Phototherapy is a useful treatment modality for atopic dermatitis (AD). This is a prospective randomised double-blind study comparing the clinical efficacy of combined ultraviolet-A (UVA)/narrowband ultraviolet-B (NBUVB) versus NBUVB phototherapy in the treatment of chronic AD. Patients with moderate-to-severe AD were randomised to receive either UVA/NBUVB or NBUVB phototherapy twice weekly over 12 weeks. At baseline, weeks 6 and 12, Eczema Area And Severity Index (EASI), itch score and adverse effects were assessed. At baseline and week 12, disease-related quality of life was evaluated using the Dermatology Life Quality Index (DLQI). Nine patients were randomised to receive UVA/NBUVB and 10 received NBUVB. At week 12, both groups showed significant improvement in EASI and itch scores (p < 0.05). Significant improvement in DLQI was seen in the UVA/NBUVB arm (p = 0.009) with a trend towards improvement in the NBUVB arm (p = 0.11). The efficacy of both modalities were comparable, as were reported adverse effects aside from skin dryness which was higher in the NBUVB arm (40% vs. 0%, p = 0.033). Combined UVA/NBUVB and NBUVB phototherapy have comparable clinical efficacy and safety in the treatment of chronic AD. NBUVB may induce greater skin dryness.
Dermatitis, Atopic , Eczema , Ultraviolet Therapy , Humans , Dermatitis, Atopic/radiotherapy , Prospective Studies , Double-Blind Method , Quality of Life , Ultraviolet Therapy/adverse effects , Phototherapy , Pruritus/etiology , Pruritus/radiotherapy , Treatment Outcome
While increasing studies have documented the link between mind wandering and task switching, less is known about which brain regions mediate this relationship. Using the MPI-Leipzig Mind-Brain-Body dataset (N = 173), we investigated the association between trait-level tendencies of mind wandering, task-switching performance, structural connectivity, and resting-state functional connectivity. At the behavioral level, we found that higher spontaneous mind-wandering trait scores were associated with shorter reaction times on both repeat and switch trials. The whole brain cortical thickness analysis revealed a strong mediating role of the left superior parietal lobe, which is part of the dorsal attention network, in the link between spontaneous mind-wandering tendency and task-switching performance. The resting-state functional connectivity analysis further demonstrated that this association was partly mediated by the negative dorsal attention network-default mode network functional connectivity. No significant mediating effects were found for deliberate mind-wandering tendency. Overall, the findings highlight the pivotal role of the left superior parietal lobe in activating new mental set during mind-wandering and task-switching processes, providing another evidence in favor of a role for switching in mind wandering.
Brain Mapping , Magnetic Resonance Imaging , Humans , Brain , Parietal Lobe/diagnostic imaging , Reaction Time
Previous research has established that mind wandering does not necessarily disrupt one's task-switching performance. Here we investigated the effects of mind wandering on electrophysiological signatures, measured using event-related potentials (ERPs), during a switching task. In the current study, a final sample of 22 young adults performed a task-switching paradigm while electroencephalography was continuously recorded; mind wandering was assessed via thought probes at the end of each block. Consistent with previous research, we found no significant disruptive effects of mind wandering on task-switching performance. The ERP results showed that at the posterior electrode sites (P3, Pz, and P4), P3 amplitude was higher for mind-wandering switch trials than on-task switch trials, thus opposing the typical pattern of P3 attenuation during periods of mind wandering relative to on-task episodes. Considering that increased P3 amplitude during higher-order switch trials (e.g., response rule switching) may reflect the implementation of new higher-order task sets/rules, the current findings seem to indicate similar executive control processes underlie mind wandering and task-set switching, providing further evidence in favor of a role for switching in mind wandering.
Attention , Evoked Potentials , Young Adult , Humans , Attention/physiology , Executive Function/physiology , Electroencephalography
Mind wandering is a universal phenomenon in which our attention shifts away from the task at hand toward task-unrelated thoughts. Despite it inherently involving a shift in mental set, little is known about the role of cognitive flexibility in mind wandering. In this article we consider the potential of cognitive flexibility as a mechanism for mediating and/or regulating the occurrence of mind wandering. Our review begins with a brief introduction to the prominent theories of mind wandering-the executive failure hypothesis, the decoupling hypothesis, the process-occurrence framework, and the resource-control account of sustained attention. Then, after discussing their respective merits and weaknesses, we put forward a new perspective of mind wandering focused on cognitive flexibility, which provides an account more in line with the data to date, including why older populations experience a reduction in mind wandering. After summarizing initial evidence prompting this new perspective, drawn from several mind-wandering and task-switching studies, we recommend avenues for future research aimed at further understanding the importance of cognitive flexibility in mind wandering.
