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The central nervous system (CNS) is thought to develop motor strategies that minimize various hidden criteria, such as end-point variance or effort. A large body of literature suggests that the dominant arm is specialized for such open-loop optimization-like processes whilst the non-dominant arm is specialized for closed-loop control. Building on recent results suggesting that the brain plans arm movements that takes advantage of gravity effects to minimize muscle effort, the present study tests the hypothesized superiority of the dominant arm motor system for effort minimization. Thirty participants (22.5 ± 2.1 years old; all right-handed) performed vertical arm movements between two targets (40° amplitude), in two directions (upwards and downwards) with their two arms (dominant and non-dominant). We recorded the arm kinematics and the electromyographic activity of the anterior and posterior deltoid to compare two motor signatures of the gravity-related optimization process; i.e., directional asymmetries and negative epochs on phasic muscular activity. We found that these motor signatures were still present during movements performed with the non-dominant arm, indicating that the effort-minimization process also occurs for the non-dominant motor system. However, these markers were reduced compared with movements performed with the dominant arm. This difference was especially prominent during downward movements, where the optimization of gravity effects occurs early in the movement. Assuming that the dominant arm is optimal to minimize muscle effort, as suggested by previous studies, the present results support the hypothesized superiority of the dominant arm motor system for effort-minimization.

Introduction: Semantic dementia (SD) is characterized by fluent speech, anomia, and loss of word and object knowledge with varying degrees of right and left anterior-medial temporal lobe hypometabolism on [18F] fluorodeoxyglucose (FDG)-PET. We assessed neurobehavioral features in SD patients across 3 FDG-PET-defined metabolic patterns and investigated progression over time. Methods: Thirty-four patients with SD who completed FDG-PET were classified into a left- and right-dominant group based on the degree of hypometabolism in each temporal lobe. The left-dominant group was further subdivided depending on whether hypometabolism in the right temporal lobe was more or less than 2 standard deviations from controls (left+ group). Neurobehavioral characteristics determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) were compared across groups. Progression of NPI-Q scores and FDG-PET hypometabolism was assessed in 14 patients with longitudinal follow-up. Results: The right-dominant group performed worse on the NPI-Q and had a greater frequency of abnormal behaviors and more severe disinhibition compared to the left-dominant group. Performance on the NPI-Q and severity of disinhibition correlated with right medial and lateral, but not left, temporal lobe hypometabolism. Severity of abnormal behaviors worsened over time in most left-dominant and left+ patients but appeared to improve in the 2 right-dominant patients with longitudinal follow-up. All groups showed progressive worsening of metabolism in both temporal lobes over time, with hypometabolism spreading from anteromedial to posterior temporal regions. However, the degree of temporal lobe asymmetry remained relatively constant over time. Conclusion: In SD, neurobehavioral features, especially disinhibition, are associated with right medial and lateral temporal lobe hypometabolism and commonly develop over time even in patients that present with left-dominant patterns of hypometabolism.

When participants respond to a task-relevant stimulus attribute by pressing a left or right key with the respective index finger, reaction time is shorter if task-irrelevant left-right stimulus location corresponds to that of the response key than if it does not. For right-handers, this Simon effect is larger for right-located than left-located stimuli; for left-handers this Simon-effect asymmetry is reversed. A similar asymmetry has been found for right-footers pressing pedals with their feet. For analyses that separate stimulus- and response-location factors, these asymmetries appear as a main effect of response location, with responses being faster with the dominant effector. If the Simon-effect asymmetry is strictly a function of effector dominance, it should reverse for left-footers responding with their feet. In Experiment 1, left-dominant persons showed faster responses with the left than right hand but with the right than left foot, a finding consistent with prior research on tapping actions. Right-dominant persons also showed the right-foot asymmetry but, unexpectedly, not the typical asymmetry with hand responses. To evaluate whether hand-presses yield results distinct from finger-presses, in Experiment 2 participants performed the Simon task with finger-presses and hand-presses. The opposing asymmetries for right- and left-dominant persons were evident for both response modes. Our results are consistent with the view that the Simon effect asymmetry is primarily due to differences in effector efficiency, usually but not always favoring the dominant effector.

