Simultaneous X-ray Video-Fluoroscopy and Pulsed Ultrasound Velocimetry Analyses of the Pharyngeal Phase of Swallowing of Boluses with Different Rheological Properties.

The Ultrasound Velocity Profiling (UVP) technique allows real-time, non-invasive flow mapping of a fluid along a 1D-measuring line. This study explores the possibility of using the UVP technique and X-ray video-fluoroscopy (XVF) to elucidate the deglutition process with the focus on bolus rheology. By positioning the UVP probe so that the pulsed ultrasonic beam passes behind the air-filled trachea, the bolus flow in the pharynx can be measured. Healthy subjects in a clinical study swallowed fluids with different rheological properties: Newtonian (constant shear viscosity and non-elastic); Boger (constant shear viscosity and elastic); and shear thinning (shear rate-dependent shear viscosity and elastic). The results from both the UVP and XVF reveal higher velocities for the shear thinning fluid, followed by the Boger and the Newtonian fluids, demonstrating that the UVP method has equivalent sensitivities for detecting the velocities of fluids with different rheological properties. The velocity of the contraction wave that clears the pharynx was measured in the UVP and found to be independent of bolus rheology. The results show that UVP not only assesses accurately the fluid velocity in a bolus flow, but it can also monitor the structural changes that take place in response to a bolus flow, with the added advantage of being a completely non-invasive technique that does not require the introduction of contrast media.

Assessment of the Food-Swallowing Process Using Bolus Visualisation and Manometry Simultaneously in a Device that Models Human Swallowing.

The characteristics of the flows of boluses with different consistencies, i.e. different rheological properties, through the pharynx have not been fully elucidated. The results obtained using a novel in vitro device, the Gothenburg Throat, which allows simultaneous bolus flow visualisation and manometry assessments in the pharynx geometry, are presented, to explain the dependence of bolus flow on bolus consistency. Four different bolus consistencies of a commercial food thickener, 0.5, 1, 1.5 and 2 Pa s (at a shear rate of 50 s-1)-corresponding to a range from low honey-thick to pudding-thick consistencies on the National Dysphagia Diet (NDD) scale-were examined in the in vitro pharynx. The bolus velocities recorded in the simulator pharynx were in the range of 0.046-0.48 m/s, which is within the range reported in clinical studies. The corresponding wall shear rates associated with these velocities ranged from 13 s-1 (pudding consistency) to 209 s-1 (honey-thick consistency). The results of the in vitro manometry tests using different consistencies and bolus volumes were rather similar to those obtained in clinical studies. The in vitro device used in this study appears to be a valuable tool for pre-clinical analyses of thickened fluids. Furthermore, the results show that it is desirable to consider a broad range of shear rates when assessing the suitability of a certain consistency for swallowing.

Bolus rheology of texture adjusted food-Effect of age.

Swallowing disorders, or dysphagia, affect a large part of the population due to factors such as degenerative diseases, medication side effects or simply age-related impairment of physiological oropharyngeal function. The management of dysphagia is mainly handles through texture-modified foods of progressively softer, smoother, moister textures, depending on the severity of the disorder. Rheological and physiological-related properties of boluses were determined for a group of five older persons (average age, 74) for a set of texture-modified foods: bread, cheese and tomato and the combination into a sandwich. The softest class was gel food, after which came a smooth timbale; both were compared to boluses of regular food. The subjects chewed until ready to swallow, at which point the bolus was expectorated and measured regarding saliva content, linear viscoelasticity and shear viscosity. The results were compared to those of a previously studied younger group (average age, 38). The general physiological status of the subjects was determined by hand and tongue strength, diadochokinesis and one-legged standing and showed that all subjects were as healthy and fit as the younger group. Age-related properties such as one-legged standing with closed eyes and salivary flow plus bolus saliva content were lower for the older group, but the average chews-until-swallow was surprisingly also lower. Consequently, bolus modulus and viscosity were higher than for the younger group. Overall, the intended texture modification was reflected in bolus rheological and physiological-related properties. Bolus modulus, viscosity, saliva content and chews-until-swallowed all decreased from regular food to timbale food to gel food.

Percolation and phase behavior in cellulose nanocrystal suspensions from nonlinear rheological analysis.

