Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

UNASSIGNED: To experimentally validate the effects of a self-developed heat-stable thickening agent on the textual characteristics of enteral nutrition solutions of standard concentration and its applicability in improving dysphagia.
UNASSIGNED: A gradient of different doses of the self-developed thickening agent (1.0 g, 1.5 g, 2.0 g, 2.5 g, and3.0 g) and three commonly used commercial thickeners were mixed with 23.391 g of a complete nutrition formula powder dissolved in 85 mL of purified water to prepare 100 mL standard concentration nutrition solutions. The textual parameters (cohesiveness, viscosity, thickness, and hardness) of these nutrition solutions were measured using a texture analyzer at various temperature gradients (20 ℃, 40 ℃, 60 ℃, and 80 ℃) to compare their thermal stability. A dysphagia rat model was created via epiglottectomy to explore the effects of the thickener on lung tissue damage scores and levels of inflammatory markers. The rats were divided into a test intervention group, a positive control group, a negative control group, and a blank control group (no surgery and normal feeding after fasting for one day), with 15 rats in each group. After fasting for one day post-surgery, the test intervention group was fed with the standard concentration nutrition solution thickened with the self-developed thickener, while the positive control group was given a standard concentration nutrition solution thickened with product 3, and the negative control group was fed a normal diet. All groups were fed for two weeks with food dyed with food-grade green dye. General conditions, body mass, and food intake were observed and recorded. After two weeks, abdominal aorta blood was collected, and heart, liver, spleen, lung, and kidney tissues were harvested and weighed to calculate the lung tissue organ coefficient. The organ conditions were evaluated using routine H&E staining, and lung damage was semi-quantitatively analyzed based on the Mikawa scoring criteria. Blood supernatants were collected to measure the total serum protein and albumin levels to determine the nutritional status of the rats. The expression of IL-6 and TNF-α genes in lung tissues was measured by RT-qPCR. IL-6 and TNF-α protein expression levels in lung tissues, lung tissue homogenate, and serum were measured by ELISA. The aspiration incidence rate was calculated.
UNASSIGNED: Within the dosage range of 1.0 g to 3.0 g, the self-developed thickener in the test samples exhibited superior thermal stability in cohesiveness compared to the three commercially available thickeners, with a statistically significant difference (P<0.01). The differences in the thermal stability of viscosity and hardness between the self-developed thickener and the three commercially available thickeners were not statistically significant. The viscosity stability was optimal for the self-developed thickener, followed by the commercially available thickeners 1 and 3, with thickeners 2 being the least stable, though the differences were not statistically significant (P>0.05). Product 1 showed the best thermal stability in thickness, followed by the self-developed thickener and product 2, while the product 3 exhibited the worst performance, with the difference being statistically significant (P<0.01). The self-developed thickener had the best thermal stability in hardness at temperatures ranging from 20℃ to 80 ℃, followed by products 1 and 2, with product 3 being the least stable. However, the differences were not statistically significant (P>0.05). Animal experiment results indicated that the body weight gain in the positive control group and the test intervention group was lower than that in the blank and negative control groups (P<0.01). The spleen coefficient of the intervention group was lower than that of the positive control group and the blank control group (P<0.01), while the heart, liver, and kidney coefficients were lower than those of the blank control group (P<0.01). The differences in the lung coefficient of the intervention group and those of the other three groups were no statistically significant. Levels of TP and ALB in the test intervention group, the positive control group, and the negative control group were all lower than those in the blank control group, with statistically significant differences (P<0.01). ELISA results showed that serum IL-6 levels in the blank and test intervention groups were lower than those in the negative and positive control groups (P<0.05), while the difference in the other indicators across the four groups were not statistically significant (P>0.05). There were no statistically significant differences among the four groups in terms of lung tissue damage pathology scores, or in the levels of IL-6 and TNF-α gene expression in lung tissues. The aspiration incidence rate was 0% in all groups.
UNASSIGNED: The self-developed enteral nutrition thickening agent demonstrated excellent thermal stability and swallowing safety. Further research to explore its application in patients with dysphagia is warranted.