Acute myocardial infarction is a condition that classically presents with chest pain and corresponding biomarkers and changes on electrocardiogram. Although most causes of acute coronary syndrome are due to acute plaque rupture resulting in coronary thrombosis, an increasingly prevalent condition known as spontaneous coronary artery dissection (SCAD) is becoming more commonly diagnosed. SCAD is characterized by a tear in the tunica media resulting in an intramural hematoma. Depending on the size of the hematoma, progressive extension can ultimately lead to coronary occlusion. Our team presents a 52-year-old female patient that presented with substernal chest pain and positive cardiac enzymes. Urgent coronary catheterization revealed bilateral SCAD involving the left anterior descending and posterior descending arteries in a right coronary dominant circuit. Our patient was treated with medical therapy alone and was safely discharged to home after close monitoring in the coronary care unit. Our team hopes to contribute to a growing body of evidence that bilateral SCAD can occur and can be successfully treated without percutaneous coronary intervention.

Contextual cueing can depend on global configuration or local item position. We investigated the role of these two kinds of cues in the lateralization of contextual cueing effects. Cueing by item position was tested by recombing two previously learned displays, keeping the individual item locations intact, but destroying the global configuration. In contrast, cueing by configuration was investigated by rotating learned displays, thereby keeping the configuration intact but changing all item positions. We observed faster search for targets in the left display half, both for repeated and new displays, along with more first fixation locations on the left. Both position and configuration cues led to faster search, but the search time reduction compared to new displays due to position cues was comparable in the left and right display half. In contrast, configural cues led to increased search time reduction for right half targets. We conclude that only configural cues enabled memory-guided search for targets across the whole search display, whereas position cueing guided search only to targets in the vicinity of the fixation. The right-biased configural cueing effect is a consequence of the initial leftward search bias and does not indicate hemispheric dominance for configural cueing.

International audience; Arrhythmogenic cardiomyopathy with right dominant form (ACR) is a rare heritable cardiac cardiomyopathy disorder associated with sudden cardiac death. Pathogenic variants (PVs) in desmosomal genes have been causally related to ACR in 40% of cases. Other genes encoding nondesmosomal proteins have been described in ACR, but their contribution in this pathology is still debated. A panel of 71 genes associated with inherited cardiopathies was screened in an ACR population of 172 probands and 856 individuals from the general population. PVs and uncertain significance variants (VUS) have been identified in 36% and 18.6% of patients, respectively. Among the cardiopathy-associated genes, burden tests show a significant enrichment in PV and VUS only for desmosomal genes PKP2 (plakophilin-2), DSP (desmoplakin), DSC2 (desmocollin-2), and DSG2 (desmoglein-2). Importantly, VUS may account for 15% of ACR cases and should then be considered for molecular diagnosis. Among the other genes, no evidence of enrichment was detected, suggesting an extreme caution in the interpretation of these genetic variations without associated functional or segregation data. Genotype-phenotype correlation points to (1) a more severe and earlier onset of the disease in PV and VUS carriers, underlying the importance to carry out presymptomatic diagnosis in relatives and (2) to a more prevalent left ventricular dysfunction in DSP variant carriers.

Background: Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making. Methods: We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables. Results: A new metric called “indexed ventricular septal defect” is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons’ Society study to set the limits of the new index. Conclusion: Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.

Unbalance in atrioventricular septal defect can be found in more than one anatomic level and in different degrees at each level. The definition of “unbalance” has historically been focused in comparing the dimensions of main cardiac structures, such as the atrioventricular valve and the ventricles. However, the hemodynamic aspects of unbalance need to be considered as having, at least, similar relevance. New concepts and already described parameters must be combined and understood as a whole to help the surgical decision-making process.

With usually preserved communication, unlike left hemisphere aphasia–related communication impairment, right hemisphere (RH) lesions reveal a manifold of cognitive disorders. Each of these may be the key to monitoring an improvement or deterioration of the clinical status or disease pathophysiology. Furthermore, the RH is dominant for more known entities (at least measurable by us thus far) than the left hemisphere (Table 9.1).

The neural face perception network is distributed across both hemispheres. However, the dominant role in humans is virtually unanimously attributed to the right hemisphere. Interestingly, there are, to our knowledge, no imaging studies that systematically describe the distribution of hemispheric lateralization in the core system of face perception across subjects in large cohorts so far. To address this, we determined the hemispheric lateralization of all core system regions (i.e., occipital face area (OFA), fusiform face area (FFA), posterior superior temporal sulcus (pSTS)) in 108 healthy subjects using functional magnetic resonance imaging (fMRI). We were particularly interested in the variability of hemispheric lateralization across subjects and explored how many subjects can be classified as right-dominant based on the fMRI activation pattern. We further assessed lateralization differences between different regions of the core system and analyzed the influence of handedness and sex on the lateralization with a generalized mixed effects regression model. As expected, brain activity was on average stronger in right-hemispheric brain regions than in their left-hemispheric homologues. This asymmetry was, however, only weakly pronounced in comparison to other lateralized brain functions (such as language and spatial attention) and strongly varied between individuals. Only half of the subjects in the present study could be classified as right-hemispheric dominant. Additionally, we did not detect significant lateralization differences between core system regions. Our data did also not support a general leftward shift of hemispheric lateralization in left-handers. Only the interaction of handedness and sex in the FFA revealed that specifically left-handed men were significantly more left-lateralized compared to right-handed males. In essence, our fMRI data did not support a clear right-hemispheric dominance of the face perception network. Our findings thus ultimately question the dogma that the face perception network – as measured with fMRI – can be characterized as “typically right lateralized”.

Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References, Learning objectives: Identify risk factors of AC and its screening tools. Recall the diagnostic criteria of AC in its classic right ventricular (RVAC) form. Describe CMRI patterns of AC atypical forms: biventricular AC (BVAC) and left ventricular arrhythmogenic...

This study compared the f0, duration and intensity patterns of disyllabic groups that undergo left- or right-dominant tone sandhi in Shanghai Chinese. We investigated the effects of contrastive focus and speech rate on these patterns, in order to further our understanding of the nature of left-/right-dominant sandhi and the phonetic realization mechanisms of focus encoding and speech rate. The results suggest that [Verb+Noun] phrases undergo right-dominant sandhi, which involves a phonetic reduction of the non-final tone as the f0 contour of σ1 is fully realized in focused or slow speech condition; [Adj.+Noun] compounds undergo left-dominant sandhi, which consists phonologically of rightward tone spread, since the f0 pattern of compounds is preserved in all conditions. The focus-induced adjustment patterns of f0, duration and intensity show that left-/right-dominant sandhi domains are composed of different prosodic structures and focus is indirectly encoded via prosodic structure. Although slow speech and focus both enhance the f0 realization, they are realized by way of different mechanisms. Focus is realized via a speaker's direct control of the intensity, while speech rate is realized via a speaker's intentional control of the duration, and the f0 adjustment is better regarded as the surface realization or byproduct of these adjustments.

Advanced endovascular technology and techniques allow interventional radiologists to utilize novel ways of basilar artery recanalization in the setting of acute ischemic stroke, especially when routine approaches are not eligible. Several authors described nonstandard revascularization techniques in acute ischemic strokes due to basilar and middle cerebral arteries occlusions with full technical and clinical success. In this report, we present retrograde right vertebral artery recanalization using left posterior communicating artery for subsequent anterograde balloon angioplasty and stenting of a right vertebral artery ostium followed by full vertebrobasilar blood flow restoration. The case underscores the complexity of arterial thrombotic events, the beneficial role of endovascular intervention in vertebral occlusions and the necessity of prospective studies that identify optimal methods of treating vertebrobasilar stroke due to large vessel occlusions and their effectiveness and safety. Keywords: Ischemic, Stroke, Vertebral, Basilar, Occlusion, Recanalization

Background: Right dominant heart (RDH) in fetuses can occur with a number of cardiac as well as noncardiac anomalies. Analysis of the enlargement of the right cardiac chamber in the fetus remains a major challenge for sonographers and echocardiographers. The aim of this study was to report the experience with prenatal diagnosis of RDH in the fetuses over a 7-year period. Methods: Fetuses with prenatal diagnosis of RDH from July 2009 to July 2016 were evaluated in two different categories: according to the gestational age, Group I (n = 154, second trimester) and Group II (n = 298, third trimester); and according to the fetal echocardiography diagnosis, Group A (n = 452, abnormal cardiac structure) and Group B (n = 90, normal cardiac structure). Differences in categorical variables were assessed by Chi-square exact test and continuous variables were evaluated by independent Student’s t-test or Mann–Whitney U-test depending on parametric or nonparametric nature of the data. Results: Over a 7-year period, 452 fetuses were referred for the assessment of suspected RDH. Left-sided obstructive lesions were observed most frequently in the fetuses with RDH. When comparing Group I with Group II and Group A with Group B, the latter groups exhibited significant differences in the right/left ventricle (RV/LV) ratio (1.435 vs. 1.236, P = 0.002; 1.309 vs. 1.168, P = 0.047), RV width Z-score (1.626 vs. 1.104, P < 0.001; 1.553 vs. 0.814, P = 0.014), and above +2 cutoff percentages (14.3% vs. 22.5%; P = 0.038; 21.5% vs. 12.2%, P = 0.046). Multivariable logistic regression revealed no variables associated with perinatal survival. Conclusions: The study demonstrates that RDH warrants careful attention to the possible presence of a structural cardiac anomaly, especially left-sided obstructive lesions. A diagnosis of RDH is best supported by a combination of the RV Z-score and RV/LV ratio. Most of the fetuses with RDH and structurally normal hearts had favorable outcomes. Key words: Fetal Echocardiography; Prenatal Diagnosis; Right Ventricle; Z-score

