Plus moist HS-W®: a new nasal packing material for the middle meatus in endoscopic sinus surgery.

PURPOSE: Removal of the current calcium alginate packing materials to the middle meatus in endoscopic sinus surgery (ESS) is usually accompanied by discomfort or pain owing to the hard and brittle nature of these materials. Plus moist HS-W® is a new calcium alginate packing material released in 2022 developed to overcome this issue by changing the uronic acid component. We aimed to compare the discomfort/pain during the removal of Plus moist HS-W® with Kaltostat®, as well as their suitability as packing materials in ESS. METHODS: Kaltostat® and Plus moist HS-W® were used as packing materials in 22 and 21 patients who underwent ESS in 2021 and 2022, respectively. Patients were asked to rate the pain during the packing removal 10 days after ESS using the Numerical Rating Scale (NRS). The ratio of residual packing materials, number of suctions (insertions/extractions of the suction cannula), and time required to remove packing materials were measured. Postoperative complications such as hemorrhage, local infection, lateralization of the middle turbinate, and synechia of the middle meatus were also evaluated. RESULTS: The Plus moist HS-W® group exhibited significantly lower NRS pain scores, a lower ratio of residual packing materials, a reduced number of suctions, and a shorter time required to remove the packing. No obvious postoperative complications occurred in both groups except for one suspicious case of a slight infection in the Kaltostat® group. CONCLUSION: Compared with Kaltostat®, Plus moist HS-W®, characterized by better gelatinization than Kaltostat®, benefits patients by minimizing discomfort/pain during removal. LEVEL OF EVIDENCE: Level 3.

(31E,32Z,71E,72Z)-4,8-Bis(3,5-di-chloro-phen-yl)-14,33,53,73-tetra-propyl-11H,32H,51H,72H-1,5(2,5),3,7(5,2)-tetra-pyrrola-2,6(2,5)-di-thiophena-cyclo-octa-phane.

Purple crystals of the title compound, C50H44Cl4N4S2 were obtained from the reaction of 2,5-bis-(4-propyl-1H-pyrrol-2-yl)thio-phene and 3,5-di-chloro-benzaldehyde in the presence of tri-fluoro-acetic acid for 3 h and subsequent addition of p-chloranil. The macrocycle in the title compound can be described as a highly planar structure wthe the average deviation of the 32 macrocyclic atoms from the least-squares plane being 0.0416 Å. Its mol-ecular conformation is stabilized by two intra-molecular N-H⋯N bonds and a three-dimensional network is formed by C-H⋯π inter-actions.

Phosphorylation of phase-separated p62 bodies by ULK1 activates a redox-independent stress response.

NRF2 is a transcription factor responsible for antioxidant stress responses that is usually regulated in a redox-dependent manner. p62 bodies formed by liquid-liquid phase separation contain Ser349-phosphorylated p62, which participates in the redox-independent activation of NRF2. However, the regulatory mechanism and physiological significance of p62 phosphorylation remain unclear. Here, we identify ULK1 as a kinase responsible for the phosphorylation of p62. ULK1 colocalizes with p62 bodies, directly interacting with p62. ULK1-dependent phosphorylation of p62 allows KEAP1 to be retained within p62 bodies, thus activating NRF2. p62S351E/+ mice are phosphomimetic knock-in mice in which Ser351, corresponding to human Ser349, is replaced by Glu. These mice, but not their phosphodefective p62S351A/S351A counterparts, exhibit NRF2 hyperactivation and growth retardation. This retardation is caused by malnutrition and dehydration due to obstruction of the esophagus and forestomach secondary to hyperkeratosis, a phenotype also observed in systemic Keap1-knockout mice. Our results expand our understanding of the physiological importance of the redox-independent NRF2 activation pathway and provide new insights into the role of phase separation in this process.

Autocitrullination confers monocyte chemotactic properties to peptidylarginine deiminase 4.

