The effect of coping strategies on health-related quality of life in acromegaly patients.

PURPOSE: Patients with acromegaly oftentimes exhibit a reduced physical and psychological health-related quality of life (HRQoL). Maladaptive coping styles are associated with poor HRQoL in a number of diseases and patients with pituitary adenomas in general exhibit less effective coping styles than healthy controls. This study aimed to assess coping strategies in acromegaly patients in order to explore leverage points for the improvement of HRQoL. METHODS: In this cross-sectional study, we administered self-report surveys for coping strategies and HRQoL (Short Form SF-36, Freiburg questionnaire on coping with illness, FKV-LIS) in patients with acromegaly. These were set into relation with a variety of health variables. RESULTS: About half of the 106 patients (44.3% female) with a mean age of 56.4 ± 1.3 years showed impaired physical and psychological HRQoL on average 11.2 years after the initial diagnosis. Body mass index, age at survey date and concomitant radiotherapy explained 27.8% of the variance of physical HRQoL, while depressive coping added an additional 9.2%. Depressive coping style and trivialization and wishful thinking were pivotal predictors of an impaired psychological HRQoL with a total explained variance of 51.6%, whereas patient health variables did not affect psychological HRQoL. CONCLUSION: Our results show that maladaptive coping styles have a substantial negative impact on psychological HRQoL in patients with acromegaly, whereas physical HRQoL is influenced to a lesser extent. Specialized training programs aimed at improving coping strategies could reduce long-term disease burden and increase HRQoL in the affected patients.

The influence of radiological tumor growth pattern on sino­nasal health in pituitary adenomas.

Pituitary adenomas are one of the most common mass lesions of the brain and are associated with a reduced quality of life. While transnasal and transsphenoidal endoscopic approaches are considered to deliver similar recovery rates for sino-nasal health (SNH), the impact of radiological tumor growth patterns on SNH has not been evaluated. In the present study, the influence of radiological tumor growth on SNH was examined before and after endoscopic transsphenoidal tumor resection. Patient data were prospectively collected between August 1, 2016 and August 31, 2022. The Knosp and Hardy classifications were used to dichotomize pituitary adenoma lesions into low- and high-graded lesions. SNH was assessed shortly before surgery and at follow-up examinations 3-6 months after operation using the Sino-Nasal Outcome Test for Neurosurgery (SNOT-NC) questionnaire. Fully completed SNOT-NC questionnaires were collected before and after surgery from a total of 101 patients. Independent t-tests showed significantly higher rates of deterioration after surgery in patients with Knosp low-graded lesions compared with those with high-graded tumors for the SNOT-NC total score P=0.048, nasal discomfort P=0.034, sleep problems P=0.024 and visual impairment P=0.042. Pre- and post-operative comparisons for the Knosp low-graded tumor cohort showed an increase of nasal discomfort (P=0.004), while the Knosp high-graded tumor cohort reported decreased visual impairment (P=0.016) after surgery. Assessing the Hardy classification, increased nasal discomfort was reported in patients with high-graded infrasellar tumors after surgery (P=0.046). Growth characteristics of pituitary adenomas based on Knosp and Hardy classifications may influence SNH. Patients with less invasive lesions were revealed to be more prone to experiencing a decrease in SNH, which went beyond the assumed deterioration of 1-3 months. These findings indicate the importance of detailed information regarding SNH as part of every pre-operative patient briefing.

Variables associated with oral health-related self-efficacy - results of a cross-sectional study.

BACKGROUND: Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions. METHODS: OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (ß), and effect size (Cohen's d) were calculated. RESULTS: The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059). CONCLUSIONS: In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.

Measuring Patient Experience and Patient Satisfaction-How Are We Doing It and Why Does It Matter? A Comparison of European and U.S. American Approaches.