Background: Primary progressive aphasia (PPA) is a degenerative disease that presents as progressive decline of language ability with preservation of other cognitive functions in the early stages. Three subtypes of PPA are known: progressive nonfluent aphasia, semantic dementia, and logopenic aphasia (LPA). Patients and Methods: We report the case of a 77-year-old patient with PPA whose clinical findings did not correspond to the three subtypes but mainly fit LPA. Unlike other LPA patients, however, this patient showed a right hemisphere predominant glucose hypometabolism and tau accumulation and a left hemisphere predominant amyloid deposition. The right-handed patient presented with comprehension difficulty followed by problems naming familiar objects. This isolated language problem had deteriorated rapidly for 2 years, followed by memory difficulties and impairment of daily activities. Using a Korean version of the Western Aphasia Battery, aphasia was consistent with a severe form of Wernicke's aphasia. According to the brain magnetic resonance imaging and 18F-fludeoxyglucose positron emission tomography results, right hemisphere atrophy and hypometabolism, more predominant on the right hemisphere than the left, were apparent despite the fact that Edinburgh Handedness Questionnaire scores indicated strong right-handedness. On Pittsburgh compound B-PET, amyloid accumulation was asymmetrical with the left hemisphere being more predominant than the right, whereas 18F-T807-PET showed a right dominant tau accumulation. Conclusions: This is the first report of atypical PPA, in which the patient exhibited crossed aphasia and asymmetrical amyloid accumulation.

Background . In right-dominant unbalanced atrioventricular (AV) canal, there are no criteria to judge adequacy of the left ventricle for biventricular repair. The purpose of this study was to test the hypothesis that right ventricular volume overload in this condition results in right-to-left septal bowing and contributes to the appearance of a small left ventricle. Methods . Five consecutive neonates and young infants (age range, 23 days to 5 months; median age, 3 months) with right-dominant unbalanced complete AV canal underwent biventricular repair. Preoperative and postoperative echocardiographic measurements of left (LV) and right ventricular size and AV valve component size were made. Potential LV volume was assessed preoperatively using a theoretic model that assumed a normalization of septal bowing. Results . There was no perioperative mortality; 1 patient died 71 days postoperatively of problems related to the left AV valve. Preoperatively, all patients had severe LV hypoplasia, with a mean end-diastolic indexed true LV volume of 14.8 ± 9.1 mL/m 2 , indexed potential LV volume of 32.0 ± 18.8 mL/m 2 , left AV valve to total AV valve ratio of 0.30 ± 0.06, and LV to right ventricular long-dimension ratio of 0.65 ± 0.1. Postoperatively, all patients had indexed true LV volumes greater than 30 mL/m 2 (mean volume, 35.6 ± 3.9 mL/m 2 ), and the left AV valve to total AV valve ratio and the LV to right ventricular long-dimension ratio increased to 0.42 ± 0.03 and 0.88 ± 0.11, respectively. Both preoperative potential and true LV volumes correlated well with postoperative true LV volumes: r = 0.90 ( p = 0.040) and r = 0.93 ( p = 0.023), respectively. Increases in LV length and left AV annulus size indicated contributions of volume loading and surgical patching to the right of the ventricular crest to the increase in LV size. Conclusions . In our small series, preoperative indexed potential LV volume of 15 mL/m 2 or greater (present in all patients) allowed biventricular repair of right-dominant unbalanced AV canal. Any previous criteria for LV hypoplasia in this condition need to be reconsidered. This study also has implications for other right-sided volume-loaded lesions in which the left ventricle initially is judged to be hypoplastic but in which biventricular repair may be feasible. (Ann Thorac Surg 1997;63:1657–63)