Peptidylarginine deiminase 4 (PAD4) contributes to the production of citrullinated proteins as autoantigens for anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA). PAD4 can also self-deiminate via autocitrullination. However, the role of this process in RA pathogenesis has not been elucidated. This study aimed to clarify PAD4 function before and after autocitrullination and identify citrullinated PAD4 in the synovial fluid of patients with RA. The autocitrullination of recombinant human PAD4 (rhPAD4) was catalyzed in vitro and determined using anti-modified citrulline immunoblotting. Monocyte chemotaxis was evaluated using Boyden chambers, and citrullinated rhPAD4's ability to induce arthritis was assessed in a C57BL/6J mouse model. Citrullinated PAD4 levels were measured in the synovial fluid of patients with RA and osteoarthritis using a novel enzyme-linked immunosorbent assay. Chemotactic findings showed that citrullinated rhPAD4 recruited monocytes in vitro, whereas unmodified rhPAD4 did not. Compared to unmodified rhPAD4, citrullinated rhPAD4 induced greater inflammation in mouse joints through monocyte migration. More citrullinated PAD4 was found in the synovial fluid of patients with RA than in those with osteoarthritis. Citrullinated PAD4 was even detected in ACPA-negative patients with RA. The autocitrullination of PAD4 amplified inflammatory arthritis through monocyte recruitment, suggesting an ACPA-independent role of PAD4 in RA pathogenesis.

Intraoperative changes in medial joint gap after posterior femoral condylar resection, posterior osteophyte removal, and femoral component placement during primary total knee arthroplasty.

BACKGROUND: "Mid-flexion stability" is important for superior patient satisfaction following total knee arthroplasty (TKA). Thus, it is important to control medial joint gap intraoperatively as a countermeasure. However, reports on the precise intraoperative changes in medial joint gap during TKA are scarce. This study evaluated the intraoperative changes in medial joint gap during TKA. METHODS: We studied 167 knees with varus osteoarthritis that underwent 80 cruciate-retaining (CR) and 87 posterior-stabilized (PS) TKAs between January 2018 and December 2020. We measured the intraoperative changes in medial joint gap with a tensor device at 137.5 N. RESULTS: The medial joint gap after posterior femoral condylar resection was significantly increased not only at 90° of flexion but also at 0° of extension in CR and PS TKAs (p < 0.01). The medial joint gap after posterior osteophyte removal was significantly increased not only at 0° of extension but also at 90° of flexion in CR and PS TKAs (p < 0.01). The medial joint gap at 0° of extension was reduced by 0.60 mm after femoral component placement in PS TKA. CONCLUSION: Surgeons need to pay close attention to these intraoperative changes in medial joint gap by measuring the medial joint gap before and after each procedure or assuming the changes in those values before bone cutting to achieve superior patient satisfaction following TKA.

[Introduction and Activities of Nurse Practitioner in Japan in a University Hospital].

Nurse practitioner (NP) is widely known to be an essential position of medical team in the United States, but has not yet been established as an official qualification in Japan. NP in Japan (NP-J) is accepted instead of NP, but they are not the same. We summarized the actual activities of NP-J at our hospital and had an insight into the roles of NP-J in a university hospital and the problems of introduction of NP in the future. The benefits of working as a NP-J at a university hospital are the safe acquisition of procedures at an educational institution and the involvement of various departments. In the future, the education of NP-J in a university hospital may lead to the training of NP-J working in public and private hospitals. The problem of introduction of NP in the future is the legislation. The importance of task shifting and education of NP-J in a university hospital may lead to the spread of NP in the future in Japan.

Chemical identification of an active component and putative neural mechanism for repellent effect of a native ant's odor on invasive species.

The invasive Argentine ants (Linepithema humile) and the red imported fire ants (Solenopsis invicta) constitute a worldwide threat, causing severe disruption to ecological systems and harming human welfare. In view of the limited success of current pest control measures, we propose here to employ repellents as means to mitigate the effect of these species. We demonstrate that cuticular hydrocarbons (CHCs) used as nestmate-recognition pheromone in the Japanese carpenter ant (Camponotus japonicus), and particularly its (Z)-9-tricosene component, induced vigorous olfactory response and intense aversion in these invasive species. (Z)-9-Tricosene, when given to their antennae, caused indiscriminate glomerular activation of antennal lobe (AL) regions, creating neural disarray and leading to aversive behavior. Considering the putative massive central neural effect, we suggest that the appropriate use of certain CHCs of native ants can facilitate aversive withdrawal of invasive ants.

