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Objectives The purpose of this multicentre study was to determine the incidence of oral candidiasis in patients treated with topical steroids for oral lichen planus (OLP) and to determine whether the application of a concurrent antifungal therapy prevented the development of an oral candidiasis in these patients. Materials and Methods Records of 315 patients with OLP seen at four Oral Medicine practices treated for at least 2 weeks with steroids with and without the use of an antifungal regimen were retrospectively reviewed. Results The overall incidence of oral fungal infection in those treated with steroid therapy for OLP was 13.6%. There was no statistically significant difference in the rate of oral candidiasis development in those treated with an antifungal regimen vs those not treated prophylactically (14.3% vs 12.6%) (P = 0.68). Conclusions Despite the use of various regimens, none of the preventive antifungal strategies used in this study resulted in a significant difference in the rate of development of an oral candidiasis in patients with OLP treated with steroids.

This chapter explores the illness experience as revealed to us by the sufferers themselves. When the primacy of the patient is recognized in healthcare, a more collaborative approach to treatment is encouraged. Common misconceptions expressed by clinicians and family/friends alike are the notions that the patient is demonstrating complacency with the disorder or that she is defending her self-starvation or binge/purge behavior as a deliberate attack on them. Many patients who have suffered from anorexia nervosa are able to articulate their own strategies for maintaining this euphoric state. Exploration of a variety of feeling states helps to describe the emotional world of those who are struggling with anorexia nervosa and bulimia nervosa. A number of these feeling states are explored, including: initial denials of pain and suffering and accompanying feelings of euphoria, shame and feelings of inferiority, fear and distrust, depression and longing, anger and grief.

Sjogren’s syndrome (SS) is an autoimmune disease targeting the exocrine glands resulting in xerostomia/keratoconjunctivitis sicca. Presently, we examined the levels and clinical correlations of IL-22 in SS. Patients with SS together with normal controls were randomly selected. IL-22 was detected at significantly higher levels in sera of patients with SS. The levels of IL-22 present in sera showed statistically significant direct correlations with hyposalivation, anti-SSB, anti-SSA/SSB combined, hypergammaglobulinemia and rheumatoid factor. IL-22 showed a direct correlation with major clinical parameters. The data suggest that IL-22 plays a critical role in the development of SS, and further study is needed to examine its function in human SS.

Using data from a 30-day diary study with 239 adults (81 young, 81 middle-aged, and 77 older adults), this study examined whether a specific ratio between positive and negative affect distinguished individuals with different mental health status and especially flourishing from non-flourishing individuals. In addition, the study addressed whether there were age differences in the positivity ratio when daily affect data were used, and whether the proposed critical positivity ratio of 2.9 discriminated equally well between individuals with different mental health status across the adult lifespan. Findings showed that the ratio of positive to negative affect differed across adulthood such that age was associated with an increasing preponderance of positive to negative affect. The positivity ratio was also associated with mental health status in the hypothesized direction; higher positivity ratios were associated with better mental health. Finally, although the data supported the notion of a positivity ratio of 2.9 as a 'critical value' in young adulthood, this value did not equally well discriminate the mental health status of middle-aged and older adults.

The objective was to estimate the duration of the effects of aerobic exercise on mood. Healthy men ( n = 13) and women ( n = 35) ages 18 to 25 years ( M = 20.2, SD = 3.4) were randomly assigned to either a control or exercise group. Participants completed the Profile of Mood States before, after, and at 1, 2, 4, 8, 12, and 24 hours following either exercise at 60% VO2 peak or quiet rest. Repeated-measures analysis of covariance was utilized with VO2 peak entered as a covariate. The exercise group showed significantly lower total mood disturbance immediately after and at 4, 8, and 12 hours following exercise.

Sjogren's syndrome is a chronic autoimmune disease complex characterized by inflammation of the exocrine glands, primarily resulting in keratoconjunctivitis sicca, hyposalivation and xerostomia, or dry mouth. Dry mouth is one of the most easily recognized components and may lead the clinician to diagnosis. Hyposalivation is more than an inconvenience, having a significant adverse effect on health and quality of life. Early recognition of this condition may minimize some of the adverse sequelae. A dental evaluation in patients with confirmed or suspected Sjogren's is recommended. The focus of this review article is to highlight oral manifestations of Sjogren's syndrome to include pathogenesis, clinical presentation, implications for health, diagnostic tools, management strategies and future perspectives.