Background— Definition and management of right dominant unbalanced atrioventricular septal defect (AVSD) remains challenging because unbalance entails a spectrum of left heart hypoplasia. Previous work has highlighted atrioventricular valve (AVV) index as a reasonable defining echocardiographic measure. We sought to assess which additional echocardiographic features might provide further characterization. Methods and Results— From a multi-institutional cohort of complete AVSD, 52 preoperative echocardiograms of patients with presumed right dominant unbalanced AVSD (based on AVV index) and 60 randomly selected preoperative echocardiograms from patients with presumed balanced AVSD were reviewed. Cluster analysis of echocardiographic variables was used to group patients with similar features. Discriminant function analysis was used to explore which variables differentiated these groups. Three groups were identified from the cluster analysis. Echocardiographic variables that differentiated these groups were right ventricle:left ventricle inflow angle, LV width/LV length, left AVV color diameter at smallest inflow, left AVV color diameter at annulus, right AVV overriding left atrium, and LV width. Based on procedures and outcomes, 1 group likely represented balanced patients, whereas 2 groups with similar outcomes likely represented unbalanced patients. The dominant differentiating echocardiographic variable between the 3 cluster groups was the right ventricle:LV inflow angle (partial R 2 =0.86), defined as the angle between the base of the right ventricle and LV free wall, using the crest of the ventricular septum as apex of the angle. Conclusions— The angle of right ventricle/LV inflow and other surrogates of inflow may be important defining echocardiographic measures of right dominant unbalanced AVSD, although confirmation is needed.

We describe a case of congenitally corrected transposition with a double aortic arch. This unique combination of lesions highlights the importance of a complete anatomic assessment prior to referral for surgery.

Complete atrioventricular (AV) canal defects usually have right and left valve components of approximately equal size, although unbalanced forms do occur. Optimal management of unbalanced AV canal defects is controversial, with no proven guidelines for choosing between biventricular repair and univentricular palliation. We describe successful biventricular repair of a right-dominant unbalanced AV canal with severe left AV valve stenosis. This case illustrates that severely unbalanced AV canal defects can be repaired successfully by tailoring the AV valve to distribute it equally between the ventricles, The increase in left ventricular volume after surgery exceeded prediction based on conformational change alone.

The outcome of biventricular (BV) repair for right-dominant unbalanced atrioventricular canal has remained poor, because it is difficult to predict left ventricular (LV) adequacy before surgery. Our aim was to determine whether preoperative echocardiographic parameters, specifically analysis of color inflow into the LV, would predict survival after BV repair in patients with right-dominant unbalanced atrioventricular canal. Subjects with right-dominant unbalanced atrioventricular canal diagnosed from 1994 to 2007 were included. The echocardiographic parameters were analyzed blinded to the palliation strategy and survival. The LV inflow index (LVII) was calculated as the secondary color inflow diameter indexed to the left atrioventricular valve (AVV) annulus diameter. Univariate analysis, survival analysis, and multivariate modeling with stepwise logistic regression were performed. Of the 45 subjects, 23 (51%) underwent single ventricle (SV) palliation and 22 (49%) underwent BV repair. Of the 23 who underwent SV palliation, 15 (65%) survived compared to 18 (82%) of 22 who underwent BV repair (p = 0.34). In the BV group, a greater LVII predicted survival (R2 = 0.46, p = 0.03). No subjects with a LVII

A 48 year-old obese male with hypertension was admitted to our department because of severe right-dominant heart failure. His heart rhythm was 2:1 atrial flutter and the left ventricle was diffusely hypertrophic and hypokinetic. Primary aldosteronism was diagnosed based on severe hypokalemia (2.6 mEq/L) and a low renin-high aldosterone state with hypertension despite the use of an angiotensin-II receptor blocker, but its etiology could not be clarified with computed tomography, adrenal scintigraphy, and adrenal vein sampling. Ascites and edema rapidly worsened. Ascites aspiration was performed daily, until serum potassium was normalized by a full dose of an aldosterone receptor blocker (spironolactone 100 mg/day). A diuretic (furosemide) was then added. Rate control of atrial flutter was obtained with a beta-adrenergic blocker, and anticoagulation therapy was started. His heart failure was successfully controlled. Coronary arteries were normal on coronary arteriograms, and an endomyocardial biopsy sample obtained from the left ventricle did not show any specific pathological findings. Blood pressure was well controlled with the full dose of the aldosterone receptor blocker, but he died one year later due to intracerebral hemorrhage. As his heart failure was right dominant, we believe that its etiology may have been hyperaldosteronism-induced cardiomyopathy, and not advanced hypertensive heart disease.