We examine the influence of surface charge on the percolation, gel-point and phase behavior of cellulose nanocrystal (CNC) suspensions in relation to their nonlinear rheological material response. Desulfation decreases CNC surface charge density which leads to an increase in attractive forces between CNCs. Therefore, by considering sulfated and desulfated CNC suspensions, we are comparing CNC systems that differ in their percolation and gel-point concentrations relative to their phase transition concentrations. The results show that independently of whether the gel-point (linear viscoelasticity, LVE) occurs at the biphasic - liquid crystalline transition (sulfated CNC) or at the isotropic - quasi-biphasic transition (desulfated CNC), the nonlinear behavior appears to mark the existence of a weakly percolated network at lower concentrations. Above this percolation threshold, nonlinear material parameters are sensitive to the phase and gelation behavior as determined in static (phase) and LVE conditions (gel-point). However, the change in material response in nonlinear conditions can occur at higher concentrations than identified through polarized optical microscopy, suggesting that the nonlinear deformations could distort the suspensions microstructure such that for example a liquid crystalline phase (static) suspension could show microstructural dynamics similar to a biphasic system.

Remote Sensing of the Nano-Rheological Properties of Soft Materials Using Magnetic Nanoparticles and Magnetic AC Susceptometry.

We have developed a nano-rheological characterization tool to extract the frequency- and scale-dependent rheological properties of soft materials during oral processing. Taking advantage of AC susceptometry, the dynamic magnetization of magnetic nanoparticles blended in the matrix material is measured. The magnetic AC susceptibility spectra of the particles are affected by the viscosity and mechanical modulus of the matrix material and provide the rheological properties of the matrix. Commercially available iron-oxide magnetic nanoparticles with 80 and 100 nm particle sizes are used as tracers in the frequency range of 1 Hz-10 kHz. The AC susceptibility is measured using two differentially connected coils, and the effects of the sample temperature and distance with respect to the detection coils are investigated. The developed measurement setup shows the feasibility of remote nano-rheological measurements up to 2 cm from the coil system, which can be used to, e.g., monitor the texture of matrix materials during oral processing.

Bolus rheology of texture-modified food: Effect of degree of modification.

Swallowing disorders, or dysphagia, require an intake of texture-modified foods progressively softer, smoother, and moister depending on the severity of the disorder. Bolus rheology was determined for five healthy subjects for a set of such solid foods regularly given to dysphagia patients. The softest class was gel food, then a smooth timbale which both were compared to the corresponding regular, un-modified food. The foods investigated were bread, cheese, tomato, and the combination as a sandwich, all for the respective texture class: gel, timbale, and regular food. The subjects chewed until ready to swallow and the expectorated bolus was immediately measured for complex shear modulus and viscosity, and moisture and saliva content were determined. Rheology show that texture-modification influenced bolus rheology with decreased viscosity and modulus for increased degree of modification. Also saliva content as well as chews-to-swallow decreased with degree of modification. Overall, the bolus saliva content was lower for the combination (sandwich) than for the individual components. Saliva content was fairly constant irrespective of food moisture content. The phase angle for all boluses was also relatively constant, indicating a similar bolus structure. All boluses of the texture-modified foods showed high extensional viscosity, which is important for bolus cohesiveness. Bolus rheology rather than food texture determines if a food is safe to swallow and the results show that the intended texture-modification is reflected in the flow properties of the respective boluses.

Physical properties of a model set of solid, texture-modified foods.

Those suffering from swallowing disorders, or dysphagia, require texture-modified foods for safe swallowing. The texture is modified according to the severity of the disorder, as maintained by the guidelines outlining classes of texture-modified foods, ranging from viscous soups to soft, solid foods. As a basis for studies of bolus rheology and oral response of solid texture-modified foods, a set of well-defined, solid foods has been identified and characterized regarding texture and physical properties. Gelled food is compared to both the firmer timbale class and to the corresponding regular food. Foods eaten at room temperature were chosen to avoid temperature effects: bread, cheese, tomato, and the combination into a sandwich. All foods were tested as gel, timbale, and regular food. The texture was determined by compression and penetration tests, thereby showing a decrease in strength (compression stress), stiffness (modulus), and penetration force for increased degree of modification. The moisture content increased with increased degree of modification. The structural change from room to oral temperature was monitored by the complex shear modulus that showed a decrease with increasing temperature. Cheese and the gelatine-based tomato gel showed a distinct melting when the temperature was increased to 37°C. The texture-modified foods were softer and moister in all aspects as compared to the regular foods, which follows the intended modification. The classes for the texture-modified foods were qualitatively comparable to other national classification systems with regard to solid foods, but there is a lack of objective, physics-based classification of texture, especially for solid, texture-modified foods.