Morphological Fabrication of Rubber Cutaneous Receptors Embedded in a Stretchable Skin-Mimicking Human Tissue by the Utilization of Hybrid Fluid.

Sensors are essential in the haptic technology of soft robotics, which includes the technology of humanoids. Haptic sensors can be simulated by the mimetic organ of perceptual cells in the human body. However, there has been little research on the morphological fabrication of cutaneous receptors embedded in a human skin tissue utilizing artificial materials. In the present study, we fabricated artificial, cell-like cutaneous receptors embedded in skin tissue mimicking human skin structure by utilizing rubber. We addressed the fabrication of five cutaneous receptors (free nerve endings, Krause and bulbs, Meissner corpuscles, Pacinian corpuscles and Ruffini endings). In addition, we investigated the effectiveness of the fabricated tissue for mechanical and thermal sensing. At first, in the production of integrated artificial skin tissue, we proposed a novel magnetic, responsive, intelligent, hybrid fluid (HF), which is suitable for developing the hybrid rubber skin. Secondly, we presented the fabrication by utilizing not only the HF rubber but our previously proposed rubber vulcanization and adhesion techniques with electrolytic polymerization. Thirdly, we conducted a mechanical and thermal sensing touch experiment with the finger. As a result, it demonstrated that intelligence as a mechanoreceptor or thermoreceptor depends on its fabric: the HF rubber sensor mimicked Krause and bulbs has the thermal and pressing sensibility, and the one mimicked Ruffini endings the shearing sensibility.

Expression of Piezo mRNA is unaffected in a rat model of knee osteoarthritis.

Osteoarthritis of the knee impairs activities of daily living of those affected. Its irreversible degenerative changes to the knee joint induce functional disturbance and unpleasant arthralgia. The pain has inflammatory components and often is manifested with mechanical allodynia and hyperalgesia. Sustained weight bearing and joint movements increase pain sensitivity in knee osteoarthritis. Understanding the mechanisms underlying the mechanical allodynia and hyperalgesia might provide a therapeutical target for pain relief in patients with such symptoms. Piezo channel is a mechanically activated ion channel that may be involved in mechanical transduction in the articular cartilage. Although it has been shown that inflammation potentiates Piezo channel current induced by mechanical stimulation, whether Piezo expression levels are influenced by knee osteoarthritis has remained unknown. We measured Piezo mRNA in knee joints and dorsal root ganglia after establishing a model of knee osteoarthritis in rats using monosodium iodoacetate and found Piezo mRNA level is not upregulated. This finding raises a question as whether and how Piezo channels may be involved in mechanically induced pain in osteoarthritis.

Mass spectrometric quantitation of AGEs and enzymatic crosslinks in human cancellous bone.

Advanced glycation end-products (AGEs) deteriorate bone strength. Among over 40 species identified in vivo, AGEs other than pentosidine were roughly estimated as total fluorescent AGEs (tfAGEs) due to technical difficulties. Using LC-QqTOF-MS, we established a system that enabled the quantitation of five AGEs (CML, CEL, MG-H1, CMA and pentosidine) as well as two mature and three immature enzymatic crosslinks. Human bone samples were collected from 149 patients who underwent total knee arthroplasty. Their clinical parameters were collected to investigate parameters that may be predictive of AGE accumulation. All the analytes were quantitated and showed significant linearity with high sensitivity and precision. The results showed that MG-H1 was the most abundant AGE, whereas pentosidine was 1/200-1/20-fold less abundant than the other four AGEs. The AGEs were significantly and strongly correlated with pentosidine, while showing moderate correlation with tfAGEs. Interestingly, multiple linear regression analysis revealed that gender contributed most to the accumulation of all the AGEs, followed by age, tartrate-resistant acid phosphatase-5b and HbA1c. Furthermore, the AGEs were negatively correlated with immature crosslinks. Mass spectrometric quantitation of AGEs and enzymatic crosslinks is crucial to a better understanding of ageing- and disease-related deterioration of bone strength.