This chapter provides an overview of skill acquisition as it relates to laterality in elite sport. The general concepts of explicit and implicit processes of learning are initially introduced and discussed with respect to the instructional approaches that coaches employ in practice. With an overarching focus on laterality, the practical implications of these concepts are then considered in the context of the current scientific evidence, most specifically with respect to learning via observation, the provision of feedback in the learning process, and structuring practice to facilitate learning. It is the authors' intention that this chapter allows practitioners to derive direct practical insights to enhance skill acquisition for athletes, irrespective of their lower or upper limb dominance.

ble aortic arch, type B interruption of the left arch, coarctation, aberrant subclavian arteries, and associated multiple right-sided facial and upper limb superficial and deep hemangiomas. Clinical summaries PATIENT 1. A baby girl was born by elective cesarean birth for cephalopelvic disproportion at term in August 1984 and required ventilatory assistance for 6 days for hyaline membrane disease. During this period she was found to have a continuous cardiac murmur and heart failure. There was no history of congenital heart disease in the family, which included one healthy sibling. Multiple capillary hemangiomas were noted over the right side of her face, shoulder, and arm and a deeper hemangioma was present on the back of her neck. Congenital aortic lesions are occasionally associated with clinical syndromes. Recognition of these syndromes is important in aiding clinical diagnosis and accurate surgical management. We describe the case histories of 2 children who appear to have a new vascular syndrome comprising right dominant douA NEW SYNDROME OF MULTIPLE HEMANGIOMAS, RIGHT DOMINANT DOUBLE AORTIC ARCH, AND COARCTATION

There are variations in the anatomy of the coronary arteries in patients with left dominant circulation. The influence of anatomical variations in patients with left dominant circulation on coronary arteriosclerosis is not clear.We investigated whether atherosclerotic involvement in patients with left dominant circulation differs from that in patients with right dominant circulation.We retrospectively compared 38 consecutive angiograms with left coronary dominance with 459 consecutive angiograms with right coronary dominance. By using the 29-segment coding system of the American College of Cardiology/American Heart Association, numerical values were given to each segment, according to the percentage of the decrease in luminary diameter. Using, the sum of numerical values in each coronary artery, LAD score, LCx score, RCA score, and left main coronary artery (LMCA) score were obtained. Using the sum of these 4 vessel scores, the coronary artery disease (CAD) score was calculated.Total LAD score (49+/-48 vs 47+/-57), total LCx score (29+/-45 vs 41+/-58), total RCA score (32+/-68 vs 30+/-51), total LMCA score (1.8+/-11.3 vs 2.9+/-13.6) and total CAD score (108+/-108 vs 108+/-123) were similar in patients with left and right dominant circulation (all differences NS).The extent of coronary atherosclerosis does not depend on the type of dominant coronary circulation.

PubMed: 15334156 Background. There are variations in the anatomy of the coronary arteries in patients with left dominant circulation. The influence of anatomical variations in patients with left dominant circulation on coronary arteriosclerosis is not clear. Aim. We investigated whether atherosclerotic involvement in patients with left dominant circulation differs from that in patients with right dominant circulation. Methods. We retrospectively compared 38 consecutive angiograms with left coronary dominance with 459 consecutive angiograms with right coronary dominance. By using the 29-segment coding system of the American College of Cardiology/American Heart Association, numerical values were given to each segment, according to the percentage of the decrease in luminary diameter. Using, the sum of numerical values in each coronary artery, LAD score, LCx score, RCA score, and left main coronary artery (LMCA) score were obtained. Using the sum of these 4 vessel scores, the coronary artery disease (CAD) score was calculated. Results. Total LAD score (49±48 vs 47±57), total LCx score (29±45 vs 41±58), total RCA score (32±68 vs 30±51), total LMCA score (1.8±11.3 vs 2.9±13.6) and total CAD score (108±108 vs 108±123) were similar in patients with left and right dominant circulation (all differences NS). Conclusions. The extent of coronary atherosclerosis does not depend on the type of dominant coronary circulation.

Objective To evaluate the clinical implication of isolated right dominant heart (RDH) in fetal echocardiography. Study design We reviewed the medical records of pregnant women diagnosed with fetal RDH at Asan Medical Center from December 1999 to December 2005. The criteria of RDH were the ratio of right-to-left atrial and ventricular width and the ratio of the diameter of pulmonary artery-to-aorta were greater than 1.5. Fetuses with congenital heart disease, including coarctation of the aorta (CoA), noncardiac anomalies or chromosomal abnormalities were excluded. Results RDH was identified in 44 fetuses. Twenty-nine (66%) were confirmed to have normal heart and 15 (34%) had cardiac anomalies by postnatal echocardiogrphy; 11 CoA, 1 interruption of aortic arch, 1 patent ductus arteriosus, and 2 ventricular septal defect. Mean gestational age at presentation with RDH was later in normal fetuses as compared to fetuses with CoA (p < 0.005). Only 26% (4/15) of fetuses presenting with RDH during the second-trimester were found to have normal heart postnatally, compared with 86% (25/29) of those diagnosed in the third-trimester. Conclusion RDH in the fetus is a risk factor for postnatal CoA particularly when diagnosed in the second-trimester, and should be an indication for neonatal echocardiography. Copyright © 2007 John Wiley & Sons, Ltd.