(1) Background: Patients' experiences and satisfaction with their treatment are becoming increasingly important in the context of quality assurance, but the measurement of these parameters is accompanied by several disadvantages such as poor cross-country comparability and methodological problems. The aim of this review is to describe and summarize the process of measuring, publishing, and utilizing patient experience and satisfaction data in countries with highly developed healthcare systems in Europe (Germany, Sweden, Finland, Norway, the United Kingdom) and the USA to identify possible approaches for improvement. (2) Methods: Articles published between 2000 and 2021 that address the topics described were identified. Furthermore, patient feedback in social media and the influence of sociodemographic and hospital characteristics on patient satisfaction and experience were evaluated. (3) Results: The literature reveals that all countries perform well in collecting patient satisfaction and experience data and making them publicly available. However, due to the use of various different questionnaires, comparability of the results is difficult, and consequences drawn from these data remain largely unclear. (4) Conclusions: Surveying patient experience and satisfaction with more unified as well as regularly updated questionnaires would be helpful to eliminate some of the described problems. Additionally, social media platforms must be considered as an increasingly important source to expand the range of patient feedback.

Pre-Surgery Patient Health Contributes to Aggravated Sino-Nasal Outcome and Quality of Life after Pituitary Adenomectomy.

Objectives: The transphenoidal bi-nostril endoscopic resection of pituitary adenomas is regarded as a minimally invasive treatment nowadays. However, sino-nasal outcome and health-related quality of life (HRQoL) might still be impaired after the adenomectomy, depending on patients' prior medical history and health status. A systematic postoperative comparison is required to assess differences in perceived sino-nasal outcome and HRQoL. Methods: In this single-center observational study, we collected data from 81 patients, operated between August 2016 and August 2021, at a 3-6-month follow-up after adenomectomy. We employed the sino-nasal outcome test for neurosurgery (SNOT-NC) and the HRQoL inventory Short Form (SF)-36 to compare sino-nasal and HRQoL outcome in patients with or without allergies, previous nose surgeries, presence of pain, snoring, sleep apnea, usage of continuous positive airway pressure (cpap), and nose drop usage. Results: At the 3-6-month follow-up, patients with previous nasal surgery showed overall reduced subjective sino-nasal health, increased nasal and ear/head discomfort, increased visual impairment, and decreased psychological HRQoL (all p ≤ 0.026) after pituitary adenomectomy. Patients with pain before surgery showed a trend-level aggravated physical HRQoL (p = 0.084). Conclusion: Our data show that patients with previous nasal surgery have an increased risk of an aggravated sino-nasal and HRQoL outcome after pituitary adenomectomy. These patients should be thoroughly informed about potential consequences to induce realistic patient expectations. Moreover, the study shows that patients with moderately severe allergies, snoring, and sleep apnea (± cpap) usually do not have to expect a worsened sino-nasal health and HRQoL outcome.

Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma.

OBJECTIVE: Childhood hydrocephalus patients treated by ventriculo-peritoneal (v.-p.) shunting are sometimes referred years after this therapy for evaluation of suspicious pituitary enlargement. Since pituitary size has been shown to depend on cerebrospinal fluid (CSF) pressure, we assume this phenomenon to be caused by shunt overdrainage. Therefore, we studied pituitary size and morphology in shunted hydrocephalus patients with radiological signs of high CSF drainage. PATIENTS AND METHODS: Retrospective study of pituitary size and morphology in 15 shunted patients with non-tumoral hydrocephalus and 7 shunted hydrocephalus patients due to childhood brain tumor compared to a population mean. In five brain tumor patients also pre- and postsurgical comparisons were performed. RESULTS: Pituitary mid-sagittal size and pituitary volume were significantly higher in both hydrocephalus groups, compared to the population mean (midsagittal size t = 5.91; p < 0.001; pituitary volume, t = 3.03; p = 0.006). In patients available for pre- and postoperative comparison, there was also a significant increase in pituitary size and volume postoperatively (mean preoperative midsagittal height 2.54 ± 1.0 mm vs. 6.6 ± 0.7 mm post-surgery; mean pre-operative pituitary volume 120.5 ± 69.2 mm3 vs. 368.9 ± 57.9 mm3 post-surgery). CONCLUSION: Our results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro-Kellie doctrine, stating that intracranial depletion of CSF-as caused by v.p. shunting-leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.

