Objective:　Aspiration pneumonia is a major cause of death in Japan, with malnutrition and swallowing dysfunction contributing to onset and severity. Oral intake of a regular diet plays an important role in nutritional management and preserving quality of life. This study investigated factors related to whether patients were able to consume a regular diet during hospitalization and at discharge who had been consuming a regular diet before admission for aspiration pneumonia.

　Subjects:　This study included 123 of 238 patients aged ≥ 65 years old hospitalized for aspiration pneumonia, who were consuming a regular diet (levels 8–10 on the Food Intake LEVEL Scale (FILS)) before admission. The patients were divided into a regular diet group and a dysphagia-modified diet group based on their FILS scores on day 7 after hospital admission. The discharge outcomes were compared. We analyzed the changes in diet between day 7 of hospital admission and at discharge, as well as factors related to consuming a regular diet, among the 101 patients discharged (61 men and 40 women).

　Results:　The survival-to-discharge rate was significantly higher in the regular diet group (63 patients, 91.3%) than in the dysphagia-modified diet group (38 patients, 70.4%) (p＜0.01). The survival-todischarge rate, FILS at discharge, and rate of return to their original residence were higher in the regular diet group than in the dysphagia-modified diet group. Those in the regular diet group had a higher body mass index (BMI) and Mini Nutritional Assessment-Short Form scores at admission as well as a higher Barthel index (BI) and energy intake on day 7 of hospitalization. A total of 57 of the 63 patients (90.5%) who consumed a regular diet on day 7 continued on a regular diet after discharge. The results of multivariate analysis for consuming a regular diet on day 7 showed that three factors―BI (odds ratio (OR) 1.04, p＝0.002), BMI (OR 1.22, p＝0.040), and energy intake (OR 1.08, p＝0.025)―were significantly associated with continuing on a regular diet after discharge. Similar associations were observed for those consuming a regular diet at discharge.

　Conclusion:　Aspiration pneumonia patients who were consuming a regular diet on day 7 of hospitalization were more likely to continue consuming a regular diet after discharge. Sufficient energy intake must be ensured from an early stage to enable patients to consume a regular diet at discharge, and comprehensive interventions including assessments of activities of daily living and swallowing function are necessary.

　Objective:　It is very important for the elderly in the community to identify the signs of dysphagia at an early stage, so that preventive methods can be practiced and early treatment can be provided, thereby prolonging healthy life expectancy. The aim of this study was to develop a simplified version of the Seirei Swallowing Questionnaire, with about five questions selected from the 15 questions of the questionnaire, to screen the elderly population for dysphagia in a simple way.

　Methods:　In this study, we used data from 50 patients with cerebrovascular disease diagnosed as having dysphagia, 145 patients with cerebrovascular disease diagnosed as having no dysphagia, and 170 healthy subjects, which were used when the Seirei Swallowing Questionnaire was developed. The method used to select about five questions from the 15 questions were: (1) in accordance with previous studies, the question “Do you feel that it is getting difficult to eat solid foods?”, which has a low specificity due to the influence of dentures and other factors, was excluded. (2) From the remaining 14 questions, the seven questions with the highest number of responses to each question as severe symptom A in patients with dysphagia were selected. (3) To reduce redundancy, the correlation between questions and the degree of agreement between responses were used as criteria for removing similar questions. (4) For combinations of five or six questions selected from seven questions, the optimal cut-off value, sensitivity, specificity and distance from the upper left corner of the ROC coordinates were calculated by ROC analysis, and the best combination among them was finally determined.

　Result:　The question “Do you ever choke when swallowing liquids?” was excluded as a redundant question. Five questions including “Do you ever choke during a meal?” were determined as the simplified version of the Seirei Swallowing Questionnaire. It had a cut-off value of 3 points, sensitivity of 88%, specificity of 87.3%, AUC of 0.92 and Cronbach’s alpha coefficient of 0.78.

　Conclusion:　The simplified version of the Seirei Swallowing Questionnaire (Swallow-5) developed in this study has excellent sensitivity and specificity and its use as a simplified screening tool for dysphagia is expected to increase.

　Introduction:　The condition in which sarcopenia and oropharyngeal swallowing dysfunction coexist is referred to as sarcopenic dysphagia (SD). In the diagnostic flowchart for SD, in addition to the skeletal muscle mass index (SMI) obtained via bioelectrical impedance analysis (BIA), calf circumference (CC) may also be used. However, no studies have compared SD detection rates using SMI versus CC. Furthermore, in Japan, the Food Intake LEVEL Scale (FILS) is often employed for SD diagnosis, but the impact of using CC together with FILS on SD detection remains unknown. Therefore, the purposes of this study were twofold: (1) to evaluate whether there is a difference in SD diagnosis rates when using SMI versus CC, and (2) to examine the influence of CC and FILS on the diagnosis of SD.

　Methods:　Participants were 78 older adults requiring support or long-term care who attended three day-care facilities in Sapporo City, Hokkaido. Data were collected from December 2023 to February 2025. Sarcopenia was diagnosed according to (1) SMI criteria measured by BIA and (2) CC cutoff values from the Asian Working Group for Sarcopenia (AWGS), and SD was defined as a FILS score ≤ 8. Among those classified as sarcopenic by SMI criteria and by AWGS criteria, sensitivity, specificity, and Cohen’s κ coefficient for SD diagnosis were calculated from cross-tabulation, and the results of univariate analyses for SDrelated factors were compared.