Flow properties of oral contrast medium formulations depend on the temperature.

BACKGROUND: During the therapeutic videofluoroscopic examination of swallowing, gradation of bolus volume, texture, and viscosity can be implemented to determine the optimal bolus characteristics in that particular patient. When a thickened liquid is given to a dysphagic patient it is served at room temperature. However, in these patients with a delayed oral and/or pharyngeal stage of swallow, the bolus is held for a long time in the oral cavity. The temperature of the thickened liquid thereby increases. PURPOSE: To study the rheological exploration (variation of viscosity with temperature) of thickened food used for radiologic swallowing examinations in patients with oral and pharyngeal dysfunction, in particular in mixtures of barium sulfate suspensions and in iodine solutions. MATERIAL AND METHODS: Deep-frozen mango purée was thawed at room temperature. It was then mixed with barium sulfate contrast medium to a density of 25% w/w. Resorce Thicken Up was mixed at room temperature at two concentrations: 4.3% w/w (4.5 g thickener + 100 g distilled water) and 6.0% w/w (4.5 g thickener + 70 g distilled water). The thickener consisted of modified corn starch. Resorce Thicken Up was also mixed at room temperature with two concentrations of an iodine contrast material, iohexol (Omnipaque, 350 mg I/ml). The two concentrations were: 4.3% w/w (4.5 g thickener + 100 g iohexol) and 6% w/w (6 g thickener + 100 g iohexol). Measurements were carried out from 20 degrees C to 37 degrees C using a Stresstech HR rheometer. The rheometer was equipped with a concentric cylinder measuring system (inner cylinder 15 mm). RESULTS: The samples containing thickener in water as well as in iohexol showed a dependence on thickener concentration and temperature. The mango purée with barium sulfate displayed very small temperature dependence. The thickener solutions in iohexol had significantly higher viscosity compared with the other thickener solutions and the mango purée. The relative decrease shows that mango purée, the 6% thickener solution in water, and solutions with iohexol exhibited similar relative viscosity change at different temperatures. CONCLUSION: Our conclusion is therefore that it is important always to make the solution with high precision. It is also of importance to observe how long the patient keeps the bolus in the mouth. This might vary and actually it may not be possible to influence this factor. When different types of thickeners are compared, it is important to take into account the temperature at which the thickener is observed.

Plasticization of zein: a thermomechanical, FTIR, and dielectric study.

Zein, the main seed storage protein of maize, has been widely studied as a possible source of material for the production of biodegradable plastic films. Plasticization of zein is critical to make functional films. While there have been a number of publications which report the behavior of systems with a wide variety of plasticizers, there have been few which attempt to examine the interactions of protein and plasticizer at the molecular level. In this paper, we report on the plasticizing effects of water, glycerol, and 2-mercaptoethanol, which were examined by a combination of spectroscopy (FTIR and dielectric) and thermomechanical methods. The results suggest that both water and glycerol are adsorbed onto the protein and form hydrogen bonds with the amide groups. The plasticizer then builds up in patches on the protein surface. 2-Mercaptoethanol only exhibited a weak plasticizing effect due probably to disulfide bond breaking.

Effect of zein protein and hydroxypropyl methylcellulose on the texture of model gluten-free bread.