Enhancement of Diversity in Production and Applications Utilizing Electrolytically Polymerized Rubber Sensors with MCF: The Second Report on Various Engineering Applications.

We investigated the proposed hybrid skin (H-Skin) for the requirement of haptic sensibility in rubber using our proposed consummate fabrication process together with a multi-layered magnetic compound fluid (MCF) rubber and stocking-like porous rubber permeated by liquids, which was demonstrated in our previous report. The objective was to assess its applicability to sensing normal force and temperature, as well as fields dominated by shear force. For normal force, we investigated the piezo-electricity and electric current induced voltage, as well as the piezo-resistivity of the MCF rubber sensor under pressure. Additionally, we clarified the viability of measuring the softness and texture of materials using the MCF rubber sensor. For the shear motion, we clarified the characteristics of the friction coefficient using the MCF rubber sensor. The MCF rubber sensor can capture the reactions of paper, cloth, convex- and concave-shaped objects such as plant leaves and metal, and the skin of the human finger. Therefore, it is useful to investigate its texture and biological surfaces. Our obtained outstanding results indicated the feasibility of sensing the surface texture for any material in fields such as paper, fashion, apparel manufacturing, and cosmetic industries, which was impossible until now.

Enhancement of Diversity in Production and Application Utilizing Electrolytically Polymerized Rubber Sensors with MCF: 1st Report on Consummate Fabrication Combining Varied Kinds of Constituents with Porous Permeant Stocking-Like Rubber.

To satisfy the requirement of haptic sensibility in rubber such as in the proposed hybrid skin (H-Skin), the authors have demonstrated a new method for solidifying rubber using electrolytic polymerization together with configured magnetic clusters of magnetic compound fluid (MCF) incorporated into the rubber by the application of a magnetic field. However, the rubber and magnetic fluid (MF) involved in the MCF rubber were water-soluble. In addition, the authors have demonstrated the practicability of using electrolytic polymerization with an emulsifier, polyvinyl alcohol (PVA), in which natural rubber (NR) or chloroprene rubber (CR) and silicone rubber (Q) can be mixed as water-soluble and water-insoluble rubbers, respectively. In this study, to enhance production, the feasibility of solidifying rubber by electrolytic polymerization is verified using varied water-insoluble rubber, varied water-insoluble MF, and varied surfactants to aid emulsion polymerization, except in the case of other kinds of rubber and MF which have been demonstrated until recent by the authors. Based on these diverse constituents, the authors propose a consummate fabrication process for multi-layered MCF rubber, which involves porous stocking-like rubber that can be permeated by any liquid. The investigation of this application is presented in the sequential second report.

Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty.

BACKGROUND: Greater accuracy is needed when determining the final femoral component (FC) rotation during total knee arthroplasty (TKA), because this parameter affects soft tissue balance during flexion and patellar tracking. Anatomical markers, such as the epicondylar axis, are typically used to determine the final FC rotation, although intraoperative confirmation may be challenging. Therefore, rotational position is frequently determined with the posterior condylar axis (PCA) as a landmark. However, the thickness of the posterior condylar cartilage has not been considered and may not be represented on preoperative images. We used plain X-rays to measure the thickness of the medial and lateral posterior condylar cartilage fragments postoperatively, and investigated the effects of differences in cartilage thickness on final FC rotation. METHODS: Fifty knees (19 men, 31 women) underwent primary TKA to treat medial knee osteoarthritis at our hospital between August 2015 and May 2017. All knees were treated using an Attune PS (DePuy Synthes, Inc., Warsaw, IN). We first measured the distance between the posterior femoral condyles, resected the posterior condyle, and measured the thickness of the resected cartilage fragments. We then took X-ray images from a direction tangential to the osteotomy surface, secured the cartilage fragments with digital calipers, and measured the thickness of the cartilage. We investigated the effects of differences in cartilage thickness on final FC rotation of the residual medial and lateral cartilage with a trigonometric function. RESULTS: Medial condylar cartilage thickness averaged 0.6 ± 0.5 mm and the lateral condylar thickness averaged 1.8 ± 0.6 mm; posterior intercondylar distance averaged 46.1 ± 3.3 mm and average impact on rotation of the cartilage remnant was 1.5 ± 0.9° (- 0.1-3.9°). There may be measurement error of up to 4° in the maximum values compared with the preoperative plan in cases with short intercondylar distance. CONCLUSIONS: In cases where the FC external rotation angle is determined using the posterior condyles as landmarks, this angle can be affected by the intercondylar distance, especially in Japanese women who have small physical stature. This angle can potentially be much larger, so caution is advised. Our results suggest that several anatomical landmarks should be referenced to achieve accurate FC rotation.

Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty.

BACKGROUND: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. METHODS: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. RESULTS: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. CONCLUSION: Patients with a pre-operative Hb level of < 11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

Development of a Magnetic Compound Fluid Rubber Stability Sensor and a Novel Production Technique via Combination of Natural, Chloroprene and Silicone Rubbers.

Expanding on our previous report, we investigate the stability of a magnetic compound fluid (MCF) rubber sensor that was developed for a variety of engineering applications. To stabilize this sensor, we proposed a novel combination technique that facilitates the addition of dimethylpolysiloxane (PDMS) to natural rubber (NR)-latex or chloroprene rubber (CR)-latex using polyvinyl alcohol (PVA) by experimentally and theoretically investigating issues related to instability. This technique is one of several other novel combinations of diene and non-diene rubbers. Silicone oil or rubber with PDMS can be combined with NR-latex and CR-latex because of PVA's emulsion polymerization behavior. In addition, owing to electrolytic polymerization based on the combination of PDMS and PVA, MCF rubber is highly porous and can be infiltrated in any liquid. Hence, the fabrication of novel intelligent rubbers using any intelligent fluid is feasible. By assembling infiltrated MCF rubber sheets and by conducting electrolytic polymerization of MCF rubber liquid with a hydrate using the adhesive technique as presented in a previous paper, it is possible to stabilize the MCF rubber sensor. This sensor is resistant to cold or hot water as well as γ-irradiation as shown in the previous report.

Positioning the femoral bone socket and the tibial bone tunnel using a rectangular retro-dilator in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to evaluate the positions of femoral bone sockets and tibial bone tunnels made with the rectangular retro-dilator (RRD), which we manufactured for anterior cruciate ligament reconstruction (ACLR) with a bone-patella tendon-bone (BPTB) graft which is fixed into the rectangular bone socket and tunnel made at anatomical ACL insertion sites. METHODS: 42 patients who had undergone ACLR with BPTB using the RRD were evaluated to assess bone socket and tunnel positions by the quadrant method and Magnussen classification using three-dimensional (3-D) CT. Intra-operative complications were also investigated in all patients. RESULTS: 3-D CT of the operated knee joints using the RRD showed that the bone socket and tunnel were placed in anatomical positions. In the quadrant method, the mean position of the femoral bone socket aperture was located at 22.0 ± 4.2% along the Blumensaat's line, and 37.4 ± 7.2% across the posterior condylar rim. The mean positions of the tibial bone tunnel aperture were 37.7 ± 5.2% and 46.1 ± 2.2% antero-posteriorly and medio-laterally, respectively. In addition, according to the Magnussen classification, 39 cases were evaluated as type 1, and almost all were located behind the lateral intercondylar ridge (also known as the resident's ridge). 3 cases were classified as type 2, which overlapped with the resident's ridge. A partial fracture of BPTB bone fragment was observed in 2 patients, but no serious complications including neurovascular injury were observed. CONCLUSION: The study indicates that the use of RRD achieves a safe anatomical reconstruction of the ACL.

Persistent activation of histamine H1 receptors in the hippocampal CA1 region enhances NMDA receptor-mediated synaptic excitation and long-term potentiation in astrocyte- and D-serine-dependent manner.

