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Background: This study investigates the serial mediation of self-esteem and smartphone dependency in the relationship between negative parenting style and adolescents’ aggression.Methods: We conducted a secondary data analysis of the 2018 Korean Children and Youth Panel Survey (KCYPS) and used the data of first-year middle school students. A mediation analysis was conducted using Hayes’ SPSS PROCESS Macro (Model 6).Results: The mediation of smartphone dependency was significant in the relationship between parents’ negative parenting style and aggression, but the mediation of self-esteem was not. Negative parenting style significantly affected adolescents’ aggression through the sequential mediation of self-esteem and smartphone dependency.Conclusions: Appropriate interventions should be prepared to help adolescents increase their self-esteem and reduce smartphone dependency, thus reducing the aggression that a negative parenting style induces.

To elucidate the experiences of school nurses when responding to public health crises in Korea.Phenomenological research.One-on-one online in-depth interviews were conducted (N = 10).Major public health crises considerably affected schools, school nurses, and the revision of the School Health Act.The experiences of school nurses in responding to periodic public health crises over the few decades have contributed to the advancement of an infectious disease response system in schools.The activities of school nurses during public health crises could serve as a foundation to improve the system.

Overactive bladder (OAB) is a syndrome causing a sudden and unstoppable need to urinate with significant global prevalence. Several drugs are used to treat OAB; however, they have various side effects. Therefore, new treatment options for OAB are required. A series of novel 5-oxo

Eun Jung Bae,1,* Soo-Hyun Nam2,* 1College of Nursing, Seoul National University, Seoul, Republic of Korea; 2Department of Nursing, Andong National University, Andong, Republic of Korea*These authors contributed equally to this workCorrespondence: Soo-Hyun Nam, Department of Nursing, Andong National University, 1375 Gyeongdong-ro, Andong, Gyeongbuk, 36729, Republic of Korea, Tel +82-54-820-6772, Fax +82-54-820-9415, Email snam@anu.ac.krPurpose: This study aimed to investigate the serial mediating effects of the time mothers spend with their adolescent children and the adolescents’ self-esteem on the relationship between mothers’ and adolescents’ problematic smartphone use.Patients and Methods: This study was a secondary analysis of data extracted from the Korean Children and Youth Panel Survey (KCYPS) in 2018, which comprised data on first-year middle school students. Mediation analysis was conducted using Model 6 of the Hayes’ PROCESS macro for SPSS.Results: The mediating effect of the time mothers spent with adolescents on the relationship between mothers’ and adolescents’ problematic smartphone use was significant, but the mediating effect of adolescents’ self-esteem was not significant. Mothers’ problematic smartphone use was found to significantly affect adolescents’ problematic smartphone use by sequentially mediating the time mothers spent with adolescent children and adolescents’ self-esteem.Conclusion: It was concluded that, to lower adolescents’ problematic smartphone use due to mothers’ problematic smartphone use, appropriate interventions should be formulated to help adolescents develop higher self-esteem through sufficient mother–child interaction time.Keywords: problematic smartphone use, mother–child relationship, adolescents self-esteem, mediation analysis

BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy is important for the prevention of sudden cardiac death, but data on clinical outcomes of ICD therapy in Asian pediatric patients are scarce. The aim of this Korean multicenter study was to evaluate the current state and elucidate the clinical outcomes of ICD therapy in children.Methods and Results:Data from 5 pediatric cardiology centers were retrospectively collected from 2007 to 2019. Altogether, 99 patients were enrolled (mean age 13.9±4.1 years). The most common underlying disease was a primary electrical disease (56%). An ICD was implanted for primary prevention in 19%. Appropriate shock occurred in 44% of patients at a median of 1.6 years after implantation. There was no significant difference in the appropriate shock rate between patients with primary and secondary prevention indications (32% vs. 48%, respectively). A total of 33 patients (33%) experienced inappropriate shock, which was associated with primary electrical disease and follow-up duration on multivariate analysis. 17% of patients had ICD-related complications. CONCLUSIONS The utilization rate of ICD for primary prevention was still low in the pediatric population in Korea, but there was a substantial rate of appropriate shock in these patients. Efforts to increase ICD usage to save the lives of high-risk patients and reduce the incidence of inappropriate shock are required.