The influence of zein protein and hydroxypropyl methylcellulose (HPMC) on the texture and volume of gluten-free bread was investigated. The addition of HPMC to starch affected the dough viscoelasticity and it improved the bread volume during baking since it acts as an emulsifier. The addition of zein protein to gluten-free bread increased the crumb firmness and reduced the crust hardness within the range of concentrations investigated. No zein protein network could be observed in the bread crumb. The zein protein, cold mixed at low concentration, did not enhance the dough elasticity. Due to the lack of a protein network noncovalent interactions may stabilize the bubble structure stabilization within the crumb, rather than covalent links of the protein chain. With an optimized amount of zein protein and HPMC hydrocolloid, the gluten-free bread showed similar texture and staling behavior to that of model wheat bread. The optimized recipe, compiled into a spreadsheet, is available in the supporting information. The microstructural observations suggest that zein could be replaced with another protein for this recipe resulting in a similar bread texture.

New insights on the influence of manufacturing conditions and molecular weight on phase-separated films intended for controlled release.

The aim of this work was to investigate how manufacturing conditions influence phase-separated films of ethyl cellulose (EC) and hydroxypropyl cellulose (HPC) with different molecular weights of HPC. Two HPC grades, SSL and M, with weight average molecular weights (Mw) of 30×103g/mol and 365×103g/mol, respectively, were combined with EC 10 cps (70:30w/w EC/HPC) and spray-coated from ethanol solutions onto a rotating drum under well-controlled process conditions. Generally, a low spray rate resulted in a more rapid film drying process and, consequently, in smaller HPC-rich domains in the phase-separated film structure. For EC/HPC films with the low Mw HPC (SSL) the most rapid drying process resulted in a shift from a HPC-discontinuous to a partly bicontinuous structure and an increase in the permeability for water. In contrast, films containing the high Mw HPC (M) all showed bicontinuous structures, which resulted in overall higher water permeabilities and polymer release compared to the low Mw films. Interestingly, a maximum in permeability was observed for the high Mw films at intermediate spray rates. Below this spray rate the permeability decreased due to a lower amount of polymer released and at higher spray rates, the permeability decreased due to a loss of pore connectivity (or increased tortuosity). To conclude, this study shows that different Mw systems of EC/HPC can respond differently to variations in manufacturing conditions.

Shear and extensional rheology of commercial thickeners used for dysphagia management.

People who suffer from swallowing disorders, commonly referred to as dysphagia, are often restricted to a texture-modified diet. In such a diet, the texture of the fluid is modified mainly by the addition of gum or starch-based thickeners. For optimal modification of the texture, tunable rheological parameters are shear viscosity, yield stress, and elasticity. In this work, the flow properties of commercial thickeners obtained from major commercial suppliers were measured both in shear and extensional flow using a laboratory viscometer and a newly developed tube viscometry technique, termed Pulsed Ultrasound Velocimetry plus Pressure Drop (PUV + PD). The two methods gave similar results, demonstrating that the PUV + PD technique can be applied to study flow during the swallowing process in geometry similar to that of the swallowing tract. The thickeners were characterized in relation to extensional viscosity using the Hyperbolic Contraction Flow method, with microscopy used as a complementary method for visualization of the fluid structure. The gum-based thickeners had significantly higher extensional viscosities than the starch-based thickeners. The rheological behavior was manifested in the microstructure as a hydrocolloid network with dimensions in the nanometer range for the gum-based thickeners. The starch-based thickeners displayed a granular structure in the micrometer range. In addition, the commercial thickeners were compared to model fluids (Boger, Newtonian, and Shear-thinning) set to equal shear viscosity at 50/s and it was demonstrated that their rheological behavior could be tuned between highly elastic, extension-thickening to Newtonian. PRACTICAL APPLICATIONS: Thickeners available for dysphagia management were characterized for extensional viscosity to improve the understanding of these thickeners in large scale deformation. Extensional deformation behavior was further explained by using microcopy as corresponding technique for better understanding of structure/rheology relationship. Moreover, the major challenge in capturing human swallowing process is the short transit times of the bolus flow (<1 s). Therefore, the ultrasound-based rheometry method; PUV+PD which measures the real-time flow curve in ∼50 ms was used in addition to classical shear rheometry. The two methods complimented each other indicating that the PUV+PD method can be applied to study the transient swallowing process which is part of our future research, where we are studying the flow properties of fluids in an in vitro swallowing tract.

Plasticization of a protein-based film by glycerol: a spectroscopic, mechanical, and thermal study.