Food bolus is the major outcome of oral processing of foods. Its structure and properties are crucial for safe swallowing and subsequent gastric digestion. However, collecting the ready-to-swallow bolus for further analysis in either normal or deficient human subjects is difficult, regulatorily or practically. Here, a novel in vitro bio-inspired oral mastication simulator (iBOMS-Ⅲ) was developed to be capable of replicating food boluses comparable to those in vivo. Cooked rice and roasted peanuts were used as the model foods (soft and hard) respectively. Particle size distribution, moisture content and rheology of the food boluses produced in the iBOMS-Ⅲ were assessed. A conventional food blender was also employed as a non-consequential comparation. Eighteen healthy young volunteers of the ages from 20-30 years (10 male and 8 female) were invited to provide the in vivo data. For cooked rice boluses produced by the iBOMS-Ⅲ with 10, 12, 14, and 20 chewing number of cycles, the moisture content exhibited minimal variation (68.3-68.8 wt%), aligning closely with values obtained from the average value of the human subjects (67.5 wt%). Similarly, the boluses from roasted peanut displayed similar moisture contents across masticatory number of cycles (36, 40, and 44 number of cycles), averaging at 35.3 %, mirroring the average in vivo results (33.8 wt%). Furthermore, the shear viscosity of both cooked rice and roasted peanut boluses exhibited minimal variations with iBOMS-Ⅲ chewing number of cycles. The particle size distributions of the boluses produced with 14 and 44 chewing number of cycles matched well with the in vivo data for cooked rice and roasted peanuts, with median particle size (d50) being 1.07 and 0.78 mm, respectively. The physical properties of the food boluses collected from the food blender, with varying grinding times, differed significantly. This study demonstrates the value of the iBOMS-Ⅲ in achieving realistic boluses with two very different food textures.

UNASSIGNED: Respiratory and bulbar dysfunctions (including swallowing, feeding, and speech functions) are key symptoms of spinal muscular atrophy (SMA), especially in its most severe forms. Demonstrating the long-term efficacy of disease-modifying therapies (DMTs) necessitates an understanding of SMA natural history.
UNASSIGNED: This study summarizes published natural history data on respiratory, swallowing, feeding, and speech functions in patients with SMA not receiving DMTs.
UNASSIGNED: Electronic databases (Embase, MEDLINE, and Evidence-Based Medicine Reviews) were searched from database inception to June 27, 2022, for studies reporting data on respiratory and/or bulbar function outcomes in Types 1-3 SMA. Data were extracted into a predefined template and a descriptive summary of these data was provided.
UNASSIGNED: Ninety-one publications were included: 43 reported data on respiratory, swallowing, feeding, and/or speech function outcomes. Data highlighted early loss of respiratory function for patients with Type 1 SMA, with ventilatory support typically required by 12 months of age. Patients with Type 2 or 3 SMA were at risk of losing respiratory function over time, with ventilatory support initiated between the first and fifth decades of life. Swallowing and feeding difficulties, including choking, chewing problems, and aspiration, were reported in patients across the SMA spectrum. Swallowing and feeding difficulties, and a need for non-oral nutritional support, were reported before 1 year of age in Type 1 SMA, and before 10 years of age in Type 2 SMA. Limited data relating to other bulbar functions were collated.
UNASSIGNED: Natural history data demonstrate that untreated patients with SMA experience respiratory and bulbar function deterioration, with a more rapid decline associated with greater disease severity. This study provides a comprehensive repository of natural history data on bulbar function in SMA, and it highlights that consistent assessment of outcomes in this area is necessary to benefit understanding and approval of new treatments.

Breathing temporarily pauses during swallowing, and the occurrence of inspiration before and after these pauses may increase the likelihood of aspiration, a serious health problem in older adults. Therefore, the automatic detection of these pauses without constraints is important. We propose methods for measuring respiratory movements during swallowing using millimeter wave radar to detect these pauses. The experiment involved 20 healthy adult participants. The results showed a correlation of 0.71 with the measurement data obtained from a band-type sensor used as a reference, demonstrating the potential to measure chest movements associated with respiration using a non-contact method. Additionally, temporary respiratory pauses caused by swallowing were confirmed by the measured data. Furthermore, using machine learning, the presence of respiring alone was detected with an accuracy of 88.5%, which is higher than that reported in previous studies. Respiring and temporary respiratory pauses caused by swallowing were also detected, with a macro-averaged F1 score of 66.4%. Although there is room for improvement in temporary pause detection, this study demonstrates the potential for measuring respiratory movements during swallowing using millimeter wave radar and a machine learning method.

