Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial.

We conducted a randomized controlled trial to examine choral singing's effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years. Change in cognitive function was measured by a composite cognitive test score (CCTS) derived from raw scores of neuropsychological tests; biomarkers included brain magnetic resonance imaging, oxidative damage and immunosenescence. The average age of the participants were 70 years and 73/93 (78.5%) were female. The change of CCTS from baseline to 24 months was 0.05 among participants in the CSI group and -0.1 among participants in the HEP group. The between-group difference (0.15, p=0.042) became smaller (0.12, p=0.09) after adjusting for baseline CCTS. No between-group differences on biomarkers were observed. Our data support the role of choral singing in improving cognitive health in aging. The beneficial effect is at least comparable than that of health education in preventing cognitive decline in a community of elderly people. Biological mechanisms underlying the observed efficacy should be further studied.

An Overview of the Use of Bromelain-Based Enzymatic Debridement (Nexobrid®) in Deep Partial and Full Thickness Burns: Appraising the Evidence.

Recent introduction of rapid bromelain-based enzymatic debridement has been increasingly popular in its use in nonsurgical debridement in deep partial and full thickness burns. We designed this study to evaluate the evidence suggested by current studies on the perceived benefits of using Nexobrid® compared with traditional surgical standard of care in burns wound debridement. A comprehensive search on electronic databases Pubmed, Embase, and Web of Science was done to identify studies published between 1986 and 2017 involving the use of Nexobrid® in deep partial and full thickness burns. Studies were evaluated for proposed benefits and categorized under supporting evidence, contradicting evidence, and anecdotal opinions. Seven well-designed prospective studies met the inclusion comprising four randomized controlled trials. Six proposed benefits associated with the use of Nexobrid® were extracted including reduced time to complete debridement, need for surgery, area of burns excised, need for autograft, time to wound closure, and improved scar quality. Most proposed benefits have strong supporting evidences with minimal anecdotal opinions from controlled trials except the proposed improvement in scar quality and reduced time to wound healing that had at least three refuting evidence and one anecdotal evidence. Incidence of pain was also evaluated and was mainly anecdotal lacking formal objective assessment or cohort study. Despite the lack of literatures available, the benefits of Nexobrid® are evident in published randomized and single arm studies. Large number of studies is needed to aid further evaluating the proposed benefits of Nexobrid®.