Kafirin, the seed storage protein of the cereal sorghum, is highly homologous with the maize storage protein zein. The effects of plasticisation of a kafirin film by glycerol in the absence of water were examined by a combination of spectroscopic (NMR and infrared), rheological, and calorimetric methods. The results suggest that at low glycerol levels the glycerol is absorbed onto and possibly into the protein. Increasing the level of glycerol increases the motion of the protein and changes the protein conformation. There are corresponding changes of the mechanical properties of protein films. At 40% (w/w) of glycerol, two glass transition temperatures were observed, one of which corresponded to the glass transition temperature of pure glycerol. This result indicates that at this level of plasticizer there are sufficient glycerol/glycerol interactions occurring to allow a separate glass formation process for glycerol.

The influence of the molecular weight of the water-soluble polymer on phase-separated films for controlled release.

Hydroxypropyl cellulose (HPC) and ethyl cellulose (EC) can be used for extended release coatings, where the water-soluble HPC may act as a pore former. The aim was to investigate the effect of the molecular weight of HPC on the microstructure and mass transport in phase-separated freestanding EC/HPC films with 30% w/w HPC. Four different HPC grades were used, with weight averaged molecular weights (Mw) of 30.0 (SSL), 55.0 (SL), 83.5 (L) and 365 (M) kg/mol. Results showed that the phase-separated structure changed from HPC-discontinuous to bicontinuous with increasing Mw of HPC. The film with the lowest Mw HPC (SSL) had unconnected oval-shaped HPC-rich domains, leaked almost no HPC and had the lowest water permeability. The remaining higher Mw films had connected complex-shaped pores, which resulted in higher permeabilities. The highest Mw film (M) had the smallest pores and very slow HPC leakage, which led to a slow increase in permeability. Films with grade L and SL released most of their HPC, yet the permeability of the L film was three times higher due to greater pore connectivity. It was concluded that the phase-separated microstructure, the level of pore percolation and the leakage rate of HPC will be affected by the choice of HPC Mw grade used in the film and this will in turn have strong impact on the film permeability.

Extensional viscosity of microfibrillated cellulose suspensions.

The extensional properties of micro fibrillated cellulose (MFC)-suspensions at different fibril concentrations and with different amounts of added sodium chloride were evaluated. The MFC-suspensions were obtained by diluting a stock solution consisting of 0.95 wt.% cellulose with either deionized water or sodium chloride solution, giving a series of different concentrations and sodium chloride contents. The extensional viscosities of the suspensions were measured utilizing contraction flow geometry. Here the specimens were forced through a hyperbolic nozzle and the required pressure drop over the nozzle was measured. The extensional viscosity exhibited an extensional-thinning behaviour over the extensional strain rates used. Furthermore the extensional viscosity decreased with decreasing concentration of the suspensions, in similarities with the shear properties of the specimens. For the suspensions containing sodium chloride, the extensional viscosity appeared to increase when the concentration of sodium chloride was increased. But excessive amounts of added sodium chloride promoted an agglomeration of the suspensions.

Effects of molecular weight on permeability and microstructure of mixed ethyl-hydroxypropyl-cellulose films.

Films of ethyl cellulose (EC) and water-soluble hydroxypropyl cellulose (HPC) can be used for extended release coatings in oral formulations. The permeability and microstructure of free EC/HPC films with 30% w/w HPC were studied to investigate effects of EC molecular weight. Phase separation during film spraying and subsequent HPC leaching after immersion in aqueous media cause pore formation in such films. It was found that sprayed films were porous throughout the bulk of the films after water immersion. The molecular weight affected HPC leaching, pore morphology and film permeability; increasing the molecular weight resulted in decreasing permeability. A model to distinguish the major factors contributing to diffusion retardation in porous films showed that the trend in permeability was determined predominantly by factors associated with the geometry and arrangement of pores, independent of the diffusing species. The film with the highest molecular weight did, however, show an additional contribution from pore wall/permeant interactions. In addition, rapid drying and increasing molecular weight resulted in smaller pores, which suggest that phase separation kinetics affects the final microstructure of EC/HPC films. Thus, the molecular weight influences the microstructural features of pores, which are crucial for mass transport in EC/HPC films.