Predictive factors associated with a decline in swallowing function after 2 years were examined in 3409 Japanese older people aged ≥ 75 years who had undergone a dental checkup in Gifu Prefecture, Japan. Participants with normal swallowing function in a baseline survey in April 2018 were followed for 2 years. Swallowing function was assessed using a repetitive saliva swallowing test. In our study, 429 participants (13%) who were swallowing less than three times in 30 s based on a repetitive saliva swallowing test after 2 years were diagnosed as those with decline in swallowing function. Multivariate logistic regression analyses showed the decline in swallowing function after 2 years was associated with the male gender (odds ratio [ORs]: 0.772; 95% confidence interval [CIs]: 0.615-0.969), age ≥ 81 years (presence; ORs: 1.523; 95% CIs: 1.224-1.895), support/care-need certification (presence; ORs: 1.815; 95% CIs: 1.361-2.394), periodontal pocket depth (PPD) ≥ 4 mm (presence; ORs: 1.469; 95% CIs: 1.163-1.856), difficulty in biting hard food (yes; ORs: 1.439; 95% CIs: 1.145-1.808), choking on tea and water (yes; ORs: 2.543; 95% CIs: 2.025-3.193), and dry mouth (yes; ORs: 1.316; 95% CIs: 1.052-1.646) at baseline. Therefore, the dental checkup items associated with a decline in swallowing function after 2 years were a PPD ≥ 4 mm, difficulty in biting hard food, choking on tea and water, and dry mouth. PPD status and confirming to the self-administered questionnaire about biting, choking, and dry mouth may be useful in predicting future decline in swallowing function.

Oropharyngeal dysphagia, or difficulty initiating swallowing, is a frequent problem in people with Parkinson\'s disease (PD) and can lead to aspiration pneumonia. The efficacy of pharmacological options is limited. Postural strategies, such as a chin-down manoeuvre when drinking, have had some degree of success but may be difficult for people who have other limitations such as dementia or neck rigidity, to reproduce consistently. Using a user-centred design approach and a multidisciplinary team, we developed and tested an anti-choking mug for people with PD that helps angle the head in the optimum position for drinking. The design reflected anthropometric and ergonomic aspects of user needs with features including regulation of water flow rate and sip volume, an inner slope, a thickened handle and a wide base, which promoted a chin-down posture when used. Prototype testing using digital technology to compare neck flexion angles (the primary outcome), plus clinical outcomes assessed using standard tools (Swallowing Clinical Assessment Score in Parkinson\'s Disease (SCAS-PD) and Movement Disorder Society-Unified Parkinson\'s Disease Rating Scale (MDS-UPDRS) Parts II and III), found significant improvements in a range of parameters related to efficient swallowing and safe drinking when using the anti-choking mug versus a sham mug.

BACKGROUND: Limited data exist on the mid- to long-term masticatory capacity of mandibular overdenture (IOD) wearers, particularly regarding the use of posterior implants to retention.
OBJECTIVE: To periodically evaluate mastication of IOD wearers, comparing the effectiveness of two to four implants to retain the prosthesis.
METHODS: In a randomised controlled clinical trial, 20 complete edentulous patients (14 women), aged 51-84 years (mean age 69.1 ± 9.6), received new bimaxillary complete dentures (CD). After adaptation, baseline measurements of masticatory performance (X50) and swallowing threshold were conducted using the sieving method. Patients were then randomly assigned to groups: control (two intra-foraminal regular implants) and experimental (two intra-foraminal regular implants and two extra-short posterior implants) (n = 10 each). After 4 months, implants were splinted, and a new mandibular IOD was fabricated with bar/clip retention. Mastication was reassessed after 6, 12, and 48 months, and data analysed with repeated measures ANOVA and Sidak\'s post hoc (α = 0.05).
RESULTS: Despite a loss of two patients per group, masticatory performance significantly improved after mandibular IOD installation (p = .031) in both groups (p = .670). A second improvement was observed after 6 months (p = .027), with no subsequent changes (p > .05). Swallowing threshold improvements were noted with IOD, and no discernible differences between groups were observed (p > .05).
CONCLUSIONS: Masticatory function significantly improved after mandibular IOD installation, with the number of implants demonstrating minimal influence.
BACKGROUND: The present study was not registered in a public database, as mandated. It is important to note that the recommendation for registration was initiated in 2017 by the Committee of Medical Journal Editors, while patient inclusion in the research took place in 2016. Given that the data presented in this manuscript cover a follow-up period of up to 4 years post-surgical intervention, delayed registration was not feasible.

