Time Spent Away from Bed to Maintain Swallowing Function in Older Adults.

INTRODUCTION: The aim of this study was to determine the associations of time spent away from bed with whole-body muscle mass and swallowing function in older adults with low activities of daily living (ADL). METHODS: This cross-sectional study was conducted at Tokyo Medical and Dental University and included adults over 65 years of age who underwent a medical intervention at their residence. Data regarding age, sex, body height and weight, activity status, medical history, time spent away from bed, and Functional Oral Intake Scale (FOIS) were collected. We calculated the body mass index, Charlson Comorbidity Index, whole-body muscle mass, the appendicular skeletal muscle mass index (ASMI), and the trunk muscle mass index (TMI). According to the time spent away from bed, the subjects were grouped as follows: <4 but ≥0 h (S), <6 but ≥4 h (M), and ≥6 h (L). These variables were analyzed using the one-way analysis of variance, the Kruskal-Wallis test, and the χ2 test, then differences among the three groups were examined. To adjust for confounding factors, we performed multiple regression analysis with ASMI and TMI as the dependent variables and ordinal logistic regression analysis with FOIS as the objective variable. RESULTS: Ninety subjects (male: n = 42; female: n = 48; mean age = 82.9 ± 8.8 years, and groups S: n = 23; M: n = 30; L: n = 37) were analyzed. Group L had a significantly higher ASMI, TMI, and FOIS score than groups S and M, while group M had a significantly higher ASMI and FOIS score than group S. After adjusting for confounding factors, the significant explanatory factors for ASMI were sex, activity status, time spent away from bed, and TMI. The factors for TMI were activity status, time spent away from bed, ASMI, and FOIS. The factors for FOIS were time spent away from bed and TMI. CONCLUSION: Spending 4 or more hours away from the bed is related to appendicular skeletal muscle mass and FOIS, while spending 6 or more hours is related to appendicular skeletal muscle mass, trunk muscle mass, and FOIS in this population. These findings highlight factors that can prevent a decline in swallowing function in the daily life of older adults with low ADL who have difficulty performing exercises to preserve swallowing function.

Higher Activity and Quality of Life Correlates with Swallowing Function in Older Adults with Low Activities of Daily Living.

INTRODUCTION: The aim of this study was to clarify the relationship among swallowing function, activity, and quality of life (QOL) in older adults with low activities of daily living (ADL). MATERIALS AND METHODS: We conducted a cross-sectional study. In total, 271 Japanese adults aged over 65 years who underwent medical intervention at their residence (male: n = 107; female: n = 164; mean age = 84.6 ± 8.3 years) participated. We collected data regarding age, sex, body mass index (BMI), residence (their house/nursing home), activity status, consciousness level (eye response), history of aspiration pneumonia, other medical history, number of medication types, frequency of going out, and time spent away from bed. We judged consciousness level (eye response) using the Glasgow Coma Scale (GCS), calculated the Charlson comorbidity index, measured QOL using the short version of the Quality of Life Questionnaire for Dementia (short QOL-D), and assessed swallowing function using the Functional Oral Intake Scale (FOIS). To examine the relationship between scores for the FOIS and the other variables, we used the Spearman rank correlation coefficient and ordinal logistic regression analysis. RESULTS: The FOIS was strongly correlated with BMI (ρ = 0.47), activity status (ρ = -0.60), GCS (ρ = -0.41), time spent away from bed (ρ = 0.56), scores for the short QOL-D (ρ = 0.40), weakly correlated with history of aspiration pneumonia (ρ = -0.27), and frequency of going out (ρ = 0.39). Results for the ordinal logistic regression analysis showed that the FOIS was associated with activity status, frequency of going out, time spent away from bed, and scores for the short QOL-D. CONCLUSION: The swallowing function of older adults with low ADL was related to their QOL and activities, such as time spent away from bed and home. Thus, in rehabilitation programs for swallowing function in older adults, not only functional but also psychological approaches may prove effective.

Jaw-retraction exercise increases anterior hyoid excursion during swallowing in older adults with mild dysphagia.