Background The importance of oral health to systemic health and quality of life (QOL) is gaining attention. Although several studies have examined generic (general) QOL in Sjogren syndrome (SS), little information exists on the effect of oral health on QOL and relationships among self-reported oral health, systemic health and objective clinical measures of health. The authors conducted this study to characterize these relationships in a sample of patients with SS. Methods Thirty-nine patients with a diagnosis of SS ascertained by means of the 2002 American-European Consensus criteria completed both the Oral Health Impact Profile (OHIP-14) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) QOL questionnaires. OHIP-14 measures pain; functional limitation; and psychological, emotional and social disability associated with the mouth. SF-36 measures physical and emotional health and the ability to perform usual activities. Additional measures included the number of self-reported autoimmune symptoms and an index of disease damage. Statistical analysis was performed by using hierarchical regression analysis. Results Both generic and oral health–related QOL were poor in these patients. Specifically, the findings indicated that salivary flow rate was correlated significantly with both Disease Damage Index and OHIP-14 ratings, the number of autoimmune symptoms was correlated significantly with both oral and generic QOL, and oral health accounted for a significant percentage of variance in SF-36 domains of general health and social function. Conclusions Oral health appears to have an independent influence on general QOL in patients with SS. These findings underscore the importance of proactive dental management of the oral manifestations of SS. Clinical Implications Dentists and physicians must work collaboratively to maintain oral health and quality of life for patients with Sjogren syndrome. The dentist should address patients' concerns of xerostomia and hyposalivation in an aggressive manner.

The purpose of this study was to evaluate the levels of sRAGE in primary Sjögren's syndrome (SS), and to assess whether there is an association between sRAGE levels and disease characteristics. Thirteen patients were randomly selected from three subgroups: primary SS, (n = 6), secondary Sjögren's, (n = 4), and ANA(+) but lacking criteria for further disease classification (n = 3). Levels of serum sRAGE were measured in triplicate using an enzyme-linked immunosorbent assay kit. Mean sRAGE levels were significantly lower in the primary Sjögren's group. Logistic regression analysis indicated that plasma sRAGE level was a significant predictor of diagnostic status. Analyses using routine serological tests for diagnosing autoimmune disorders failed to reach statistical significance. This preliminary study supports the hypothesis that the RAGE system might participate in the disease pathway of primary SS, and that sRAGE may be a potential biomarker to aid in the diagnosis of primary SS.

TH17 cells and their associated signature cytokines, IL-17 and IL-22, are highly elevated in primary Sjögren's syndrome (pSjS). The levels of IL-22 present in sera showed significant correlations with many disease parameters, specifically hyposalivation, anti-SSB, anti-SSA/SSB, hypergammaglobulinemia and rheumatoid factor. The present study aims to examine the biological function of IL-22 on human salivary glands. To accomplish the goal, microarray analysis using the HumanHT-12 v4 Expression BeadChip was utilized to determine the biological function of IL-22. Differential expression analyses were conducted using the LIMMA package from the Bioconductor project. MTT assay, flow cytometry and Western blotting were used to identify the function of IL-22 on human salivary gland cells. Results indicate an extensive effect of IL-22 on many major molecular functions including activation of antimicrobial genes and downregulation of immune-associated pathways. Functional studies performed in-vitro using human salivary gland cells treated with IL-22 indicated a direct effect of IL-22 on cell cycling, specifically reducing cellular proliferation at the G2-M phase by activation of STAT3. These results suggest the important role of IL-22 in the salivary gland function. The present study suggests that IL-22 might be involved in regulating inflammation and controlling the cell proliferation in SjS. Keywords: IL-22, Cytokine, Sjogren's syndrome, Gene expression, Microarray

Studies using burst comparison procedures to examine age-related changes in intensity discrimination have reported that the ability to discriminate differences in intensity does not reach maturity until late childhood. In the present study, developmental changes in intensity discrimination were examined in 1- to 3-year-old children, using an increment detection paradigm. Children and adults detected increments in a continuous standard presented at three levels ranging from 35 to 55 dB SPL. Adults were also tested at lower levels of the standard in order to permit age comparisons at equivalent sensation levels. Standard stimuli were two-octave bands of noise centered at either 400 or 4000 Hz, and increments were 200 msec in duration. Discrimination performance improved significantly with both age and level of the standard. For all age groups, performance was significantly better for high- than for low-frequency stimuli, but frequency-dependent differences in increment thresholds did not vary reliably with age. Age differences were largest at low levels of the standard. At the highest level (approximately 30 dB nHL), children's difference limens for both low- and high-frequency noise bands were adultlike by 3 years of age. These results suggest that the developmental time course of increment detection is more rapid than that previously reported in burst comparison studies.