BACKGROUND: Niemann-Pick disease, type C1 (NPC1) is a rare lysosomal disorder with progressive neurological manifestations, historically recognized as a pediatric disease. However, awareness of the adult-onset (AO) subtype is increasing, often with non-specific symptoms leading to delayed and misdiagnosis. Dysphagia, commonly recognized as a clinical morbidity in NPC1, raises concerns for swallowing safety and aspiration risk. This study aims to characterize swallowing function in AO NPC1, addressing the gap in understanding and clinical management.
METHODS: Fourteen AO NPC1 individuals in a prospective natural history study (NCT00344331) underwent comprehensive assessments, including history and physical examinations utilizing the NPC1 severity rating scale, videofluoroscopic swallowing studies with summary interpretive analysis, and cerebrospinal fluid (CSF) collection for biomarker evaluation at baseline visit. Descriptive statistics and multivariate statistical modeling were employed to analyze NPC1 disease covariates, along with the American Speech-Language-Hearing Association National Outcome Measure (ASHA-NOMS) and the NIH Penetration Aspiration Scale (NIH-PAS).
RESULTS: Our cohort, comprised of 14 predominately female (n = 11, 78.6%) individuals, had an average age of 43.1 ± 16.7 years at the initial visit. Overall, our AO patients were able to swallow independently with no/minimal cueing, with 6 (43%) avoiding specific food items or requiring more time. Upon risk analysis of aspiration, the cohort demonstrated no obvious aspiration risk or laryngeal aspiration in 8 (57%), minimal risk with intermittent laryngeal penetration and retrograde excursion in 5(36%), and moderate risk (7%) in only one. Dietary modifications were recommended in 7 (50%), particularly for liquid viscosities (n = 6, 43%) rather than solids (n = 3, 21%). No significant correlations were identified between swallowing outcomes and NPC1-related parameters or CSF biomarkers.
CONCLUSIONS: Despite the heterogeneity in NPC1 presentation, the AO cohort displayed functional swallowing abilities with low aspiration risk with some participants still requiring some level of dietary modifications. This study emphasizes the importance of regular swallowing evaluations and management in AO NPC1 to address potential morbidities associated with dysphagia such as aspiration. These findings provide clinical recommendations for the assessment and management of the AO cohort, contributing to improved care for these individuals.

The oral and suprahyoid muscles are responsible for movements of swallowing. Our study aimed to determine the reproducibility of static and dynamic measurements of these muscles using bedside ultrasound equipment. Forty healthy participants were recruited prospectively. Primary outcomes were evaluation of mass measurements of the anterior bellies of the digastric, mylohyoid, geniohyoid and tongue in B-mode ultrasound. Secondary outcomes were evaluation of geniohyoid muscle layer thickness and function using M-mode. Muscle mass measurements demonstrated little within-participant variability. Coefficient of Variance (CoV) across muscles were: anterior belly digastric (5.0%), mylohyoid (8.7%), geniohyoid (5.0%) and tongue (3.2%). A relationship between sex (r2 = 0.131 p = 0.022) was demonstrated for the geniohyoid muscle, with males having higher transverse Cross Sectional Area (CSA) (14.3 ± 3.6 mm vs. 11.9 ± 2.5 mm, p = 0.002). Tongue size was correlated with weight (r2 = 0.356, p = 0.001), height (r2 = 0.156, p = 0.012) and sex (r2 = 0.196, p = 0.004). Resting thickness of the geniohyoid muscle layer changed with increasing bolus sizes (f = 3.898, p = 0.026). Velocity increased with bolus size (p =  < 0.001, F = 8.974). However swallow time and slope distance did not, potentially influenced by higher coefficients of variation. Oral and suprahyoid muscle mass are easily assessed using bedside ultrasound. Ultrasound may provide new information about muscle mass and function during swallowing.