The Effect of Voice Therapy Applying Self-Regulation Concepts on Dysphonia Patients

BACKGROUND AND OBJECTIVES: The goal of this study is to present a strategy for improving the self-regulation (SR) ability and facilitating the change of vocal behavior by applying voice therapy using the SR concept to the patients with vocal cord nodule and muscle tension dysphonia. MATERIALS AND METHOD: The subjects were 80 patients and 80 patients who were diagnosed with muscle tension dysphonia and vocal nodules. As a control group, the results were compared among patients with the same dysphonia without using SR strategies. The concept of SR before voice therapy was explained to the patients, and the treatment was divided into three stages according to the goal of voice therapy. The treatment stages consist of 1) skill acquisition, 2) habit formation, and 3) habit changes. voice therapy was performed by applying SR strategies such as goal implementation intentions and a less routine behavior. Patient's dropout rates were measured to compare the adherence of voice therapy. RESULTS: Significant improvement was seen in all groups receiving voice therapy. However, in the group using the SR strategy, the voice analysis results showed a relatively low dropout rate of voice therapy. In the generalization confirmation stage, patients who applied SR concept showed better results. SR strategy did no longer be necessary to maintain newly adopted vocal behavior. CONCLUSION: The results of this study show that SR is one of the cognitive factors that can have a significant impact on the outcome of voice therapy, and also has a positive impact on the acquisition and generalization of new skills. A better understanding of SR and the development of therapeutic strategies using it will play an important role in solving voice problems in clinical settings.

Oral Metagenomic Analysis Techniques / 치위생과학회지

The modern era of microbial genome analysis began in earnest in the 2000s with the generalization of metagenomics and gene sequencing techniques. Studying complex microbial community such as oral cavity and colon by a pure culture is considerably ineffective in terms of cost and time. Therefore, various techniques for genomic analysis have been developed to overcome the limitation of the culture method and to explore microbial communities existing in the natural environment at the gene level. Among these, DNA fingerprinting analysis and microarray chip have been used extensively; however, the most recent method of analysis is metagenomics. The study summarily examined the overview of metagenomics analysis techniques, as well as domestic and foreign studies on disease genomics and cluster analysis related to oral metagenome. The composition of oral bacteria also varies across different individuals, and it would become possible to analyze what change occurs in the human body depending on the activity of bacteria living in the oral cavity and what causality it has with diseases. Identification, isolation, metabolism, and presence of functional genes of microorganisms are being identified for correlation analysis based on oral microbial genome sequencing. For precise diagnosis and treatment of diseases based on microbiome, greater effort is needed for finding not only the causative microorganisms, but also indicators at gene level. Up to now, oral microbial studies have mostly involved metagenomics, but if metatranscriptomic, metaproteomic, and metabolomic approaches can be taken together for assessment of microbial genes and proteins that are expressed under specific conditions, then doing so can be more helpful for gaining comprehensive understanding.

Metabolic Syndrome in South Korean Patients with Chronic Obstructive Pulmonary Disease: A Focus on Gender Differences

PURPOSE: This study investigated the relationship between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS), focusing on gender differences and using large-scale data on the Korean general population. METHODS: The total sample included 9,079 eligible participants aged ≥ 40 years who participated in the fifth Korea National Health and Nutrition Examination Survey, conducted between 2010 and 2012. Complex sampling methods, including strata sampling, clustering, and sample weighting were used to allow generalization of the findings to the Korean population. For the bivariate analysis, chi-square tests were conducted to compare differences in general/behavioral characteristics, individual MetS components, the prevalence of COPD, and the number of MetS components according to the presence or absence of COPD and gender. Finally, a multiple logistic regression analysis adjusted for variables was conducted. RESULTS: The prevalence rates of COPD and MetS were 13.6% and 26.0%, respectively. The prevalence rate of MetS in the COPD group was 23.0% for the total sample, 18.5% for men, and 38.5% for women. After sample weighting and adjusting for covariates, there were no significant relationships among COPD, MetS, and the individual MetS components. CONCLUSION: Although MetS components were not significantly associated with COPD, the results indicate that health care professionals should recognize that two conditions, respiratory symptoms and MetS, may coexist in patients, women in particular, or healthy general populations encountered even if a patient has a normal body mass index and does not drink or smoke at all.