OBJECTIVES: The present study aimed to evaluate the effectiveness of a newly designed jaw-retraction exercise for strengthening the geniohyoid muscle and thus improving the anterior movement of the hyoid bone during swallowing. BACKGROUND: Although previous studies suggest a relationship between anterior hyoid excursion and upper esophageal sphincter (UES) opening, there are currently no reports of physical exercises without the use of special equipment that can effectively improve this movement of the hyoid bone during swallowing. MATERIALS AND METHODS: This before-after study included patients presenting to the authors' hospital with mild dysphagia (Level 5 on the Dysphagia Outcome and Severity Scale). The participants were instructed to perform a jaw-retraction exercise designed to strengthen the geniohyoid muscle. Each participant was instructed to perform two sets of the exercise daily for four weeks, with each set consisting of five repetitions. Before and after the four-week training period, videofluoroscopic swallowing studies were performed and later analysed. RESULTS: Twenty-five patients with a median age of 77 were included. The median peak anterior hyoid position before and after exercise were 129.82 and 132.74 (%C2-C4 length), respectively, and this increase was found to be significant (P = .007). The median extent of UES opening before and after exercise were 8.6 and 9.3 (mm), respectively, and this increase was also found to be significant (P = .040). CONCLUSION: Our findings demonstrate that the jaw-retraction exercise can effectively improve the anterior movement of the hyoid bone. This exercise may be effective in individuals with oral frailty when signs of swallowing disorders are observed.

Association between myotonometric measurement of masseter muscle stiffness and maximum bite force in healthy elders.

BACKGROUND: Maximum bite force (MBF) is a common and useful index of masticatory function; it correlates with physical strength in elderly people. Palpation of stiffness in the masseter muscle during forceful biting has been considered to be associated with MBF. However, this assessment method relies on subjective judgments; no study has verified the relationship between MBF and quantitative measurements of masseter muscle stiffness (MMS). OBJECTIVE: We aimed to verify the association between masseter muscle myotonometric assessment results and MBF. METHODS: In total, 117 community-dwelling >65-year-old individuals from the Tokyo metropolitan area were assessed. MMS on the dominant side during forceful biting was measured with a MyotonPRO device. Masseter muscle thickness (MMT) during rest and forceful biting was measured with an ultrasonic diagnostic apparatus, and the difference in MMT (DMMT) between the rest and forceful biting conditions was determined. MBF data were obtained with a pressure-sensitive sheet and an associated device. To determine the independent variables affecting MBF and MMS, multivariate linear regression analyses with adjustments for age, sex and number of teeth were performed. RESULTS: The multivariate analysis revealed that MBF correlated with the number of teeth (ß = .489, P < .001) and MMS (ß = .259, P = .003) (R2  = .433). MMS correlated with MBF (ß = .308, P = .003) and DMMT (ß = .430, P < .001) (R2  = .326). CONCLUSION: Masseter muscle stiffness possibly reflects a force generated by the masseter muscle during forceful biting. Therefore, MMS is effective to assess tooth loss as well as an index of masseter muscle strength when evaluating MBF.

Near-infrared imaging polarimetry of LkCa 15: A possible warped inner disk.

We present high-contrast H-band polarized intensity images of the transitional disk around the young solar-like star LkCa 15. By utilizing Subaru/HiCIAO for polarimetric differential imaging, the angular resolution and the inner working angle reach 0.07 and r = 0″.1, respectively. We obtained a clearly resolved gap (width ≲ 27 au) at ~48 au from the central star. This gap is consistent with images reported in previous studies. We also confirmed the existence of a bright inner disk with a misaligned position angle of 13° ±4° with respect to that of the outer disk, i.e., the inner disk is possibly warped. The large gap and the warped inner disk both point to the existence of a multiple planetary system with a mass of ≲ 1 M Jup.

Associations of swallowing-related muscle quantity and quality with sarcopenic parameters.