A visually reinforced operant procedure was employed to obtain 2-point threshold-duration functions in 7-month-old infants and adults in two experimental paradigms. In Experiment 1, thresholds were determined for 10- and 100-msec, 500-Hz tones and octave-band noise bursts presented in quiet and noise backgrounds. Threshold-duration functions were significantly steeper for infants than for adults under all experimental conditions, and did not differ in slope as a result of differences in either stimulus bandwidth or masking noise. In Experiment 2, thresholds for trains of brief 500-Hz tone pulses were examined in infant and adult subjects. Infant functions were adult-like for integration of multiple-pulse stimuli, suggesting that the traditional, long-term process of temporal summation is mature by 7 months of age. Differences between the present results and those previously obtained for 4-kHz stimuli appear to be consistent with the view that different mechanisms are involved in the detection of low- and high-frequency signals.

Behavioral thresholds of 6-month-old infants and adults were determined for 1/3-octave filtered clicks and 300-msec noise bursts with center frequencies ranging from .5 to 8 kHz. For noise bursts, differences between infant and adult thresholds were largest at low frequencies and smallest at 8 kHz. For clicks, infants' thresholds were most like adults' at 4 kHz, and age differences increased at both lower and higher frequencies. Differences between click and noise thresholds were significantly larger for infants than for adults at .5, 1, and 8 kHz, but not at 2 and 4 kHz. These results suggest that improvements in threshold for long-duration stimuli during infancy may not be accompanied by comparable changes in threshold at short durations. The delayed development of sensitivity to low- and high-frequency clicks appears consistent with maturational trends recently described for the auditory brainstem response.

The importance of oral health to systemic health and quality of life (QOL) is gaining attention. Although several studies have examined generic (general) QOL in Sjögren syndrome (SS), little information exists on the effect of oral health on QOL and relationships among self-reported oral health, systemic health and objective clinical measures of health. The authors conducted this study to characterize these relationships in a sample of patients with SS.Thirty-nine patients with a diagnosis of SS ascertained by means of the 2002 American-European Consensus criteria completed both the Oral Health Impact Profile (OHIP-14) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) QOL questionnaires. OHIP-14 measures pain; functional limitation; and psychological, emotional and social disability associated with the mouth. SF-36 measures physical and emotional health and the ability to perform usual activities. Additional measures included the number of self-reported autoimmune symptoms and an index of disease damage. Statistical analysis was performed by using hierarchical regression analysis.Both generic and oral health-related QOL were poor in these patients. Specifically, the findings indicated that salivary flow rate was correlated significantly with both Disease Damage Index and OHIP-14 ratings, the number of autoimmune symptoms was correlated significantly with both oral and generic QOL, and oral health accounted for a significant percentage of variance in SF-36 domains of general health and social function.Oral health appears to have an independent influence on general QOL in patients with SS. These findings underscore the importance of proactive dental management of the oral manifestations of SS.Dentists and physicians must work collaboratively to maintain oral health and quality of life for patients with Sjögren syndrome. The dentist should address patients' concerns of xerostomia and hyposalivation in an aggressive manner.

Objectives The accuracy and diagnostic benefits of the labial salivary gland (LSG) biopsy for Sjogren's syndrome (SS) have received mixed reviews. This study was conducted to assess (1) the inter-rater agreement among 5 pathologists, and (2) the relationship between biopsy findings and clinical disease parameters. Study design Three oral pathologists (OP) and two surgical pathologists (SP) provided independent diagnoses, focus scores, and plasma cell characterizations for 37 LSG biopsies. Inter-rater reliability was assessed using percentage of overall agreement and intraclass correlation coefficients. Relationships between diagnoses and clinical parameters were assessed by nonparametric correlations. Results Overall agreement among the pathologists was poor, although the intra-specialty agreement was good. The ratings of OP were most highly correlated with serological measures, while those of SP were correlated with salivary flow rate and disease damage. Conclusion Since the LSG biopsy can be the determining factor in SS diagnoses, these demonstrated inconsistencies merit further consideration.