Social Perceptions of Quack in Qing Dynasty and Its Transformation in the Late Qing Period / 의사학

“Yong-yi” means “quack” in English, which generally refers to a doctor who does not have good medical skills. In the Ming and Qing dynasties in China, various criticism about “Yong-yi” became popularized, and by the late Qing period, “quacks” had become a serious social issue. The theory of traditional Chinese medicine was developed during the Ming and Qing dynasties, and local medical resources also increased. Moreover, the prevalence of medical book publishing led to the openness and generalization of medical knowledge. As a result, not only the number of doctors increased, but also the number of doctors who lack medical knowledge and clinical experience increased. However, at the outset, “Yong-yi” did not only mean doctors with poor medical skills. “Yong-yi” also reflected conflicts and contradictions between doctors. Doctors consistently criticized quacks in an attempt to maintain their identity as a “good” doctor or a Confucian doctor. In this sense, “Yong-yi” was used among physicians as an expression of discrimination and exclusion. The concept of “quackery” was also determined by the relationship between patients and doctors. In general, itinerant doctors, midwives and shaman doctors were regarded as “Yong-yi”; however, they served the medical needs of various patients. Thus, to some extent, “Yong-yi” were also useful medical resources. On the contrary, in certain situations, “shiyi,” physicians who serviced a family for generations and were generally believed to be reliable and as trustworthy doctors, were also labelled as quacks, especially when the patient did not trust them or was not satisfied with the treatment. Therefore, doctors' thoughts about “Yong-yi” did not always coincide with patients' thoughts about “Yong-yi.” However, by the late Qing period, the description of quacks in media reports found a singular connotation, and the divergent social image of quacks disappeared. By this time, quacks were uniformly described as ignorant and irresponsible Chinese medicine practitioners. Specifically, in one murder case in which a “Yong-yi” was accused as the murderer, the report unilaterally reported the patient's claims. Consequently, Chinese medicine practitioners who failed in their treatment of patients became labeled as “quack” doctors. In newspaper reports, “Yong-yi” no longer simply referred to individual cases of “quacks” but had come to represent the entirety of the Chinese medicine practitioner community. On the contrary, Western medical doctors who replaced the status of traditional doctors were positively portrayed. Pictorials also had similar perspectives with newspapers, supporting the narrative of the news with ironic drawings and articles. Overall, media reports regarding “Yong-yi” did not focus on reporting facts, but they had the purpose of making quacks a serious social problem.

Multi class disorder detection of magnetic resonance brain images using composite features and neural network

Brain disorder recognition has becoming a promising area of study. In reality, some disorders share similar features and signs, making the task of diagnosis and treatment challenging. This paper presents a rigorous and robust computer aided diagnosis system for the detection of multiple brain abnormalities which can assist physicians in the diagnosis and treatment of brain diseases. In this system, we used energy of wavelet sub bands, textural features of gray level co-occurrence matrix and intensity feature of MR brain images. These features are ranked using Wilcoxon test. The composite features are classifi ed using back propagation neural network. Bayesian regulation is adopted to fi nd the optimal weights of neural network. The experimentation is carried out on datasets DS-90 and DS-310 of Harvard Medical School. To enhance the generalization capability of the network, fi vefold stratifi ed cross validation technique is used. The proposed system yields multi class disease classifi cation accuracy of 100% in diff erentiating 90 MR brain images into 18 classes and 97.81% in diff erentiating 310 MR brain images into 6 classes. The experimental results reveal that the composite features along with BPNN classifi er create a competent and reliable system for the identifi cation of multiple brain disorders which can be used in clinical applications. The Wilcoxon test outcome demonstrates that standard deviation feature along with energies of approximate and vertical sub bands of level 7 contribute the most in achieving enhanced multi class classifi cation performance results.