PURPOSE: To examine the associations between swallowing-related muscle characteristics and sarcopenic parameters. METHODS: We included 147 community-dwelling older adults (age: 71.6 ± 4.7 years, body mass index: 23.0 ± 2.7 kg/m2 (mean ± standard deviation), men: 50; women: 97) and categorized them into robust (n = 125), low-function (n = 17), and sarcopenia (n = 5) groups based on the diagnostic criteria of the Asia Working Group for Sarcopenia 2019. We evaluated the geniohyoid muscle (GHM) and tongue characteristics (muscle quantity and quality). The cross-sectional area (CSA) indicated the muscle quantity, and echo intensity (EI) values indicated the muscle quality. A multiple regression analysis was performed to clarify the relationship of swallowing-related muscle characteristics and strength with sarcopenic parameters. RESULTS: The grip strength (CSA of GHM: ß = 1.64, p = 0.03) and skeletal muscle mass index (CSA of tongue: ß = 74.81, p = 0.003, EI of tongue: ß = 1.92, p = 0.009) were better indicators of swallowing-related muscle characteristics. CONCLUSION: These findings may facilitate the early detection of aging-related deterioration in swallowing-related musculature through the diagnostic process of sarcopenia and increase our understanding of muscle physiology.

Association between characteristics of swallowing-related muscles and trunk muscle mass.

Swallowing function is associated with systemic factors. Whether trunk or appendicular skeletal muscle mass is a better indicator of swallowing-related muscle characteristics in community-dwelling older adults is not clear. Hence, we investigated the association between the characteristics of swallowing-related muscles (e.g., mass and quality) and trunk muscle mass. Community-dwelling older adults aged ≥ 65 years (n = 141; men: n = 45, women: n = 96) were recruited for this cross-sectional observational study via a health survey conducted in 2018. Trunk muscle mass index (TMI) and appendicular skeletal muscle mass index (SMI) were measured using bioelectrical impedance analysis. Cross-sectional areas (CSAs) and echo intensity (EI) of the geniohyoid muscle (GHM) and tongue were evaluated using an ultrasonic diagnostic apparatus. Multiple regression analysis was used to examine the relationship of the characteristics of swallowing-related muscle with TMI and SMI. Multiple regression analysis showed that CSA of the GHM was positively associated with both TMI (B = 24.9, p < 0.001) and SMI (B = 13.7, p = 0.002). EIs of swallowing-related muscles were not associated with TMI and SMI. Trunk muscle mass was associated with swallowing-related muscle mass and not muscle quality. The results of this study shed light on the elucidation of association of dysphagia with TMI and SMI.

Relationship between the jaw-closing force and dietary form in older adults without occlusal support requiring nursing care.

In clinical practice, we encounter cases wherein older adults lacking occlusal support consume foods requiring mastication and adequate swallowing function. This study investigated the relationship between jaw-closing force (JCF) and dietary form in older adults without occlusal support requiring nursing care. This prospective cross-sectional study included 123 older adults requiring nursing care who lost their molar occlusal support and consumed food orally without dentures. JCF was defined as the force required for crushing food with the edentulous ridges or with the tooth and edentulous ridge while closing the mouth. Participants were classified into four groups based on the International Dysphagia Diet Standardization Initiative framework for recommended dietary forms. Basic information was collected, and tongue pressure and JCF were measured. Differences in JCF were analyzed using one-way analysis of variance, while factors related to dietary form were evaluated using ordinal logistic regression analysis. Significant differences in JCF were observed among the four groups. Factors such as the Barthel Index, tongue pressure, and JCF were dietary form-related. Our findings suggest that older adults requiring nursing care tend to have higher JCF when consuming meals requiring mastication. Therefore, JCF could serve as an index for determining appropriate dietary forms in this population.

Usefulness of a newly developed endoscope for the observation of the posterior tracheal wall.

Objective: Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults. Methods: Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two-step angulation endoscope (two-AE) with a two-step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t-test were used for statistical analysis. Kappa coefficients and concordance rates were calculated. Results: The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two-AE (p < .001), compared to only three of 20 participants with the CE. The time to observation of the posterior tracheal wall for examiners 1 and 2 was 13.3 ± 6.5 and 12.0 ± 6.7 s, respectively, with no difference between groups (p = .400). The kappa coefficients of examiners 1 and 2 and between the examiners were 0.444, 0.643, and 0.643, respectively, with concordance rates of 90%, 95%, and 95%, respectively. Conclusion: Regardless of the examiner's years of experience, we observed that the two-AE could observe the posterior tracheal wall. Level of Evidence: Step 5.