Quality of life and mood assessment in conservatively treated cavernous malformation-related epilepsy.

BACKGROUND: To estimate the quality of life, anxiety, depression, and illness perception in patients with medically treated cerebral cavernous malformation (CCM) and associated epilepsy. METHODS: Nonsurgically treated patients with CCM-related epilepsy (CRE) were included. Demographic, radiographic, and clinical features were assessed. All participants received established questionnaires (short-form 36 health survey, SF-36; hospital anxiety and depression score, HADS-A/D; visual analogue scale score, VAS) assessing the functional and psychosocial burden of disease. To some extent, calculated values were compared with reference values from population-based studies. Test results were related to seizure control. RESULTS: A total of 37 patients were included. Mean age was 45.8 ± 14.4 years, and 54.1% were female. Diagnosis of CRE was significantly associated with attenuated quality of life and increased level of anxiety, affecting physical and psychosocial dimensions. The assessment of illness perception identified considerable burden. HADS was significantly associated with VAS and SF-36 component scores. Efficacy of antiepileptic medication had no restoring impact on quality of life, anxiety, depression, or illness perception. CONCLUSIONS: CRE negatively influences quality of life and mood, independent of seizure control due to antiepileptic medication. Screening for functional and psychosocial deficits in clinical practice might be useful for assessing individual burden and allocating surgical or drug treatment.

How high-dose alcohol intoxication affects the interplay of automatic and controlled processes.

Binge drinking is an increasingly prevalent pattern of alcohol consumption that impairs top-down cognitive control to a much stronger degree than automatic response generation. Even though an imbalance of those two antagonistic processes fosters the development and maintenance of alcohol use disorders (AUDs), it has never been directly investigated how binge drinking affects the interaction of those two processes. We therefore assessed a sample of n = 35 healthy young men who were asked to perform a newly developed Simon Nogo paradigm once sober and once intoxicated (~1.2‰) in a balanced within-subject design. Additionally, an EEG was recorded to dissociate controlled and automatic cognitive subprocesses. The results demonstrate that alcohol seems to reduce top-down cognitive control. This control impairment was associated with changes in S-R mapping (reflected by a reduced parietal P3 amplitude), top-down response selection (reflected by modulations of lateralized readiness potentials), and (the evaluation of) response inhibition (reflected by modulations of the Nogo P3). In sharp contrast to this, automatic processing does not seem to be equally altered, as we found neither increases nor decreases in this domain. Most importantly, we also found that the interaction between control and automatisms might be less impaired by alcohol than control alone, which may help to overcome alcohol-induced response inhibition deficits. These "carryover" effects of control from one domain to the other could potentially prove beneficial in AUDs.

Intact Context-Dependent Modulation of Conflict Monitoring in Childhood ADHD.

Objective: Conflict monitoring is well known to be modulated by context. This is known as the Gratton effect, meaning that the degree of interference is smaller when a stimulus-response conflict had been encountered previously. It is unclear to what extent these processes are changed in ADHD. Method: Children with ADHD (combined subtype) and healthy controls performed a modified version of the sequence flanker task. Results: Patients with ADHD made significantly more errors than healthy controls, indicating general performance deficits. However, there were no differences regarding reaction times, indicating an intact Gratton effect in ADHD. These results were supported by Bayesian statistics. Conclusion: The results suggest that the ability to take contextual information into account during conflict monitoring is preserved in patients with ADHD despite this disorder being associated with changes in executive control functions overall. These findings are discussed in light of different theoretical accounts on contextual modulations of conflict monitoring.

How non-veridical perception drives actions in healthy humans: evidence from synaesthesia.