A Pharmacogenomic-based Antidepressant Treatment for Patients with Major Depressive Disorder: Results from an 8-week, Randomized, Single-blinded Clinical Trial

OBJECTIVE: Pharmacogenomic-based antidepressant treatment (PGATx) may result in more precise pharmacotherapy of major depressive disorder (MDD) with better drug therapy guidance. METHODS: An 8-week, randomized, single-blind clinical trial was conducted to evaluate the effectiveness and tolerability of PGATx in 100 patients with MDD. All recruited patients were randomly allocated either to PGATx (n=52) or treatment as usual (TAU, n=48) groups. The primary endpoint was a change of total score of the Hamilton Depression Rating Scale-17 (HAMD-17) from baseline to end of treatment. Response rate (at least 50% reduction in HAMD-17 score from baseline), remission rate (HAMD-17 score ≥7 at the end of treatment) as well as the change of total score of Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER) from baseline to end of treatment were also investigated. RESULTS: The mean change of HAMD-17 score was significantly different between two groups favoring PGATx by −4.1 point of difference (p=0.010) at the end of treatment. The mean change in the FIBSER score from baseline was significantly different between two treatment groups favoring PGATx by −2.5 point of difference (p=0.028). The response rate (71.7 % vs. 43.6%, p=0.014) were also significantly higher in PGATx than in TAU at the end of treatment, while the remission rate was numerically higher in PGATx than in TAU groups without statistical difference (45.5% vs. 25.6%, p=0.071). The reason for early drop-out associated with adverse events was also numerically higher in TAU (n=9, 50.0%) than in PGATx (n=4, 30.8%). CONCLUSION: The present study clearly demonstrate that PGATx may be a better treatment option in the treatment of MDD in terms of effectiveness and tolerability; however, study shortcomings may limit a generalization. Adequately-powered, well-designed, subsequent studies should be mandatory to prove its practicability and clinical utility for routine practice.

Generalization of Conscious Fear Is Positively Correlated with Anxiety, but Not with Depression

Generalization of learned fear has been considered to be critical for our survival. Patients with anxiety problems show overgeneralization of learned fear, as reflected by defensive physiological responses to harmless stimuli. Together with these physiological responses, conscious feeling of fear is a seminal part of emotional process that is directly related to the suffering of anxiety patients. However, the effect of anxiety on the generalization of conscious feeling remains unclear. We thus focused on the question whether the generalization of conscious feeling of fear depends on individual anxiety level in nonpatient participants. To address this question, we developed a fear generalization paradigm using natural scene images. We found that subjective feeling of fear was generalized to similar stimuli with the conditioned stimuli (CS), and that this generalization of conscious fear was positively correlated with the level of individual anxiety. Anxiety and depression frequently co-occur, but the individual depression level was not correlated with the fear generalization. These suggest that individual anxiety level mainly affects the generalization of conscious fear.

Current Status of Electronic Medical Record Systems in Hospitals and Clinics in Korea / 대한의료정보학회지

OBJECTIVES: Many healthcare organizations and professionals have had interests in healthcare information and communication technology (ICT). The objective of this study was to investigate the current status of overall healthcare ICT, especially focusing on Electronic Medical Record (EMR) systems in Korea. METHODS: This study used a part of the nationwide survey collected for the OECD benchmarking ICT study. The Health Insurance Review and Assessment Service conducted the survey from November 19, 2013 to January 10, 2014. This study followed the methodological guidelines of the OECD. A total of 2,093 hospitals and clinics, including long-term care hospitals, participated in the survey. Among them, 554 hospitals and 906 clinics were included in this study for the generalization of the results. RESULTS: The adoption rates of EMR systems were 96.3% in hospitals and 95.7% in clinics. Most of the hospitals and clinics had high rates of healthcare information exchange (HIE) within the organization; however, there were extremely low HIE rates among external organizations. Most of the hospitals and clinics had EMR systems with clinical-decision-supporting functionalities. Ninety-six percent of the EMR systems of the hospitals and 89.2% of the clinic systems had checking functions, such as alerts or reminders, on contraindications of drug-drug and drug-age interaction. CONCLUSIONS: Korea has maintained a high healthcare ICT status compared to countries in the European Union. The EMR systems of hospitals and clinics in Korea had sophisticated functionalities; however, their HIE status was extremely low, which indicates the need for healthcare ICT standardization.