Tongue Strength of Older Adults Requiring Long-Term Care Varies throughout the Day.

Physical performance shows approximately 30% diurnal variation; however, diurnal variation in oral function remains unclear. This study aimed to determine the diurnal variation in oral and swallowing function in older adults requiring long-term care. The participants included 13 adults aged >60 years (3 men and 10 women, mean age: 77.2 ± 6.3 years, age range: 62-90 years) requiring long-term care. Tongue strength (TS) and oral mucosal moisture were measured as indices of oral and swallowing function, while hand grip strength was measured as an index of general muscle strength. The patients were asked to participate in a "test" after breakfast, lunch, and dinner on the same day. Multilevel linear regression analysis was used to examine diurnal differences in each item. Multilevel linear regression analysis with adjustment for age and sex revealed that TS was significantly higher at noon (p = 0.001) than in the morning. Therefore, caregivers who provide support during meals to older people requiring long-term care should consider the possibility of swallowing function differing according to the time of the day. In conclusion, it may be beneficial to establish a nutritional therapy that accounts for the diurnal variation in TS.

Analysis of swallowing function after anterior/posterior surgery for cervical degenerative disorders and factors related to the occurrence of postoperative dysphagia.

BACKGROUND CONTEXT: Dysphagia is one of the postoperative complications of cervical degenerative disorders. However, few studies have evaluated the pre- and postoperative swallowing function in detail. PURPOSE: To analyze pre- and postoperative swallowing dynamics kinetically and investigate factors associated with postoperative dysphagia in patients with cervical degenerative disorders. STUDY DESIGN: Retrospective review of prospectively collected data. PATIENT SAMPLE: A total of 41 consecutive patients who underwent an anterior approach (anterior cervical discectomy/corpectomy and fusion (ACDF, ACCF), hybrid surgery (ACDF+ACCF) and total disc replacement) and 44 consecutive patients who underwent a posterior approach (laminoplasty and laminoplasty/laminectomy with fusion). OUTCOME MEASURES: We compared the pre- and postoperative functional oral intake scale (FOIS), dysphagia severity scale (DSS), esophageal dysphagia, anterior/superior hyoid movement, upper esophageal sphincter (UES) opening, pharyngeal transit time, bolus residue scale (BRS), and the number of swallows. METHODS: Videofluoroscopy was performed on the day before surgery and within two weeks after surgery. Data related to age, gender, disease, surgical procedure, surgical site, operative time, and blood loss were collected from the medical records. Pre- and postoperative data were compared for each item in the anterior and posterior approaches. The odds ratio of dysphagia after an anterior approach was also calculated. RESULTS: In the anterior approach, DSS, FOIS, the anterior and superior hyoid movements, maximum UES opening, BRS, and number of swallows worsened postoperatively (p<.05, respectively). In the posterior approach, DSS, FOIS, the anterior hyoid movement, and BRS worsened postoperatively (p<.05, respectively). The factors associated with dysphagia were a proximal surgical site above C3 (OR: 14.40, CI: 2.84-73.02), blood loss >100 mL (OR: 9.60, CI: 2.06-44.74), an operative time >200 minutes (OR: 8.18, CI: 1.51-44.49), and an extensive surgical field of more than three intervertebral levels (OR: 6.72, CI: 1.50-30.07). The decline in swallowing function after the posterior approach was related to aging (p=.045). CONCLUSIONS: Each approach may decrease swallowing function, especially because of the limitation on the anterior hyoid movement. Dysphagia after anterior approaches was associated with the operative site, operative time, and blood loss.

Free-flap volume correlates with body mass index in patients with tongue squamous cell carcinoma.