We continually perform actions that are driven by our perception and it is a commonly held view that only objectively perceived changes within the 'real' world affect behaviour. Exceptions are generally only made for mental health disorders associated with delusions and hallucinations where behaviour may be triggered by the experience of objectively non-existent percepts. Here, we demonstrate, using synaesthesia as a model condition (in N = 19 grapheme-colour synaesthetes), how objectively non-existent (i.e. non-veridical) but still non-pathological perceptions affect actions in healthy humans. Using electroencephalography, we determine whether early-stage perceptual processes (reflected by P1 and N1 event-related potential (ERP) components), or late-stage-integration processes (reflected by N2 component), underlie the effects of non-veridical perceptions on action control. ERP analysis suggests that even though the examined peculiarities and experimental variations are perceptual in nature, it is not early-stage perceptual processes, but rather higher-order executive control processes linking perceptions to the appropriate motor response underlying this effect. Source localization analysis implicates activation within medial frontal cortices in the effect of how irrelevant non-veridical perceptions modulate behaviour. Our results challenge common conceptions about the determinants of human behaviour but can be explained by well-established theoretical frameworks detailing the link between perception and action. This article is part of a discussion meeting issue 'Bridging senses: novel insights from synaesthesia'.

How perceptual ambiguity affects response inhibition processes.

The ability to inhibit responses is a central requirement for goal-directed behavior but has been dominated by a top-down or cognitive control view. Only recently, the role of bottom-up perceptual factors were focused in research. However, studies usually use clearly distinguishable stimulus categories to trigger response execution or inhibition. In the current study, we present a novel Gabor patch Go/No-go task to induce perceptual ambiguity during response inhibition. To examine the neurophysiological processes in detail, we use EEG recordings and combined temporal EEG signal decomposition methods with source localization analyses. We show that perceptual similarity between Go and No-go trials compromises response inhibition performance. Interestingly, the EEG data show that this is due to a modulation of stimulus-response transition or decision processes, and not purely stimulus-related processes. This was possible by applying a temporal EEG decomposition method. We provide evidence that a prefrontal P2 (pP2) likely reflects decision processes on action execution using stimulus information. These processes were associated with superior and middle prefrontal regions (BA8). When these processes fail, occasions to execute a response become misinterpreted as occasions to inhibit a response. Successful and unsuccessful decisions to inhibit a response under high perceptual ambiguity seem to further depend on how well "what-decisions," supported by neural mechanisms in BA19, can be processed. However, these what-decisions seem to be closely linked to the specification of the required action. Stimulus processing is closely linked to response programming so that response control is already informed when uncertainty with regard to stimulus identity is detected.NEW & NOTEWORTHY This study introduces a novel Go/No-go paradigm and shows what neurophysiological subprocesses and functional neuroanatomical are involved during inhibitory control when ambiguous stimulus input is provided. The results show that bottom-up perceptual processes are important to consider during top-down controlled response inhibition. Stimulus processing is closely linked to response programming so that response control is already informed when uncertainty with regard to stimulus identity is detected.

How the depth of processing modulates emotional interference - evidence from EEG and pupil diameter data.

The ability to process emotionally conflicting information is an important requirement for emotional self-control. While it seems obvious that the impact of interfering emotional information critically depends on how deeply this interfering information is processed, it is still unknown what cognitive subprocesses are most affected by manipulating the depth of processing of emotionally interfering information. We examine these aspects integrating neurophysiological (EEG) and source localization data with pupil diameter data as an indirect index of the norepinephrine (NE) system activity. We show that when processing depth of interfering emotional stimulus dimensions is increased, emotional Stroop effects become stronger. The EEG data show that this was associated with modulations of decision-making processes, as reflected by the P3 event-related potential. Notably, the integration with pupil diameter data suggests that these decision processes were modulated by the NE system, especially when the depth of processing of interfering emotional stimulus dimensions was increased. This likely reflects gain modulation processes to facilitate processing of complex interfering, emotional information. The source localization results suggest that regions in the parietal (BA7) and insular cortex (BA13) are associated with these modulatory effects. The results suggest that overcoming more complex emotional interference triggers engagement of the norepinephrine system (indexed by pupil diameter) to facilitate action control mechanisms in a time-specific manner when deeper processing of emotional stimulus dimensions is required.