Effects of an Auditory Lateralization Training in Children Suspected to Central Auditory Processing Disorder

BACKGROUND AND OBJECTIVES: Central auditory processing disorder [(C)APD] refers to a deficit in auditory stimuli processing in nervous system that is not due to higher-order language or cognitive factors. One of the problems in children with (C)APD is spatial difficulties which have been overlooked despite their significance. Localization is an auditory ability to detect sound sources in space and can help to differentiate between the desired speech from other simultaneous sound sources. Aim of this research was investigating effects of an auditory lateralization training on speech perception in presence of noise/competing signals in children suspected to (C)APD. SUBJECTS AND METHODS: In this analytical interventional study, 60 children suspected to (C)APD were selected based on multiple auditory processing assessment subtests. They were randomly divided into two groups: control (mean age 9.07) and training groups (mean age 9.00). Training program consisted of detection and pointing to sound sources delivered with interaural time differences under headphones for 12 formal sessions (6 weeks). Spatial word recognition score (WRS) and monaural selective auditory attention test (mSAAT) were used to follow the auditory lateralization training effects. RESULTS: This study showed that in the training group, mSAAT score and spatial WRS in noise (p value≤0.001) improved significantly after the auditory lateralization training. CONCLUSIONS: We used auditory lateralization training for 6 weeks and showed that auditory lateralization can improve speech understanding in noise significantly. The generalization of this results needs further researches.

Games as a measure of reading and writing generalization after computerized teaching of reading skills

Abstract Behavior Analysis is usually accused of not being able to account for the generalization of verbal behavior that is present in linguistically competent individuals. However, several behavior analytic studies investigate this theme, and gamification has been seen as a useful way to study generalization. The purpose of this study was to evaluate reading and writing generalization in games, after these behaviors were taught through the program Learning to Read in Small Steps. Participants were four children between 7 and 12 years old who had reading and writing deficits. The experimental design was a pre-posttest design that encompassed five phases. Performance in probes suggests generalization of reading and writing skills to new activities (games) and responses. This study represents a small step in a systematic understanding of how games can be used to assess behavior change. (AU)

Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder in Korea

OBJECTIVE: Cognitive behavioral therapy (CBT) is regarded as one of the most effective intervention for obsessive-compulsive disorder (OCD). However, many patients remain untreated or inadequately treated due to time or geographical constraints. The purpose of this study was to develop an internet-based CBT (ICBT) for OCD, and to examine its efficacy in the Korean clinical setting. METHODS: The ICBT program ('COT') was developed from the same OCD manual in the standard CBT intervention. Twenty-seven participants of the total 42 patients completed all training sessions of the ICBT and the remainder (n=15) were classified as non-completers. Self-report measures of OCD, depression, anxiety, and work/social functioning, in addition to a neurocognitive test battery, were administered by face-to-face before and after treatment. RESULTS: The participants showed significant improvements in OCD and depressive symptoms, and in work/social functioning after ICBT completion. The presence of combined medication had no significant impact on treatment effect. The non-completers displayed more severe depressive and anxiety symptoms, and ICBT responders were younger and performed better in the Wisconsin Card Sorting Test. CONCLUSION: ICBT was found to be as effective for patients with moderate OC symptoms and little treatment experience. Considering the high accessibility and convenience of ICBT, it could be a helpful first treatment step for OCD patients when face-to-face treatment is unavailable. In the future a randomized controlled study will be necessary for verification and generalization of these results.

Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures

BACKGROUND: Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). METHODS: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. RESULTS: Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. CONCLUSION: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.

Unaided Stapling Technique for Pure Single-Incision Distal Gastrectomy in Early Gastric Cancer: Unaided Delta-Shaped Anastomosis and Uncut Roux-en-Y Anastomosis

PURPOSE: Intracorporeal anastomosis is the most difficult procedure during pure single-incision distal gastrectomy (SIDG) that affects its generalization. We introduced unaided delta-shaped anastomosis (uDelta), a novel anastomosis technique, for gastroduodenostomy after pure SIDG, and compared the results with those of previously reported Roux-en-Y anastomosis (RY). MATERIALS AND METHODS: Between March 2014 and March 2015, SIDG with D1+ lymph node dissection was performed for early gastric cancer through a 2.5-cm transumbilical incision without any additional port. uDelta was performed by the operator alone, without any intracorporeal assistance. RESULTS: uDelta was performed on 11 patents, and uncut RY was performed on 5-patients without open or multiport conversion. R0 resection was performed in all cases. No significant differences were observed in mean age and body mass index between patients who underwent uDelta or RY. Mean operation times were 214.5+/-36.2 minutes for uDelta and 240.8+/-65.9 minutes for RY, which was not significantly different. Reconstruction time for uDelta was shorter than that for RY, with marginal statistical significance (26.1+/-8.3 minutes vs. 38.0+/-9.1 minutes, P=0.05). There were no intraoperative transfusions, 30-day mortality, or anastomosis-related complications in either group. Average length of hospital stay was 8.2+/-1.9 days in the uDelta group and 7.2+/-0.8 days in the RY group (P=0.320). CONCLUSIONS: After carefully considering indications, uDelta can be a feasible and can be a reproducible reconstruction method after SIDG in early gastric cancer.