Objectives: This study aimed to investigate the relationship between postoperative reconstructed tongue flap volume (RTFV) and body mass index (BMI) and identify factors affecting the flap volume in patients with tongue squamous cell carcinoma. Methods: Thirty-two patients were evaluated for RTFV from computed tomography images and BMI. The first and second evaluations were done at 6 months and 1.5 years after surgery respectively. RTFV rate changes and BMI differences from the first and second evaluations were calculated. The correlation between RTFV rate change and BMI difference was assessed using Spearman's rank correlation coefficient. Multiple regression analysis evaluated the relationship between the flap volume rate change and age, sex, flap type, and BMI difference to identify influencing factors. Results: The flap volume rate change and BMI difference correlated significantly (r = .594, p < .05). BMI difference and flap type were independent factors that affected reconstructed flap volume rate change in multiple regression analysis (p < .05). Conclusion: The flap volume of patients with tongue squamous cell carcinoma correlates with the BMI change in the chronic phase. Patients after tongue reconstruction need to be well nourished to maintain BMI and thus postoperative tongue volume to maintain the quality of life. Level of Evidence: Level 3.

Usefulness and Validity of a Jaw-Closing Force Meter in Older Adults.

We prototyped a new device with a soft and flexible pressure sensor to measure the force to close the mandible with or without occlusal support (jaw-closing force, JCF). This study aimed to clarify the practicality of this instrument. Healthy young and older adults with occlusal support were recruited. Intra- and inter-rater reliability of the JCF meter was examined using data from younger participants. Data regarding age, sex, body mass index, remaining teeth, and dentures of the older adults were obtained. Furthermore, the right and left JCFs were measured using a JCF meter; occlusal force was measured using an existing occlusal force-measuring device. Intra- and inter-rater correlation coefficients were significantly reproducible (0.691−0.811, p < 0.05). JCF was correlated with occlusal force (p < 0.05). Multiple regression analysis revealed that factors significantly associated with JCF included denture status (p < 0.001), age (p = 0.038), and occlusal force (p = 0.043). The prototyped JCF meter can measure JCF with high reproducibility, reliability, and validity. Further, association with occlusal force, which is an existing index, was observed. This device could be used to measure the JCF with or without occlusal support as a new method of evaluating oral function in older adults.

Strength and morphology of a suprahyoid muscle and their relationship to forward head posture in healthy older adults.

AIM: Forward head posture, an abnormality in head and trunk positioning, adversely affects suprahyoid muscle activity. Jaw-opening force, which reflects suprahyoid muscle strength, is a useful index of dysphagia. However, the relationship between forward head posture and strength and morphology of suprahyoid muscles remains unclear. This study aims to clarify the relationship between forward head posture, jaw-opening force and morphology of suprahyoid muscles. METHODS: During October 2018, we enrolled older adults aged ≥65 years. The craniovertebral angle was measured, and an angle <49° was defined as forward head posture. Jaw-opening force was also measured. The geniohyoid muscle (GHM) was selected to represent the suprahyoid muscles, and its cross-sectional area and length were measured using ultrasonography. Sarcopenia was also determined based on the criteria of the 2019 Asian Working Group for Sarcopenia. Multiple regression analyses were conducted to determine the association between morphological characteristics of the suprahyoid muscle and jaw-opening force as well as the association between the former and forward head posture. RESULTS: Data of 87 participants were analyzed. Sex, cross-sectional area and length of the GHM, and sarcopenia were significantly associated with jaw-opening force. In addition, sex and forward head posture were significantly associated with the length of the GHM. CONCLUSIONS: Our study demonstrated that an overextended length of suprahyoid muscles mediates the relationship between forward head posture and jaw-opening force. Forward head posture is easily visualized and can be a useful indicator of decline in suprahyoid muscle strength. Geriatr Gerontol Int 2022; 22: 779-784.

A circumstellar disk associated with a massive protostellar object.

The formation process for stars with masses several times that of the Sun is still unclear. The two main theories are mergers of several low-mass young stellar objects, which requires a high stellar density, or mass accretion from circumstellar disks in the same way as low-mass stars are formed, accompanied by outflows during the process of gravitational infall. Although a number of disks have been discovered around low- and intermediate-mass young stellar objects, the presence of disks around massive young stellar objects is still uncertain and the mass of the disk system detected around one such object, M17, is disputed. Here we report near-infrared imaging polarimetry that reveals an outflow/disk system around the Becklin-Neugebauer protostellar object, which has a mass of at least seven solar masses (M(o)). This strongly supports the theory that stars with masses of at least 7M(o) form in the same way as lower mass stars.