Attention , Mental Processes , Humans , Attention/physiology
Introduction: Ustekinumab is a human monoclonal antibody that binds to the p40 subunit of both interleukin (IL)-12 and IL-23, and it is approved for the treatment of moderate to severe plaque psoriasis. In this study, we assessed the efficacy and safety of patients receiving ustekinumab for psoriasis. Methods: This retrospective study included all adults with chronic plaque psoriasis who were prescribed ustekinumab in a tertiary dermatologic centre between December 2009 and December 2015. Efficacy end points included a proportion of patients achieving at least 50% and 75% improvement from baseline psoriasis area and severity index (PASI) and body surface area (BSA) at Weeks 4 and 16. Results: A total of 99 patients were prescribed ustekinumab; 69% of these were Chinese, followed by 15% Indians and 9% Malays. 31 patients had documented PASI scores and 55 patients had documented BSA improvements. In patients with recorded PASI scores, 29 (93.5%) of 31 patients achieved PASI 50, and 21 (67.7%) of 31 achieved PASI 75 at week 16. In patients with recorded BSA, 43 (78.2%) of 55 had at least 50% BSA improvement, and 31 (56.4%) of 55 achieved 75% BSA improvement at 16 weeks. Regarding safety, no patient experienced tuberculosis reactivation. A total of 11 (11%) of 99 patients had latent tuberculosis infection and were treated with prophylactic isoniazid. No patient experienced serious adverse events. No cardiovascular events, cutaneous malignancies or deaths were reported over six years. Conclusion: Ustekinumab is safe and efficacious in the treatment of patients with moderate to severe plaque psoriasis in a multiethnic Asian population.
Psoriasis , Ustekinumab , Adult , Humans , Ustekinumab/therapeutic use , Singapore , Retrospective Studies , Treatment Outcome , Severity of Illness Index , Double-Blind Method , Psoriasis/drug therapy
Despite that previous studies have investigated mind wandering using task-switching paradigms, the association between the tendency to mind wander and cognitive flexibility remains largely unexplored. The present study investigated the relationship between self-reported spontaneous mind-wandering tendencies and task-switching performance in young adults. Seventy-nine university students performed a forced task-switching and a voluntary task-switching paradigm and then completed a battery of questionnaires. The results showed that compared to participants with lower spontaneous mind-wandering tendencies, participants with higher spontaneous mind-wandering tendencies demonstrated better performance (evidenced by smaller switch cost reaction times) in the forced task-switching paradigm despite indicating more mind wandering during task performance. Performance on the voluntary task-switching paradigm, on the other hand, did not differ between the two groups. The findings in the forced task-switching paradigm indicate a link between mind wandering and cognitive flexibility, thus providing initial evidence in favor of a role for switching in mind wandering.
Attention , Task Performance and Analysis , Cognition , Humans , Self Report , Thinking , Young Adult
Psoriasis is a common chronic inflammatory skin disease that is increasingly being recognized as a disease that not only affects the skin but also has multi-systemic implications. The pathophysiological link between psoriasis and obesity is becoming increasingly elucidated by recent studies. The cross-talk between adipocytes and the immune system via various mediators such as adipokines could explain how obesity contributes to psoriasis. The effects of obesity on adipocytes include upregulation of pro-inflammatory adipokines such as leptin and resistin, downregulation of anti-inflammatory adipokine, and also the stimulation of pro-inflammatory cytokine production by macrophages. This article provides an update on the role of adipose tissues in psoriasis.
Adipose Tissue/immunology , Psoriasis/immunology , Adipocytes/immunology , Adipokines/immunology , Animals , Fatty Acids/immunology , Humans , Obesity/immunology , Skin/immunology
Narrowband ultraviolet B (NBUVB) phototherapy is a well-established treatment modality for psoriasis. We performed a retrospective analysis of children of East Asian descent with psoriasis treated with NBUVB phototherapy at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008 and found that NBUVB phototherapy is safe and effective for the treatment of psoriasis in children of East Asian descent.
Psoriasis/ethnology , Psoriasis/radiotherapy , Ultraviolet Therapy/methods , Adolescent , Asian People/statistics & numerical data , Child , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Patient Safety , Phototherapy/methods , Psoriasis/diagnosis , Retrospective Studies , Severity of Illness Index , Singapore , Treatment Outcome
The Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (QS 1064-nm Nd:YAG) laser is increasingly used for nonablative skin rejuvenation or "laser toning" for melasma. Multiple and frequent low-fluence, large-spot-size treatments are used to achieve laser toning, and these treatments are associated with the development of macular hypopigmentation as a complication. We present a case series of three patients who developed guttate hypomelanotic macules on the face after receiving laser toning treatment with QS 1064-nm Nd:YAG.