Lifestyle intervention might easily improve blood pressure in hypertensive men with the C genotype of angiotensin II type 2 receptor gene

BACKGROUND/OBJECTIVES: Recent studies have reported an association of the angiotensin II type 2 receptor (AT2R) 3123Cytosine/Adenine (3123C/A) polymorphism with essential hypertension and cardiovascular diseases. The purpose of the study was to investigate whether the AT2R 3123C/A polymorphism affects blood pressure for free-living hypertensive men during a 5-month intervention period. SUBJECTS/METHODS: The subjects were free-living hypertensive Japanese men aged 40 to 75 years who agreed to intervention in the period from 2004 to 2011. Detection of the AT2R 3123C/A polymorphism was determined by polymerase chain reaction. The dietary intervention was designed to decrease salt level and to increase potassium level through cooking instructions and self-monitoring of the diet. The exercise session consisted of activities such as stretching, resistance training, and walking. Blood pressure, urinary sodium and potassium excretion, dietary and lifestyle data, and non-fasting venous blood sample were collected at baseline and after the intervention period. RESULTS: Thirty nine subjects were eligible for participation and the follow-up rate was 97.4%. The C allele proportion was 57.9%. AT2R 3123C/A polymorphism was X-chromosome-linked, therefore we analyzed the C and A genotypes. At baseline, no significant differences were observed between the genotype groups. After the intervention, there were no significant differences in lifestyle habit between the groups. Nevertheless, the estimated salt excretion (g/day) was significantly decreased only in the C genotype (13.0-10.3, P = 0.031). No significant change was observed in systolic blood pressure (SBP) (mmHg) in the A genotype, but a significant decrease was observed in the C genotype (150.0-141.5, P = 0.024). CONCLUSTIONS: In the C genotype, it might be easy to improve SBP through lifestyle intervention in free-living hypertensive Japanese men, however generalization could not be achieved by the small sample size.

Fetal tumors: prenatal ultrasonographic findings and clinical characteristics

The incidence of fetal tumors has been increased due to generalization of prenatal evaluation and improvement of imaging techniques. The early detection of a fetal tumor and understanding of its imaging features are very important for fetal, maternal, and neonatal care. Ultrasonography is usually used for the detection and differential diagnosis of fetal tumors, and magnetic resonance imaging is increasingly being used as a complementary study. Many fetal tumors have different clinical and imaging features compared with pediatric tumors. Although several fetal tumors may mimic other common anomalies, some specific imaging features may carry early accurate diagnosis of fetal tumors, which may alter the prenatal management of a pregnancy and the mode of delivery, and facilitate immediate postnatal treatment.

IgG4-Related Intracranial Hypertrophic Pachymeningitis : A Case Report and Review of the Literature

Hypertrophic pachymeningitis is an uncommon disorder that causes a localized or diffuse thickening of the dura mater. Recently, the possibility that IgG4-related sclerosing disease may underlie some cases of intracranial hypertrophic pachymeningitis has been suggested. We herein report the tenth case of IgG4-related intracranial hypertrophic pachymeningitis and review the previous literature. A 45-year-old male presented with left-sided focal seizures with generalization. Magnetic resonance imaging (MRI) revealed a diffuse thickening and enhancement of the right convexity dura matter and falx with focal nodularity. The surgically resected specimens exhibited the proliferation of fibroblast-like spindle cells and an infiltration of mononuclear cells, including predominantly plasma cells. The ratio of IgG4-positive plasma cells to the overall IgG-positive cells was 45% in the area containing the highest infiltration of plasma cells. On the basis of the above findings, IgG4-related sclerosing disease arising from the dura mater was suspected. IgG4-related sclerosing disease should be added to the pachymeningitis spectrum.