Swallowing Function Evaluation in a Patient with Gerstmann-Sträussler-Scheinker Disease with Pro105Leu: A Case Report.

Gerstmann-Sträussler-Scheinker disease (GSS) is a genetic prion disease. Swallowing function evaluation in patients with GSS remains unclear. Here, we describe a case of videofluoroscopic examination of swallowing (VF) to facilitate continued oral ingestion in a patient with P105L GSS. A 67-year-old woman developed gait disturbance and Parkinsonism symptoms at the age of 54 years. Since her family wanted her to continue oral ingestion, we performed VF, which revealed impairment and preservation of the oral and pharyngeal phases, respectively. Moreover, the impairment of the oral phase was improved by adjusting the patient's posture and food consistency. A swallowing function evaluation based on the condition of a patient with GSS may facilitate continued oral ingestion.

High-Contrast Imaging of Intermediate-Mass Giants with Long-Term Radial Velocity Trends.

A radial velocity (RV) survey for intermediate-mass giants has been operated for over a decade at Okayama Astrophysical Observatory (OAO). The OAO survey has revealed that some giants show long-term linear RV accelerations (RV trends), indicating the presence of outer companions. Direct imaging observations can help clarify what objects generate these RV trends. We present the results of high-contrast imaging observations of six intermediate-mass giants with long-term RV trends using the Subaru Telescope and HiCIAO camera. We detected co-moving companions to γ Hya B ( 0.61 - 0.14 + 0.12 M ⊙ ) , HD 5608 B (0.10 ± 0.01M ⊙), and HD 109272 B (0.28 ± 0.06M ⊙). For the remaining targets(ι Dra, 18 Del, and HD 14067) we exclude companions more massive than 30-60 M Jup at projected separations of 1''-7''. We examine whether these directly imaged companions or unidentified long-period companions can account for the RV trends observed around the six giants. We find that the Kozai mechanism can explain the high eccentricity of the inner planets ι Dra b, HD 5608 b, and HD 14067 b.

Identification and antimicrobial susceptibility of enterococci isolated from dogs and cats subjected to differing antibiotic pressures.

The purpose of the present study was to determine the prevalence of antibiotic-resistant enterococci in dogs and cats subjected to differing antibiotic pressures, and the prevalence of vancomycin resistance genes in isolates from these animals. Enterococci were isolated from fecal samples of 65 healthy dogs and 29 healthy cats brought to animal hospitals, from rectal swabs of 73 puppies and 15 kittens from five breeders and two pet shops, and from fecal samples of 20 dogs and 9 cats that were treated with antibiotics in Nippon Veterinary and Life Science University Animal Medical Center. The rates of resistance to ampicillin among isolates from the kitten-puppy group and healthy dog-cat group were 6.8 and 4.3%, respectively. In contrast, the rates of resistance to ampicillin in enterococci from the treatment group under antibiotic pressure were 37.5%. There was a significant difference between the antibiotic-treated group and the untreated group (P<0.01). Similarly, in the treatment group, the rate of resistance to enrofloxacin was extremely high (75.0%). In comparison, in the healthy group and kitten-puppy group, the rates of resistance to enrofloxacin were 23.4 and 12.1%, respectively. Among these groups, a significant difference was also observed in the apparent resistance rates (P<0.01). Vancomycin-resistant enterococci (VRE) harboring vanA or vanB were not detected in any groups. Therefore, contamination of VRE in dogs and cats is still considered to be minimal in Japan.

Direct imaging of bridged twin protoplanetary disks in a young multiple star.

Studies of the structure and evolution of protoplanetary disks are important for understanding star and planet formation. Here we present the direct image of an interacting binary protoplanetary system. Both circumprimary and circumsecondary disks are resolved in the near-infrared. There is a bridge of infrared emission connecting the two disks and a long spiral arm extending from the circumprimary disk. Numerical simulations show that the bridge corresponds to gas flow and a shock wave caused by the collision of gas rotating around the primary and secondary stars. Fresh material streams along the spiral arm, consistent with the theoretical scenarios in which gas is replenished from a circummultiple reservoir.