Background and Purpose:　The presence of dysphagia is closely related to aspiration pneumonia and has been shown to increase the risk of developing aspiration pneumonia. In our hospital, we mainly perform videoendoscopic (VE) examination for observing swallowing dynamics of patients who are suspected of dysphagia. VE examination is a simple and useful method for diagnosing dysphagia. However, there are few reports that have examined factors associated with the onset of aspiration pneumonia based on VE findings, and sufficient research has not been performed. The purpose of this study was to elucidate the factors associated with aspiration pneumonia by analyzing swallowing dynamics obtained from VE findings, focusing on older patients because cases of aspiration pneumonia are frequently encountered among the elderly in clinical sites.

　Methods:　The present study included 254 elderly patients aged 65 years or older, who underwent VE for suspected dysphagia. Of these, 54 and 200 patients had a history of aspiration pneumonia and no history of aspiration pneumonia, respectively. The VE findings were compared between the two groups. In addition, statistical comparison tests were performed for posture during examination, Fujishima dysphagia scale (FILS), and nutritional status.

　Results:　A comparison between the groups with and without previous aspiration pneumonia showed significant differences in male, older age, presence of neurological disease, posture during examination, and FILS (p＜0.05). The VE findings showed significant differences in the degree of glottis closure, salivary retention in the pyriform sinus, premature spillage into the pharynx and post-swallow pyriform sinus pooling of liquid (p＜0.05). In a logistic regression analysis using the presence or absence of a history of aspiration pneumonia as the objective variable and the VE items that showed significant differences between the two groups as explanatory variables, early pharyngeal inflow was extracted.

　Conclusions:　Premature spillage into the pharynx on VE was shown to be a highly relevant factor in patients with a history of aspiration pneumonia.

　Purpose:　We conducted a survey to investigate the percentage of people with undernourishment, degree of undernourishment, and factors related to undernourishment such as oral and swallowing functions and the frequency of dietary intake in older adults receiving support and nursing care in daycare rehabilitation centers. Additionally, we examined the factors related to undernourishment and explored appropriate nutritional management methods. Participants and Methods:　We included 118 elderly (aged ＞ 65 years) community-dwelling individuals, who used daycare rehabilitation centers, required assistance at levels 1 and 2, and nursing care from levels 1 to 3. Participants were recruited from November 2017 to June 2018. The participants were explained the research methods used and provided informed consent. This was a cross-sectional study, and the factors investigated were: nutritional status (Mini Nutritional Assessment Short-Form and body mass index), oral function (maximum tongue pressure, food intake level scale, oral diadochokinesis measurement, and chewing ability assessment), swallowing function (modified water swallowing test, Eating Assessment Tool [EAT-10], and volume of water per swallow), and food intake frequency (food diversity score and eating habits). Based on the nutritional status, participants were divided into undernourished, risk of undernourishment, and well-nourished groups for statistical analyses.

　Results and Discussion:　In total, 23 participants were defined as undernourished (19.4%), 63 as at risk of undernourishment (53.4%), and 32 as well-nourished (27.2%). Factors involved in oral and swallowing function, namely tongue pressure, volume of water swallowed per swallow, and EAT-10, were associated with nutritional status (p＜0.05). Food diversity scores were lower in the undernourished group than in the well-nourished group (p＝0.059). The undernourished group also had a lower food intake diversity score and an especially low protein-rich food intake. When examining the frequency of food intake, a significant association was observed between nutritional status and a diet including chicken and noodles (p＜0.05). Both items were consumed at a lower frequency in the undernourished group than in the wellnourished group. The examination of the association between undernourishment and oral and swallowing functions, items, and food intake diversity scores indicated that impaired oral and swallowing function affects eating.

　Conclusions:　Undernourishment was associated with decreased oral and swallowing function and food intake frequency. It is important to take measures against undernutrition, including preventing the deterioration of oral and swallowing function, before patients require support and nursing care for these deficiencies.

　Objective:　“Thickeners” as Foods for Special Dietary Uses are foods that have been approved by the government as thickeners suitable for people with dysphagia. In an approval examination, third-party organizations test whether the physical properties of a product meet standard criteria for approval. To ensure the fairness of the approval examination, the test results between laboratories should be highly reproducible. Thus, in this study, we investigated the reliability of the test method in an inter-laboratory study and discussed its fitness for purpose.

