Objective: To examine whether quantitative analysis of videofluoroscopic swallowing study (VFSS) images can quantitatively demonstrate the pathophysiology of swallowing disorders in patients.Methods: In total, 71 patients with Parkinson's disease (PD) (mean age 73.4±7.2 years) and 45 patients with sarcopenia (mean age 81.7±4.8 years) were included in the pathological group in this study. The control group comprised 151 individuals without swallowing disorders (mean age 76.0±7.6 years). To examine the distinctive features of swallowing dynamics in the pathological and control groups, a quantitative analysis of VFSS images was conducted. VFSS analysis parameters included measures of bolus movement, such as oral transit time (OTD), pharyngeal transit time (PTD), total transit time (TTD), and stage transition duration (STD). Furthermore, the onset and duration of movements in swallowing organs, including the soft palate, hyoid bone, epiglottis, and upper esophageal sphincter, were measured. VFSS was conducted using a 3-mL liquid bolus.Results: In the PD group, the swallowing disorder features included extended OTD, PTD, TTD, delayed STD, delayed onset times of the soft palate and epiglottis, and shortened movement duration. The sarcopenia group revealed a shortened movement duration in the hyoid bone and epiglottis.Conclusion: The quantitative analysis of VFSS permitted the assessment of swallowing dynamics. The abnormalities observed during swallowing movements in the PD and sarcopenia groups indicated specific pathophysiologies of these conditions, underscoring the utility of VFSS image analysis in understanding swallowing disorders.

Distigmine has reversible and persistent cholinesterase (ChE) antagonism, and is used for the dysuria due to low activity bladders such as the neurogenic bladder dysfunction widely postoperatively, but fatal cases were reported by cholinergic syndrome. Therefore a dose was limited to 5mg only for adaptation of “the dysuria due to hypotonic bladder such as after surgery and the neurogenic bladder dysfunction” in March, 2010. In the current study, we examined a ministerial policy in the package insert revision using Japanese Adverse Drug Event Report database (JADER). Using a side effect report registered with JADER from January, 2004 to June, 2016, we calculated Reporting Odds Ratio (ROR) which was the index of the safe signal of the medical supplies adverse event and we compared number of reports and ROR of the cholinergic syndrome by the distigmine in approximately the measure in March, 2010 and evaluated it. The number of reports of the cholinergic syndrome by the distigmine was 138 cases before March 2010 and 65 cases after March 2010. After a measure, the number of reports decreased. The possibility that the package insert revision of the distigmine contributed to a decrease in cholinergic syndrome onset was suggested. Whereas monitoring careful sequentially needs the onset of the cholinergic syndrome in constant frequency to be found.