Thickening agents are usually added to thin liquids administered to dysphagic patients to prevent aspiration. In this study, we aimed to identify the viscosity best suited for easy swallowing in elderly people and to examine the optimal shear rate for measuring, through sensory evaluation, these thickening liquids. Ten elderly participants were selected for sensory evaluation of diluted solutions for ease of swallowing and stickiness. Diluted solutions containing > 2.0% xanthan gum-based product were judged to be significantly more difficult to swallow than solutions containing < 2.0%. Fifty-two healthy panelists were selected for sensory evaluation of oral viscosity to compare sensory evaluation with instrument-based viscosity measurement. We found that the optimal shear rate was approximately 100 s -1 . These findings indicate that the thickening agent-diluted solutions that the elderly found difficult to swallow exceeded 120 mPa·s at a shear rate of 100 s -1 .Keywords: viscosity, thickening agents, TOROMI, shear rate *To whom correspondence should be addressed. E-mail: kayashita@pu-hiroshima.ac.jp IntroductionDysphagic patients with delayed pharyngeal swallow response or reduced lingual control find it difficult to swallow thin liquids safely (O'Gara, 1990). Thickening agents may promote safer swallowing as they lower the risk of aspiration (Kuhlemeier et al., 2001). Compared to thin liquids, thickened liquids are associated with higher values of some swallowing parameters, such as the total swallowing duration (Chi-Fishman and Sonies, 2002), number of swallowing movements (Hamlet et al., 1996), and peak lingual force amplitude (Miller and Watkin, 1996); however, the range of liquid viscosity suitable for dysphagic patients remains unclear.In Japan, thickeners in a dry mix powder form are used to provide instant viscosity to liquids, and the products formed are called "TOROMI". Although Japanese people favor thinner liquids, clinical staff prepare thicker TOROMI to prevent aspiration in dysphagic patients; however, they are often unsure how to adjust the liquid consistency for each individual dysphagic patient.In 1994, the Japanese Ministry of Health, Labour and Welfare defined the "Foods for the elderly with difficulty in masticating or swallowing," and categorized them as "Food for Special Dietary Uses (FOSDU)." This criterion indicates a lower limit of viscosity and states that the viscosity of soltype foods should be measured using a Brookfield-type viscometer, commonly known as the B-type viscometer, at a rotor rotation rate of 12 rpm at 20℃. This rotor rotation rate is calculated to an approximate shear rate of 2 − 3 s -1 (Kumagai et al., 2009). In 2009, FOSDU was changed to "Foods for the elderly with difficulty in swallowing," which denotes a new measuring standard for gel-type foods, but the sol-type foods criterion was excluded because there was insufficient evidence for the measuring method of sol-type foods in Japan. As a result, the old method involving measurement at 12 rpm by a B-type viscomete...

The effects of medical and surgical interventions on the survival of patients with trisomy 18 have been reported, leading to changes in perinatal management and decision-making. However, few studies have fully reported the recent changes in survival and treatment of trisomy 18. We examined how treatment and survival of patients with trisomy 18 have changed over a decade in a Japanese pediatric tertiary referral center. This retrospective cohort study included patients with trisomy 18 who were admitted within the first 7 days of life at the Hyogo Prefectural Kobe Children's Hospital between 2008 and 2017. The patients were divided into early period (EP) and late period (LP) groups based on the birth year of 2008-2012 and 2013-2017, respectively. Changes in treatment and survival rates were compared between the two groups. A total of 56 patients were studied (29 in the EP group and 27 in the LP group). One-year survival rates were 34.5% and 59.3% in the EP and LP groups, respectively. The survival to discharge rate significantly increased from 27.6% in the EP group to 81.5% in the LP group (p < 0.001). The proportion of patients receiving surgery, especially for congenital heart defects, significantly increased from 59% in the EP group to 96% in the LP group (p = 0.001). In our single-center study, survival and survival to discharge were significantly improved in patients with trisomy 18, probably because of increased rate of surgical interventions. These findings may facilitate better decision-making by patients' families and healthcare providers.

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