　Results:　Of the 78 participants, 51 (65.3%) were diagnosed with sarcopenia according to the SMI criteria, and 52 (66.7%) according to the AWGS criteria; SD was diagnosed in 13 participants (16.7%) under both criteria. For sarcopenia diagnosis, the sensitivity between SMI and AWGS criteria was 0.90, specificity was 0.78, and Cohen’s κ coefficient was 0.69; for SD diagnosis, Cohen’s κ coefficient was 1.00.

　Conclusions:　The use of the Food Intake LEVEL Scale (FILS) enables the detection of sarcopenic dysphagia (SD) with comparable validity when applying either the AWGS or SMI criteria. However, FILS identifies dysphagia based on the need for modification of food texture. While FILS is unlikely to overlook cases of SD, it may fail to detect early-stage SD unless sarcopenia of the swallowing-related muscles has progressed to the point of dietary adjustment. These findings suggest that FILS alone may not be sufficient for comprehensive screening, and comparative evaluation with other dysphagia screening tools is warranted to improve the identification of SD.

　Introduction:　Videofluoroscopic swallowing study (VFSS) is widely used to evaluate swallowing function. In Japan, rice and rice gruel are main foods, even among patients with dysphagia. Typically, barium sulfate is sprinkled on cooked rice to create contrast for VFSS. However, cooked rice mixed with barium sulfate does not provide sufficient internal radiopacity. Recent electron microscopy findings have demonstrated that non-ionic iodine contrast media can penetrate the interior of rice grains. However, no studies have evaluated iodine contrast-enhanced rice in three dimensions. This study used microcomputed tomography (micro-CT) to assess the distribution of contrast within rice and gruel cooked with a non-ionic iodine contrast medium and to quantify the contrast enhancement via pixel values.

　Methods:　Sixteen types of simulated VFSS test foods, rice and rice gruel, were prepared with and without a contrast medium under varying pressure and soaking conditions. A non-ionic iodine contrast media, iodixanol, was mixed with water and uncooked rice, and the water level was adjusted to prepare rice or rice gruel (rice with excess water). Cooking was performed using an electric pressure cooker under low or high pressure, with either no soaking or 18 h of soaking. After cooking, samples were placed in plastic containers and scanned using a micro-CT device. Imaging conditions included 75 kV tube voltage, 50 mA current, and 600 projection angles. DICOM images were reconstructed and evaluated using open-source software. Pixel values were measured in 10 regions of interest. Samples were compared using the t-test at the significance level of 0.05.

　Results:　All test foods retained appropriate physical forms for VFSS. Micro-CT enabled non-destructive, three-dimensional observation of the contrast distribution of prepared test foods. Contrast-enhanced rice and rice gruel showed significantly higher pixel values than non-contrast test foods. Depending on the cooking pressure, the pixel values of contrast-enhanced rice ranged from 170 to 250, while those of rice gruel ranged from 150 to 190. Increasing the cooking pressure resulted in higher pixel values, suggesting greater penetration of contrast into the rice interior. Rice gruel exhibited a more uniform contrast distribution than rice owing to its higher water content. Additionally, soaking uncooked rice for a short time increased the pixel values.

　Conclusion:　Cooking rice and rice gruel with a non-ionic iodine contrast medium in a pressure cooker enhanced internal contrast. Micro-CT proved suitable for evaluating VFSS food models, allowing three-dimensional quantitative assessment of the distribution of contrast within VFSS test foods.

　Introduction:　Several cases of myositis have been reported after the COVID-19 vaccination, and the concept of COVID-19 vaccine-associated myositis (CVAM) as a distinct disease entity has been proposed. However, no reports have focused on the dysphagia of this condition, and its details are unknown. Here, we report a case of myositis with dysphagia after the COVID-19 vaccination.

　Case:　An 86-year-old woman who lived alone was independent in ADLs, and had no difficulty swallowing regular food. Forty-eight days before admission, she received her third intramuscular injection of the COVID-19 vaccine, Spikevax Intramuscular Injection^® (Moderna Japan). Two weeks later, she developed muscle pain in the limbs and difficulty raising both arms, but these symptoms improved with follow-up observation. She then developed a fever and muscle weakness in the neck, trunk, and limbs, and was urgently admitted to our hospital. On admission, the patient had redness on both forearms and trunk, which gradually worsened and developed blisters with erosions. Muscle weakness in the proximal muscles, predominantly in the upper limbs, also progressed, making it difficult for the patient to stand or move about. Although the patient was on a swallowing-adjusted diet 4, the swallowing worsened and oral intake became difficult, so the patient was placed on total parenteral nutrition. An inflammatory muscle disease was suspected, and methylprednisolone pulse therapy was administered on the 13th day of hospitalization, but was ineffective. On the 41st day of hospitalization, intravenous immunoglobulin therapy (IVIg) was initiated, and from the 46th day, the hypernasal voice and muscle strength of the trunk and proximal muscles improved quickly. On the other hand, the severe dysphagia, mainly due to pharyngeal residue, persisted. Strengthening exercises for muscles involved in swallowing were continued, and the patient was eventually able to ingest a swallowing-adjusted diet 4 and was discharged home on the 132nd day. Based on the negative results for myositis-specific antibodies and clinical course, the patient was ultimately diagnosed with CVAM.

　Conclusion:　We report a case in which dysphagia was thought to be due to CVAM. IVIg was effective in this case, and the recovery of dysphagia was slower compared to the recovery of the cervical flexor muscles and proximal limb muscles.