New insights on how to adjust the release profile from coated pellets by varying the molecular weight of ethyl cellulose in the coating film.

The major aims of this work were to study the effect of the molecular weight (Mw) of ethyl cellulose (EC) on the drug release profile from metoprolol succinate pellets coated with films comprising EC and hydroxypropyl cellulose (HPC) with a weight ratio of 70:30, and to understand the mechanisms behind the different release profiles. A broad range of Mws was used, and the kinetics of drug release and HPC leaching followed. The higher the Mw of EC, the slower the HPC leaching and the drug release processes. Drug release occurred by diffusion through the pores created in the coating by the HPC leaching. A novel method was used to explain the differences in the release profiles: the effective diffusion coefficient (De) of the drug in the coating film was determined using a mechanistic model and compared to the amount of HPC leached. A linear dependence was found between De and the amount of HPC leached and, importantly, the value of the proportionality constant decreased with increasing Mw of EC. This suggests that the Mw of EC affects the drug release profile by affecting the phase separated microstructure of the coating and the hindrance it imparts to drug diffusion.

Mechanical and structural properties of solution-cast high-amylose maize starch films.

Environmental issues have forced the introduction of sustainable solutions such as annually renewable resources being used as a raw material for packaging and disposables. This paper examined the effects of time and temperature during manufacturing and plasticiser content on the molecular structure of high-amylose maize starch films. It also analysed how manufacturing conditions, plasticiser content and molecular structure of the films affected their material properties. It was found that increased time or temperature increased the degradation of amylose and of amylopectin, which in turn negatively affected film cohesiveness. However, neither time nor temperature had any effect on tensile properties.

Effect of ethanol on the water permeability of controlled release films composed of ethyl cellulose and hydroxypropyl cellulose.

The robustness of controlled release formulations when co-ingested with alcohol is a current concern expressed by regulatory authorities, especially with regard to dose dumping. One such controlled release formulation commonly used is film coating composed of ethyl cellulose (EC) and hydroxypropyl cellulose (HPC). The aim of this study was to investigate how the presence of ethanol in the dissolution medium affects the water permeability of such films. Film samples were prepared in various EC-HPC compositions, and the effect of different ethanol concentrations in the dissolution medium on the permeability was studied using a modified Ussing chamber and tritiated water. It was found that the effect of ethanol on the film permeability varied depending on the composition of the films. The results were interpreted in terms of swelling of the EC in the films, where the swelling increased with increasing ethanol concentration. Thus, for films with low HPC content (non-interconnected pores), the water permeability of the films increased with increasing ethanol concentration as the diffusion through the ethyl cellulose increased due to swelling. However, for films with higher HPC content (having interconnected pores through the films), the permeability decreased, likely due to the swelling of the ethyl cellulose blocking the pores. The interpretation of the results was supported by dynamic mechanic analysis and SEM analysis.

Objective and quantitative definitions of modified food textures based on sensory and rheological methodology.

INTRODUCTION: Patients who suffer from chewing and swallowing disorders, i.e. dysphagia, may have difficulties ingesting normal food and liquids. In these patients a texture modified diet may enable that the patient maintain adequate nutrition. However, there is no generally accepted definition of 'texture' that includes measurements describing different food textures. OBJECTIVE: Objectively define and quantify categories of texture-modified food by conducting rheological measurements and sensory analyses. A further objective was to facilitate the communication and recommendations of appropriate food textures for patients with dysphagia. DESIGN: About 15 food samples varying in texture qualities were characterized by descriptive sensory and rheological measurements. RESULTS: Soups were perceived as homogenous; thickened soups were perceived as being easier to swallow, more melting and creamy compared with soups without thickener. Viscosity differed between the two types of soups. Texture descriptors for pâtés were characterized by high chewing resistance, firmness, and having larger particles compared with timbales and jellied products. Jellied products were perceived as wobbly, creamy, and easier to swallow. Concerning the rheological measurements, all solid products were more elastic than viscous (G'>G''), belonging to different G' intervals: jellied products (low G') and timbales together with pâtés (higher G'). CONCLUSION: By combining sensory and rheological measurements, a system of objective, quantitative, and well-defined food textures was developed that characterizes the different texture categories.