A visually reinforced operant paradigm was employed to examine the relationship between the difference limen (DL) for intensity and level of the standard during infancy. In Experiment 1, 7-month-old infants and adults detected increments in continuous noise presented via headphones at each of four levels ranging from 28 to 58 dB SPL. Noise stimuli were 2-octave bands centered at either 400 or 4000 Hz, and increments were 10 and 100 msec in duration. Infants' DLs were significantly larger than those of adult subjects and significantly larger for low- than for high-frequency stimuli. For the high-frequency noise band, infants' DLs were generally consistent with Weber's law, remaining essentially constant for standards higher than 28 dB SPL (3 dB SL) for 100-msec increments and 38 dB SPL (13 dB SL) for 10-msec increments. For low-frequency noise, infants' absolute thresholds were exceptionally high, and sensation levels of the standards were too low to adequately describe the relationship. In Experiment 2, 7-month-old infants detected 10- and 100-msec increments in 400-Hz noise stimuli presented in sound field. Infants' low-frequency DLs were large at low intensities and decreased with increases in level of the standard up to at least 30 dB SL. For both low- and high-frequency noise, the difference between DLs for 10- and 100-msec increments tended to be large at low levels of the standard and to decrease at higher levels. These results suggest that the relationship between the DL and level of the standard varies with both stimulus frequency and duration during infancy. However, stimulus-dependent immaturities in increment detection may be most evident at levels within approximately 30 dB of absolute threshold.

A visually reinforced operant procedure was employed to determine the behavioral thresholds of 6- to 7-month-old infants and adults for stimuli of various bandwidths and durations. Experi­ ment 1 compared absolute thresholds for broadband and '!.I-octave filtered clicks and 300-msec noise bursts. For adult subjects, the difference in threshold for clicks and noise bursts was quite comparable in the two bandwidth conditions, but infants' click-noise threshold differences were significantly larger for broadband than for Ill-octave stimuli. In Experiment 2, 2-point threshold­ duration functions were compared for 4-kHz tones and octave-band noise bursts presented in back­ grounds of quiet and continuous noise. Infants' threshold-duration function for octave-band noise bursts was significantly steeper than the comparable adult function in quiet, but not in masking noise. These results suggest that young infants may have particular difficulty detecting low­ intensity broadband sounds when durations are very short. The relationship between the duration of an auditory stimulus and the intensity necessary for its detection has been the subject of numerous investigationsduring the past 4 to 5 decades, and still continues to be a topic of both theoretical and clinical interest. In general, auditory thresholds are found to decrease exponentially with in­ creases in stimulus duration up to a maximum duration of approximately 200-300 msec. This decrease in threshold is thought to reflect the summation of neural activity within the auditory system over brief periods of time and is typically referred to as temporal summation or temporal integration. The time constant of integration varies with signal frequency; however, for midfrequency tones between durations of 10 and 100-200 msec, audi­ tory thresholds closely approximate perfect integration of stimulus energy, decreasing at the rate of 8-10 dB per decade increase in stimulus duration (Gerken, Bhat, & Hutchison-Clutter, 1990; Plomp & Bouman, 1959; Wat­ son & Gengel, 1969). Much of the interest in temporal summation stems from reports suggestingthat alterations of the threshold-duration function may be systematically related to certain types of auditory dysfunction. For conditions in which the thresholds of normal-hearing adults decrease by approx­ imately 10 dB for each decade increase in duration, shal

Studies of binaural perception have indicated that subjects are able to use temporal information available in high-frequency regions of the spectrum to lateralize high-frequency waveforms but not to detect these waveforms in masking noise. The present experiments demonstrate that although high-frequency interaural difference cues are relatively ineffective in simultaneous and forward masking, they can be utilized in backward masking. In Experiment 1, large maskinglevel differences were found in backward masking for high-frequency transients presented either monaurally or with an interaural temporal delay. Experiments 2–4 examined fringe masking, effects of masker duration, and combined forward-backward masking for both high- and lowfrequency transients presented with interaural differences in phase and intensity. The results are interpreted as support for the view that the auditory system is organized into parallel shortand long-term integration systems specialized for processing transient and sustained aspects of acoustic stimulation. It is suggested that information from the two integrators is combined when analysis of interaural differences within each of the systems yields similar estimates of spatial location.

The frequency discrimination of a 20-msec test tone was measured for the same subjects in four psychophysical paradigms: a single-interval procedure, a two-alternative forced-choice procedure, a same-different procedure, and a method-of-adjustment procedure. In each paradigm, the 20-msec test tone was preceded or followed by a 500-msec, 800-Hz interfering tone. The interfering tone occurred 50 or 5 msec before the onset of the test tone (forward interference) or 100 or 5 msec after the offset of the test tone (backward interference). In each of the four paradigms and for each of the interference conditions the value of Δf for the test tone was varied symetrically around 800 Hz to obtain an estimate of the frequency discrimination thresholds. In all psychophysical paradigms except for the single-interval procedure, there were small or no significant differences in observers’ frequency discrimination behavior among the interference conditions. The thresholds for Δf from these conditions were approximately the same as those obtained without an interfering tone. In the single-interval task, when the test tone preceded the interfering tone (backward interference) by 5 msec, an increase in the value of Δf required for discrimination over that required in the other conditions was measured. These results suggest that the effect of backward interference on a target tone does depend on psychophysical procedure.