Paradoxical response inhibition advantages in adolescent obsessive compulsive disorder result from the interplay of automatic and controlled processes.

Response inhibition deficits have often been described in obsessive compulsive disorder (OCD). Yet, research on response inhibition in OCD focusses on "top-down" controlled mechanisms, and it has been neglected that response inhibition performance depends on the interplay of controlled and automatic processes during response selection. Based on pathophysiological considerations we test the counterintuitive hypothesis that OCD patients show superior inhibitory control when automatic mechanisms govern processes involved in response inhibition. We examined a group of adolescent OCD patients (n = 27) and healthy controls (n = 27) using a combined Simon-Go/NoGo task. This task is able to examine conjoint effects of automatic and controlled processes during response inhibition. EEG and source localization analyses were applied to examine the underlying neural mechanisms. OCD patients committed fewer false alarms than healthy controls (HC) in the congruent Simon-NoGo condition, which is dominated by automatic response selection mechanisms. On a neurophysiological (EEG) level, these effects were reflected by intensified correlates of 'braking' processes associated with modulation of right inferior prefrontal regions. There is no general response inhibition deficit in adolescent OCD. When considering conjoint effects of automatic and controlled processes during the inhibition of responses paradoxical response inhibition advantages can emerge in OCD. This is likely a result of otherwise pathological fronto-striatal hyperactivity and loss of a situation-specific modulation of response selection mechanisms in OCD.

Stimulus Feature Conflicts Enhance Motor Inhibitory Control Processes in the Lateral Prefrontal Cortex.

The ability to inhibit prepotent responses is a central facet of cognitive control. However, the role of perceptual factors in response inhibition processes is still poorly understood and an underrepresented field of research. In the current study, we focus on the role of conflicts between perceptual stimulus features (so-called S-S conflicts) for response inhibition. We introduce a novel semantic Stroop Condition task and analyze EEG data using source localization and temporal EEG signal decomposition methods to delineate the neural mechanisms how semantic S-S conflicts modulate response inhibition. We show that semantic conflicts enhance response inhibition performance by modulating neural processes relating to conflict resolution mechanisms in the middle and inferior frontal cortex, as well as the ACC. Opposed to that, Stroop-like (S-S) conflicts compromise response execution by affecting decision processes in inferior parietal cortices. The data suggest that when action control processes and their neurophysiological correlates depend on regions specialized in the processing of semantic conflicts, there is an improvement in response inhibition. The results show that Stroop-like semantic conflicts have opposite effects depending on whether a response has to be executed or inhibited. These opposing effects are then also associated with different functional-neuroanatomical structures. The results of the study show mechanisms by which stimulus-related processes influence mechanisms of response control.

Stimulus-response recoding during inhibitory control is associated with superior frontal and parahippocampal processes.

Inhibitory control is affected by perceptual processes, but the mechanisms how perceptual features affect response inhibition are poorly understood. Theoretical frameworks detailing how variations in stimulus features that create overlaps between response categories can affect action control, like the Theory of Event Coding (TEC), have not been transferred to inhibitory control. We present a novel Go/Nogo paradigm in which we varied stimulus feature overlap between Go and Nogo trials. To examine what cognitive-neurophysiological subprocesses and functional neuroanatomical structures are modulated by stimulus-response feature overlap and recoding during inhibitory control, we combine event-related potential (ERP) recordings with source localization analyses. We show that response inhibition was compromised when stimulus features overlapped between Go and Nogo trials. The EEG data show that the recoding of stimulus-response mappings induced by such a stimulus feature overlaps affects subprocesses from perceptual gating/categorization (P1 ERP-component) to pre-motor inhibition (Nogo-N2 ERP-component) and motor inhibition (Nogo-P3 ERP-component). Although these are distinct processes, overlapping neuronal structures are associated with these modulations. The cascade of processes starts in the superior frontal cortex and is associated with perceptual categorization mechanisms. Subsequently, pre-motor inhibition or stimulus-response unbinding processes are modulated in parahippocampal structures before stimulus-response rebinding and motor inhibition is accomplished in parahippocampal and superior frontal structures. The study shows how perceptual processes can affect response inhibition using a theoretical framework, which has, until now, not been brought into connection with inhibitory control and establishes links between neurophysiology and functional neuroanatomy of inhibitory control with the TEC framework.