The Association Between the 10-Year Risk of the Korean Stroke Risk Prediction Model and the Carotid Intima-Media Thickness

BACKGROUND: Both carotid intima-media thickness (IMT) and global risk score of cardiovascular disease were independent risk factors of stroke and heart disease. We assessed the correlation between the 10-year risk of Korean Stroke Risk Prediction model (KSRP) and carotid intima-media thickness. Additionally, from a perspective of carotid IMT measurement following KSRP risk stratification, we analyzed the difference of carotid IMT and plaque according to the KSRP risk strata. METHODS: Subjects were 282 persons who visited one hospital for the screening of stroke. The 10-year risk was calculated automatically based on the equation of KSRP model. The maximal carotid IMT and the plaque were adopted as the study variables. The sensitivity and the positive predictive value of the KSRP risk categories were calculated. RESULTS: The correlation coefficient between the KSRP risk and the maximal carotid IMT was 0.29 (p<0.01). The mean (+/-standard deviation) of KSRP risk of the group with carotid plaque was statistically significantly higher, 5.3 (+/-4.1), than that of the group without plaque, 3.3 (+/-3.1) (p< or =0.01). The sensitivity of the risk stratum with more than 6% of KSRP risk for the plaque was 28.2%. The positive predictive value of the above cut-point was 48.8%. CONCLUSIONS: The 6% of KSRP risk may be considered as the beginning point of intermediate risk stratum to recommend the carotid ultrasonography. However, generalization needs further studies for various populations.

Meningioma in a 20-Month-Old Boy

A 20-month-old boy presented with a intraparenchymal mass in the right frontoparietal area manifesting as complex partial seizure, secondary generalization and left hemiparesis. Magnetic resonance images (MRI) of the brain showed inhomogeneously enhancing mass in the right frontoparietal area which has irregular margin and perilesional edema. Based on the radiological findings, a preoperative diagnosis was an intraaxial tumor, such as pilocytic astrocytoma or dysembryoplastic neuroepithelial tumor. The patient underwent a surgery including frontal craniotomy. The tumor had a partially extreme adherence to the surrounding brain tissue but it showed no dural attachment. Gross-total resection of the tumor was achieved. Postoperative follow-up computed tomography scans showed no residual tumor. The pathological findings confirmed the tumor as a WHO grade I meningioma, transitional type. Nine months after the surgery, follow-up brain MRI showed no recurrence of the tumor, porencephaly in site where the tumor was resected; the patient's symptoms had fully recovered. We report the case of a meningioma in a 20-month-old boy.

Meningioma in a 20-Month-Old Boy

A 20-month-old boy presented with a intraparenchymal mass in the right frontoparietal area manifesting as complex partial seizure, secondary generalization and left hemiparesis. Magnetic resonance images (MRI) of the brain showed inhomogeneously enhancing mass in the right frontoparietal area which has irregular margin and perilesional edema. Based on the radiological findings, a preoperative diagnosis was an intraaxial tumor, such as pilocytic astrocytoma or dysembryoplastic neuroepithelial tumor. The patient underwent a surgery including frontal craniotomy. The tumor had a partially extreme adherence to the surrounding brain tissue but it showed no dural attachment. Gross-total resection of the tumor was achieved. Postoperative follow-up computed tomography scans showed no residual tumor. The pathological findings confirmed the tumor as a WHO grade I meningioma, transitional type. Nine months after the surgery, follow-up brain MRI showed no recurrence of the tumor, porencephaly in site where the tumor was resected; the patient's symptoms had fully recovered. We report the case of a meningioma in a 20-month-old boy.

Generalization of Treatment Effect on Motor Learning after Stroke

Approximately two thirds of stroke survivors have residual neurological deficits that persistently impair function. Hence, alternative strategies are needed to reduce the long-term disability and functional impairment from severe weakness of limbs. Generalization of treatment effect takes place when the effects of the therapy spread to a variety of related behaviors and similar movements. And the transfer effect that training of the limbs on one side of the body appeared to be shared by those on the other side simultaneously. The two concepts are closely linked together. These forms of learning are organized through a higher-level cerebral mechanism and can be associated corpus callosum. Several promising new rehabilitation approaches such as bilateral training are based on the transfer effect. The purpose of this review is to introduce transfer effect of treatment on motor learning after stroke.