The present study assessed use of food as a coping mechanism and cognitive distortions regarding food and weight in relation to extent of bulimic symptomatology. Subjects were 19 women who fulfilled an operationalized defination of the DSM-III diagnostic criteria for bulimia (bulimics), 35 women who fulfilled an operationalized definition of an absence of bulimic symptomology (symptom-free), and 41 women who fulfilled some but not all bulimic criteria (bulimic-like). The symptom-free, bulimic-like, and bulimic groups each differed from one another in a linear fashion from low to high on measures of use of food as a coping mechanism, five of eight types of cognitive distortions regarding food and weight (dichotomous thinking, worry, exaggeration, superstitious thinking, and personalization), drive for thinness, and lack of interoceptive awareness. The bulimic and bulimic-like groups evidenced greater perfectionism, defeatism, regret, and body dissatisfaction than the symptom-free group. Variation in the extent of use of food and cognitive distortions accounted for 70% of explained variance in the severity of DSM-III bulimic symptomatology. These results suggest that behavioral, affective, and cognitive indices of bulimia fall along parallel continua of symptomatic severity. The results also support the relevance of preventative and therapeutic programs with multidimensional foci.

Forward, backward, and combined forward‐backward masking of a 1‐msec click by noise bursts were examined for N0S0 and N0Sπ stimulus configurations. The silent interval between the noise masker and the click ranged from 0 to 30 msec for forward and backward masking conditions. For combined forward‐backward masking, the silent interval between the two noise maskers ranged from 1 to 60 msec, and the click was positioned at various points within this interval. The results, which were consistent with previous reports, indicated that masking level difference (MLDs) are obtained for both forward and backward masking. The largest MLDs were obtained in the combined forward‐backward masking conditions. In both the N0S0 and N0Sπ stimulus configuration, the amount of masking in the combined forward‐backward masking conditions varied as much as 10 dB as the click was moved within the intermasker interval. The results of this study are compared with data from investigations of masking with forward and backward fringes....

An adaptive up-down tracking procedure was used in combination with a visually reinforced head turn response to examine auditory sensitivity for 500, 2000, and 8000-Hz tone bursts in infants 6 to 18 months of age. Six- and 10-month-old infants were tested with headphone presentation of stimuli, while 10-, 14, and 18-month-olds were tested in sound field. Infant threshold estimates for both headphone and sound field were within 15 dB of adult comparisons for all frequencies and age groups. Six-month-olds were significantly less sensitive to the 8000-Hz tone than to either of the lower frequency stimuli, but older infants demonstrated approximately equal sensitivity for all three frequencies tested.

Heart rate (HR) response to simple stimuli apparently changes from an accelerative to decelerative response in the first few months of life. The present study of 4 month old infants showed that response depends on state and on the intensity and rise time of stimuli. The response was solely decelerative in alert infants but in less alert states of increasing agitation or increasing somnolence, deceleration lessened and acceleration appeared. Rapid rise time had an acceleratory effect which was more pronounced during sleep than during the waking state. Results were compared with those obtained to the same stimuli in parallel studies of newborns and adults. It appears that the decelerative response in awake Ss, presumably an orienting response, has a curvilinear relationship to age which cannot be ascribed to differences in initial HR level, state, stimulus intensity, or stimulus rise time.

He art-rate changes, recorded from human Ss under conditions appropriate for eliciting orienting, were curvilinearly related to age and independent of differences in prestimulus heart rate. Deceleration was absent at birth, increased from 6 to 16 weeks, and lessened between 16 weeks and young adulthood.

Behavioral thresholds for 500, 2000, and 8000 Hz tone bursts were determined for 6‐ and 10‐month‐old human infants using a transformed up‐down tracking procedure in a conditioned head turn paradigm. In experiment 1, stimuli were presented in free field and tracking was initiated at an intensity well above threshold. For 10‐month‐old infants, threshold estimates were approximately 15 dB above adult values at all three frequencies. Six‐month‐old thresholds were slightly higher and relatively flat across frequencies. In experiment 2, stimuli were presented via earphone, tracking was initiated below threshold, and supra threshold probe trials were introduced to assess the infants' motivation to respond. With these changes in procedure, 6‐month‐olds showed the adult U‐shaped sensitivity function. [Work supported by NINCDS.]