We present a multiagent model illustrating the emergence of two different quantum statistics, Bose-Einstein and Fermi-Dirac, in a friendly population of individuals with the right-brain dominance and in a competitive population of individuals with the left-brain hemisphere dominance, correspondingly. Doing so, we adduce the arguments that Lefebvre's ``algebra of conscience'' can be used in a natural way to describe decision-making strategies of agents simulating people with different brain dominance. One can suggest that the emergence of the two principal statistical distributions is able to illustrate different types of society organization and also to be used in order to simulate market phenomena and psychic disorders, when a switching of hemisphere dominance is involved.

In right-dominant unbalanced atrioventricular (AV) canal, there are no criteria to judge adequacy of the left ventricle for biventricular repair. The purpose of this study was to test the hypothesis that right ventricular volume overload in this condition results in right-to-left septal bowing and contributes to the appearance of a small left ventricle.Five consecutive neonates and young infants (age range, 23 days to 5 months; median age, 3 months) with right-dominant unbalanced complete AV canal underwent biventricular repair. Preoperative and postoperative echocardiographic measurements of left (LV) and right ventricular size and AV valve component size were made. Potential LV volume was assessed preoperatively using a theoretic model that assumed a normalization of septal bowing.There was no perioperative mortality; 1 patient died 71 days postoperatively of problems related to the left AV valve. Preoperatively, all patients had severe LV hypoplasia, with a mean end-diastolic indexed true LV volume of 14.8 +/- 9.1 mL/m2, indexed potential LV volume of 32.0 +/- 18.8 mL/m2, left AV valve to total AV valve ratio of 0.30 +/- 0.06, and LV to right ventricular long-dimension ratio of 0.65 +/- 0.1. Postoperatively, all patients had indexed true LV volumes greater than 30 mL/m2 (mean volume, 35.6 +/- 3.9 mL/m2), and the left AV valve to total AV valve ratio and the LV to right ventricular long-dimension ratio increased to 0.42 +/- 0.03 and 0.88 +/- 0.11, respectively. Both preoperative potential and true LV volumes correlated well with postoperative true LV volumes: r = 0.90 (p = 0.040) and r = 0.93 (p = 0.023), respectively. Increases in LV length and left AV annulus size indicated contributions of volume loading and surgical patching to the right of the ventricular crest to the increase in LV size.In our small series, preoperative indexed potential LV volume of 15 mL/m2 or greater (present in all patients) allowed biventricular repair of right-dominant unbalanced AV canal. Any previous criteria for LV hypoplasia in this condition need to be reconsidered. This study also has implications for other right-sided volume-loaded lesions in which the left ventricle initially is judged to be hypoplastic but in which biventricular repair may be feasible.

The hierarchic branching tree structure of the right coronary artery in a right-dominant human heart is examined in terms of detailed measurements of lengths and diameters of the individual vessel segments comprising the structure. The results show that, while the right coronary artery in this heart does not supply a large portion of the posterior left ventricular wall, it nevertheless serves the left side of the heart to a greater extent than it does the right side in terms of the number and volume of vessel segments involved. The results show further that on the right side of this heart the right coronary artery exhibits clear features of a "distributing' vessel, but these features change abruptly as the vessel reaches the small region of the posterior left ventricular wall which it serves.

We have studied clinical and ECG stress features of 119 patients with left main disease and 113 matched patients with three vessels coronary disease. Clinical features and ECG stress test do not differentiate the two groups as a whole. Exercise time duration was shorter, ST criteria were more positive, and peak heart rate was lower in the subgroups of patients with left main and involvement of a right dominant coronary artery. However due to a large overlap these criteria do not seem to be clinically useful. In conclusion, in an individual patient angina and stress ECG criteria do not differentiate the patients with left main from those with three vessels coronary artery disease.