　Methods:　Three commercial xanthan gum-based thickeners were employed as samples. From December 2018 to February 2019, we conducted an inter-laboratory study involving ten laboratories. Each laboratory tested the physical characteristics of each sample according to the notification issued in March 2017. The results were evaluated to confirm the degree of agreement between the laboratories regarding analytical values and determinations.

　Results:　Regarding the performance requirements (solubility/dispersibility), serious discrepancies in the determinations between the laboratories were found. Regarding the performance requirements (temperature stability), although the determinations between laboratories were almost the same, analytical values were dispersed to some extent compared to the acceptance range, suggesting poor reproducibility. On the other hand, the test methods regarding viscosity requirements and performance requirements (temporal stability and resistance to saliva) seemed acceptable.

　Discussion:　In terms of the test methods issued in March 2017, the results for the performance requirements (solubility/dispersibility) were poorly reproducible, and thus the test conditions and determination criteria need to be realistically relaxed. Regarding the performance requirements (temperature stability), in order to improve the reproducibility, the addition concentration should be increased. Furthermore, to ensure the validity of the overall test methods, it would be helpful to add a stirring step immediately before the viscosity measurement and to set the addition concentration in the performance requirements to the design values indicated by the manufacturers.

　Aim:　Dietary support is important for institutionalized older adults. However, few studies have examined the relationship between daily meals and patient-reported outcomes in institutionalized older adults. We cross-sectionally evaluated the association between diet and dysphagia-related symptoms and oral health-related quality of life (QOL) among elderly people admitted to a fee-paying nursing home with longterm care.

　Methods:　A questionnaire survey was conducted in 2016 among 102 elderly people admitted to a feepaying nursing home with long-term care (33 men and 69 women) aged 60 years or older in Kitakyushu City. Information on nutritional intake and health status was collected from the staff of the nursing homes. Subjects who did not need any adjustment to their diet were classified as the no-adjustment group, those who were eating rice and soft dishes were classified as the adjustment-required group 1, and those who needed further adjustment to their diet as adjustment-required group 2. The frequency of dysphagiarelated symptoms in the past week was assessed by self-rating on a 5-point scale. QOL was assessed using the General Oral Health Assessment Index (GOHAI) as an oral health-related QOL scale. The odds ratio (OR) of a GOHAI score below the national norm (＜53.1) was calculated across the dietary groups by logistic regression analysis, adjusting for sex, age, and other potential confounding factors. The chi-squared test was used to analyze the symptoms and dietary groups.

　Results:　Overall, 73% of the subjects did not require dietary adjustment and 21% and 7% were classified into adjustment-required group 1 and 2, respectively. Of the subjects, 44% reported aGOHAI score below the national norm. There was no significant association between diet and GOHAI score. Compared to the no-adjustment group, the groups who required adjustment to their diet had a lower rate of answering “rarely or not at all” for drooling.

　Conclusion:　Elderly people admitted to a fee-paying nursing home with long-term care who required dietary adjustment were more likely to have subjective symptoms of drooling. There was no significant association between diet and oral-health-related QOL.

　We present a case of a woman in her 30s with panhypopituitarism that had persisted for 3 years. She fell unconscious and was diagnosed with central pontine myelinolysis. After acute stage therapy, she regained alertness; however, spastic tetraparesis, dysphagia, and dysarthria persisted. She was transferred to our hospital to undergo rehabilitation. To reduce spasticity of shoulder joints, orthopedic selective spasticity control surgery (OSSCS) of the bilateral latissimus dorsi, teres major, long and short heads of the humeral biceps, and long head of the humeral triceps muscles was performed. Before OSSCS, her tongue movement was compensated using her jaw motion while talking. Her speech intelligibility rating scale score was 4. She underwent grade 3 swallowing training of food with partial aid in a 50° upright position. She could not move the bolus of food using her tongue; instead, she extended her neck in order to swallow. After OSSCS, the voluntary movement of her tongue improved, and her speech intelligibility rating scale score was 3-4. She could remain in a sitting position in a wheelchair. She started eating normal food by herself using chopsticks 47 days postoperatively. The time required for meal intake remarkably reduced.

　OSSCS of the bilateral shoulder joints was performed to reduce spasticity of the upper extremities. In addition, dysphagia and dysarthria also improved following OSSCS. Recently, dysphagia due to malposition of the scapula or trunk has been reported. OSSCS has been found to facilitate the sitting position and improve the range of shoulder joint and scapula movements as well as the range of tongue and larynx movements.

　Thus, an approach to correcting truncal position and improving shoulder joint and scapula movements may be necessary to treat spastic dysphagia and dysarthria.