RETRACTED: Neurophysiological mechanisms underlying the modulation of cognitive control by simultaneous conflicts.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal) This article has been retracted at the request of the Editor-in-Chief with the agreement of the authors. In a previous version of the paper reviewed in another journal, the reviewer suggested changing the filter settings because the setting used (reported hp 0.5) can produce serious artifactual effects on the ERP components (N200, N400 and P300) that the authors were interested in. In this published version of the article a different filter (0.2Hz HP) setting is reported in the methods. However, the results sections are identical. A change in filter setting should have led to different results. There is reasonable doubt that the reported filter settings were indeed applied on the reported data. However, there is consensus that this was due to an error, acknowledged by the authors who fully co-operated with the investigation and agreed with the decision. There is no indication of any fraudulent motivation.

Evidence for an altered architecture and a hierarchical modulation of inhibitory control processes in ADHD.

Inhibitory control deficits are a hallmark in ADHD. Yet, inhibitory control includes a multitude of entities (e.g. 'inhibition of interferences' and 'action inhibition'). Examining the interplay between these kinds of inhibitory control provides insights into the architecture of inhibitory control in ADHD. Combining a Simon task and a Go/Nogo task, we assessed the interplay of 'inhibition of interferences' and 'action inhibition'. This was combined with EEG recordings, EEG data decomposition and source localization. Simon interference effects in Go trials were larger in ADHD. At the neurophysiological level, this insufficient inhibition of interferences in ADHD related to the superior parietal cortex. Simon interference effects were absent in action inhibition (Nogo) trials in ADHD, compared to controls. This was supported by bayesian statistics. The power of effects was higher than 95%. The differential effects between the groups were associated with modulations of neurophysiological response selection processes in the superior frontal gyrus. ADHD is not only associated with deficits in inhibitory control. Rather, the organization and architecture of the inhibitory control system is different in ADHD. Distinguishable inhibitory control processes operate on a hierarchical 'first come, first serve' basis and are not integrated in ADHD. This is a new facet of ADHD.

E-Cigarettes Increase Candida albicans Growth and Modulate its Interaction with Gingival Epithelial Cells.

Electronic cigarette (e-cigarette) vapor comes in contact with the different constituents of the oral cavity, including such microorganisms as Candida albicans. We examined the impact of e-cigarettes on C. albicans growth and expression of different virulent genes, such as secreted aspartic proteases (SAPs), and the effect of e-cigarette vapor-exposed C. albicans on gingival epithelial cell morphology, growth, and lactate dehydrogenase (LDH) activity. An increase in C. albicans growth was observed with nicotine-rich e-cigarettes compared with non-exposed cultures. Following exposure to e-cigarette vapor, C. albicans produced high levels of chitin. E-cigarettes also increased C. albicans hyphal length and the expression of SAP2, SAP3, and SAP9 genes. When in contact with gingival epithelial cells, e-cigarette-exposed C. albicans adhered better to epithelial cells than the control. Indirect contact between e-cigarette-exposed C. albicans and gingival epithelial cells led to epithelial cell differentiation, reduced cell growth, and increased LDH activity. Overall, results indicate that e-cigarettes may interact with C. albicans to promote their pathogenesis, which may increase the risk of oral candidiasis in e-cigarette users.