The COMDQ-15 was then created. Cronbach's alpha of four subscale scores ranged from 0.7 to 0.91, indicating good internal consistency reliability of the COMDQ-15. Correlations between total and subscale scores of the COMDQ-15 and its parent scale were high, supporting good criterion validity of this shortened scale.Conclusion: The COMDQ-15 is a brief, valid and reliable instrument that can give an overview of the patient's quality of life related to their chronic oral mucosal conditions. [ABSTRACT FROM AUTHOR]

Objective: To detail a scoping review on the global and regional relative frequencies of oral mucosal disorders in the children based on both clinical studies and those reported from biopsy records. Materials and Methods: A literature search was completed from 1 January 1990 to 31 December 2018 using PubMed and EMBASE. Results: Twenty clinical studies (sample size: 85,976) and 34 studies from biopsy services (40,522 biopsies) were included. Clinically, the most frequent conditions were aphthous ulcerations (1.82%), trauma‐associated lesions (1.33%) and herpes simplex virus (HSV)‐associated lesions (1.33%). Overall, the most commonly biopsied lesions were mucoceles (17.12%), fibrous lesions (9.06%) and pyogenic granuloma (4.87%). By WHO geographic region, the pooled relative frequencies of the most common oral lesions were similar between regions in both clinical and biopsy studies. Across regions, geographic tongue (migratory glossitis), HSV lesions, fissured tongue and trauma‐associated ulcers were the most commonly reported paediatric oral mucosal lesions in clinical studies, while mucoceles, fibrous lesions and pyogenic granuloma were the most commonly biopsied lesions. Conclusions: The scoping review suggests data from the clinical studies and biopsy records shared similarities in the most commonly observed mucosal lesions in children across regions. In addition, the majority of lesions were benign in nature. [ABSTRACT FROM AUTHOR]

Chronic mucocutaneous candidiasis (CMC) is a heterogenous group of primary immunodeficiency diseases characterised by susceptibility to chronic or recurrent superficial Candida infection of skin, nails and mucous membranes. Gain‐of‐function mutations in the STAT1 gene (STAT1‐GOF) are the most common genetic aetiology for CMC, and mutation analysis should be considered. These mutations lead to defective responses in Type 1 and Type 17 helper T cells (Th1 and Th17), which, depending on the mutation, also predispose to infection with Staphylococci, Mycobacteria and Herpesviridae. We describe the clinical and genetic findings for three patients with CMC due to gain‐of‐function mutations in the STAT1 gene. [ABSTRACT FROM AUTHOR]

Objective: To assess the economic burden of oral lichen planus (OLP) from the perspective of the healthcare provider in a U.K. population. Methods: This prevalence-based cost-of-illness analysis was carried out via a cross-sectional study conducted in the Oral Medicine Unit of the Eastman Dental Hospital. This study was conducted in three phases - phase 1 involved framing of the cost-of-illness analysis, development of the cost inventory and design of the patient questionnaire for ease of data collection. Data collected from patients were inputted during phase 2, and costings were determined. The final phase consisted of the calculation of the cost of illness of OLP. Results: One hundred patients were enrolled in the study, 30 males and 70 females, with an average age of 59.9 years (±13.4 years). The average OLP patient, based on our cohort, attends the oral medicine unit 2.64 times per year, their general medical practitioner 1.13 times annually, their general dental practitioner 0.82 times in a year and fills on average 3.37 prescriptions annually. This leads to an average annual cost of £398.58 (€541.16) per patient per year from the perspective of the healthcare provider. Conclusion: The annual average cost of OLP to the healthcare provider in the U.K. is substantial. The prevalence-based cost-of-illness data generated in this study will facilitate comparison with other chronic oral mucosal diseases and with chronic diseases managed in allied medical specialties. [ABSTRACT FROM AUTHOR]

Rationale: Smokers show heightened activation toward smoking-related stimuli and experience increased cravings which can precipitate smoking cessation relapse. Exercise can be effective for modulating cigarette cravings and attenuating reactivity to smoking cues, but the mechanism by which these effects occur remains uncertain. Objective: The objective of the study was to assess the effect of exercise on regional brain activation in response to smoking-related images during temporary nicotine abstinence. Methods: In a randomised crossover design, overnight abstinent smokers ( n = 20) underwent an exercise (10-min moderate-intensity stationary cycling) and passive control (seating for the same duration) treatment, following 15 h of nicotine abstinence. After each treatment, participants underwent functional magnetic resonance imaging (fMRI) brain scanning while viewing a random series of blocked smoking or neutral images. Self-reported cravings were assessed at baseline, mid-, and post-treatments. Results: There was a significant interaction effect (treatment × time) for desire to smoke, F (2,32) = 12.5, p < 0.001, with significantly lower scores following the exercise at all time points compared with the control treatment. After both exercise and rest, significant areas of activation were found in areas of the limbic lobe and in areas associated with visual attention in response to smoking-related stimuli. Smokers showed increased activation to smoking images in areas associated with primary and secondary visual processing following rest, but not following a session of exercise. Conclusion: The study shows differing activation towards smoking images following exercise compared to a control treatment and may point to a neuro-cognitive process following exercise that mediates effects on cigarette cravings. [ABSTRACT FROM AUTHOR]

Abstract: Understanding causal relationships and violations of those relationships is fundamental to learning about the world around us. Over time some of these relationships become so firmly established that they form part of an implicit belief system about what is possible and impossible in the world. Previous studies investigating the neural correlates of violations of learned relationships have focused on relationships that were task-specific and probabilistic. In contrast, the present study uses magic-trick perception as a means of investigating violations of relationships that are long-established, deterministic, and that form part of the aforementioned belief system. Compared to situations in which expected causal relationships are observed, magic trick perception recruited dorso-lateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), brain regions associated with the detection of conflict and the implementation of cognitive control. These activations were greater in the left hemisphere, supporting a role for this hemisphere in the interpretation of complex events. DLPFC is more greatly activated by magic tricks than by surprising events, but not more greatly activated by surprising than non surprising events, suggesting that this region plays a special role in causality processing. The results suggest a role for cognitive control regions in the left hemisphere in a neurobiology of disbelief. [Copyright &y& Elsevier]