Behavioral studies using pharmacological tools have implicated histamine H1 receptors in cognitive function via their interactions with N-methyl-D-aspartate receptors (NMDARs) in the hippocampus. However, little is known about the neurophysiological mechanism that underlies the interaction between H1 receptors and NMDARs. To explore how H1 receptor activation affects hippocampal excitatory neurotransmission and synaptic plasticity, this study aimed to examine the effect of H1 receptor ligands on both NMDAR-mediated synaptic currents and long-term potentiation (LTP) at synapses between Schaffer collaterals and CA1 pyramidal neurons using acute mouse hippocampal slices. We found that the H1 receptor antagonist/inverse agonists, pyrilamine (0.1 µM) and cetirizine (10 µM), decreased the NMDAR-mediated component of stimulation-induced excitatory postsynaptic currents (EPSCs) recorded from CA1 pyramidal neurons without affecting the AMPA receptor-mediated component of EPSCs and its paired pulse ratio. Pretreatment of slices with either the glial metabolism inhibitor, fluoroacetate (5 mM), or D-serine (100 µM) diminished the pyrilamine- or cetirizine-induced attenuation of the NMDAR-mediated EPSCs. Furthermore, the LTP of field excitatory postsynaptic potentials induced following high frequency stimulation of Schaffer collaterals was attenuated with application of pyrilamine or cetirizine. Pretreatment with D-serine again attenuated the pyrilamine-induced suppression of LTP. Our data suggest that H1 receptors in the CA1 can undergo persistent activation induced by their constitutive receptor activity and/or tonic release of endogenous histamine, resulting in facilitation of the NMDAR activity in a manner dependent of astrocytes and the release of D-serine. This led to the enhancement of NMDA-component EPSC and LTP at the Schaffer collateral-CA1 pyramidal neuron synapses.

Novel Adhesion Technique Using Metallic or Non-Metallic Hydrous Oxide of Metal Complexes Involving Magnetic Compound Fluid Rubber under Electrolytic Polymerization and Magnetic Field for Producing Sensors.

As per sequential studies on new types of soft rubber for the artificial skin of robots, smart sensors, etc., we have proposed and investigated hybrid skin (H-Skin) and haptic sensors by using magnetic compound fluid (MCF), compounding natural rubber latex (NR-latex), and applying electric and magnetic fields. Through electrolytic polymerization, the MCF rubber is solidified. The MCF rubber has hybrid sensing functions and photovoltaic effects, and electric charge as battery. In case of the production of soft rubber sensors, however, the problem of adhesion between metal electrodes and rubber is very important. In the present study, we propose a novel adhesive technique for bonding the metal electrodes and MCF rubber by using metallic or non-metallic hydrous oxide, which is a metal complex, via electrolytic polymerization. The anionic radical hydrate reacts with the isoprene molecules of NR-latex or chloroprene rubber latex (CR-latex) such that they are cross-linked and the MCF rubber with the hydrate is solidified, which can be represented via a chemical reaction equation. By means of this adhesive technique, we presented five cases of sensors fabricated using metal electrodes and rubbers. This technique is applicable for novel cohesion between rubber and metal.

Medial pontomedullary junctional infarction presenting vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia and dysphagia without lateral gaze palsy, curtain sign and hoarseness: a case presentation of a novel brain stem stroke syndrome with sensory disturbance-based dysphagia and review of the literature.

In this report, we describe unilateral medial pontomedullary junction (MPMJ) syndrome as a novel brain stem stroke syndrome. A 68-year-old woman suddenly developed vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia (TH) and dysphagia without lateral gaze palsy, curtain sign and hoarseness. Magnetic resonance (MR) imaging showed a small infarction at the right MPMJ. MR angiography did not show vertebrobasilar arterial dissection, thrombosis or vasospasm. Finally, her dysphagia regressed over 4 weeks in synchronization with recovery of TH. To the best of our knowledge and based on a review of the literature, this MPMJ syndrome associated with the unilateral MPMJ infarction is a novel brain stem stroke syndrome different from Foville syndrome, Millard-Gubler syndrome, Wallenberg syndrome or Dejerine's syndrome. In the MPMJ syndrome, transient, albeit severe, dysphagia based on the TH-impaired swallowing reflex bothered the patient more than hemiparesthesia of TH did.