A stratified random sample of 153 right-dominant children (6 to 9 years of age) with normal or above intelligence was selected to study the development of hand strength, and the quality and duration of prone extension as a function of age, sex, height, and weight of the child. The Jamar hand dynamometer was used to measure hand strength, and a new scale for rating the quality of prone extension was presented. Both right- and left-hand strength increased monotonically with age, with the right being significantly higher than the left. Duration of prone extension increased monotonically with age, but quality of prone extension did not correlate with age. Sex differences were found only on the variable left-hand strength (males greater than females). Hand strength demonstrated weak correlation with duration of prone extension. Both height and weight exhibited strong positive correlations with hand strength, weaker positive correlations with duration of prone extension, and no correlation with quality of prone extension. The results suggest hand strength can be an index of normal development, and children ages 6 to 9 can attain the prone extension position; however, the meaning of duration greater than 30 seconds needs to be researched further.

Transcatheter aortic valve replacement (TAVR) has become a mainstay of treatment in the management of severe aortic stenosis. It is a challenging procedure that requires expertise in obtaining proper access, delivery of catheters to and beyond the aortic valve, and finally accurate deployment of the aortic bioprosthesis. Patients with aortic anomalies portend an added challenge in performing TAVR procedures. We present the case of a patient incidentally found to have a right dominant double aortic arch who underwent successful TAVR for severe aortic stenosis.

A crucial ability for athletes playing sports that involve coincidence timing actions is the motor timing ability. The efficiency of perceptual and motor processes underlying the motor timing ability has been related to the motor experience gained in interceptive sports, such as tennis. In the present study, the motor timing ability in young tennis players (TP) and age-matched control participants (CTRL) was compared by means of a synchronization paradigm. Participants were asked to perform finger-opposition movements in synch to a metronome beating 0.5 and 2 Hz in (1) a bimanual coordination test, which compared the performance of the dominant hand with that of the contralateral hand, and (2) a movement lateralization test, which compared the motor performance of the dominant hand during single-hand and bimanual tasks (BTs). The motor performance was evaluated through movement strategy [defined by touch duration (TD), inter-tapping interval (ITI), and movement frequency] and movement accuracy (temporal accuracy defined by the synchronization error and spatial accuracy defined by the percentage of correct touches—%CORR_SEQ). Results showed that motor expertise significantly influences movement strategy in the bimanual coordination test; TD of TP was significantly higher than those of CTRL, specifically at 0.5 Hz. Furthermore, overall ITI values of TP were lower than those of CTRL. Lastly, in the movement lateralization test, the %CORR_SEQ executed with the right dominant hand by TP in the BT was significantly higher than those of CTRL. A discussion about the role of motor expertise in the timing ability and the related neurophysiological adaptations is provided.

Introduction: After chronic impairment of the right dominant hand, some individuals are able to compensate with increased performance with the intact left nondominant hand. This process may depend on the nondominant (right) hemisphere's ability to access dominant (left) hemisphere mechanisms. To predict or modulate patients' ability to compensate with the left hand, we must understand the neural mechanisms and connections that underpin this process. Methods: We studied 17 right-handed healthy adults who underwent resting-state functional connectivity (FC) magnetic resonance imaging scans before 10 days of training on a left-hand precision drawing task. We sought to identify right-hemisphere areas where FC from left-hemisphere seeds (primary motor cortex, intraparietal sulcus [IPS], inferior parietal lobule) would predict left-hand skill learning or magnitude. Results: Left-hand skill learning was predicted by convergent FC from left primary motor cortex and left IPS onto the same small region (0.31 cm(3)) in the right superior parietal lobule (SPL). Discussion: For patients who must compensate with the left hand, the right SPL may play a key role in integrating left-hemisphere mechanisms that typically control the right hand. Our study provides the first model of how interhemispheric functional connections in the human brain may support compensation after chronic injury to the right hand. IMPACT STATEMENT: This article presents the first model of how the human brain applies left-hemisphere (dominant hand [DH]) specializations to support the right hemisphere for compensatory action with the nondominant hand (NDH). Compensation with the NDH is critical for the rehabilitation after many neurological disorders that lead to irreversible impairment of the DH (e.g., stroke, amputation, nerve injury), but no effective therapies exist to promote compensation because the neural mechanisms remain unknown. Therefore, this article will open up new directions in rehabilitation neuroscience by presenting a testable model of the connections that underpin much needed (and currently nonexistent) therapies.

A 23-month-old female child accidentally fell while inside a factory, and 2–5 fingers (Tamai IV area) of her right dominant hand were completely cut off by a high-speed cutting machine gear (Fig. 3.1a, b). The amputated fingers were refrigerated immediately after the injury.