We encountered siblings with familial Majewski osteodysplastic primordial dwarfism type II (MOPD II) with acute myocardial infarction in adolescence and in their early 20s. We successfully performed percutaneous and surgical coronary interventions. From these cases, we were able to better understand coronary artery disease of MOPD II and provide better management. (Level of Difficulty: Intermediate.), Central Illustration

Aim The study aimed to identify social factors predicting improvement of frailty in community-dwelling older adults after 2 years using a population-based cohort study. Methods We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community-dwelling older adults aged 70-84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five-item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. Results In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.34) was significantly associated with frailty improvement. In pre-frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07-1.28, OR 1.13, 95% CI 1.03-1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84-0.91) were associated with pre-frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02-1.33) were also associated with improvements of frailty. Conclusions Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community-dwelling older adults. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.

Background Pre-Fontan risk stratification is still less than optimal. We aimed to evaluate the effectiveness of intraoperative pulmonary flow study (IOFS), in combination with conventional preoperative evaluation, in the identification of high-risk candidates for the Fontan operation. Method Data from 37 patients (age: 38.1 ± 4.9 months) who underwent the Fontan operation with IOFS were retrospectively reviewed. After anastomosing the Gore-Tex vascular graft to the confluent pulmonary artery, IOFS was performed through the graft at various cardiac indices (CI) (1–4 L/min/m2) generated from a roller pump. Mean pulmonary artery pressure (mPAP) and left atrial pressure (LAP) were recorded. The patients were divided into two groups: those who required Fontan circuit fenestration (group Ff) and those who did not (group Fn). Results Eleven patients (29.7%) required fenestration, intraoperatively (n = 4) and postoperatively (n = 7), due to hemodynamic instability. Heterotaxy syndrome (P = 0.005) and atrioventricular valvar regurgitation (P = 0.04) were more frequent, and ventricle posterior wall thickness (VPWT) was higher (P = 0.024) in group Ff. On IOFS, the increase in mPAP by CI was sharper in group Ff than in group Fn (P Conclusions IOFS may be helpful to identify high-risk Fontan candidates, and high mPAP at CI of 3.0 L/min/m2 on IOFS is a significant predictor of the requirement for fenestration. VPWT is an important preoperative risk factor which correlates with the IOFS results.

Background Because of the absence of a specific diagnostic test and pathognomonic clinical features, physicians must rely on the presence of specific clinical criteria and laboratory data that support the diagnosis of KD. To help clinicians distinguish KD, KDSS, septic shock, and TSS earlier, we suggest differential diagnosis and treatment guideline. Methods Medical records of immunocompetent patients who were admitted to the pediatric department with a diagnosis of KDSS, septic shock or TSS (SS group) were retrospectively reviewed. In addition, KD patients were selected by seasonal matching to each case of KDSS patient by date of admission (± 2 weeks). Results There were 13 patients with KDSS, 35 patients with SS group, and 91 patients with KD. In comparison between KDSS and septic shock group, KDSS group had significantly higher rate of coronary aneurysm incidence, and higher left ventricle dysfunction rate. In comparison between KDSS and TSS, patients with KDSS had a significantly higher erythrocyte sedimentation rate (ESR) and significantly lower creatinine. Receiver operation characteristic curve revealed that the optimal ESR cut off value for determining the KDSS was 56.0 (sensitivity 75.0%, specificity of 100.0%) and the optimal creatinine cut off value for determining the TSS was 0.695 (sensitivity 76.9%, specificity 84.6%). Conclusions Clinical symptoms, laboratory finding, echocardiography, and culture studies can be used to differentiate KD, KDSS, septic shock and TSS.

Background To evaluate subclinical liver fibrosis after Fontan procedure using a comprehensive method that reflects the overall liver status rather than the focal biopsy lesion. Method This cross-sectional study included 66 patients without symptoms of liver disease who had at least 5 years of elapsed time since the Fontan procedure (time since Fontan procedure 17.5 ± 7.3 years). Serum enhanced liver fibrosis (ELF) scores and 2D shear wave elastography (SWE), which are expected to detect liver fibrosis earlier than liver enzyme tests and ultrasonography, were evaluated along with general examinations. Results Liver cirrhosis diagnosed by ultrasonography showed a marked increase 16 years after surgery (elapsed time: 6–15 years since Fontan, 43.8%; 16–25 years, 70.8%; 26–35 years, 90.0%). The age-adjusted ELF score and liver stiffness according to SWE were elevated during the early postoperative period (6–15 years since Fontan). In adulthood (elapsed time > 16 years), the adjusted ELF score was correlated with liver stiffness (r = 0.514, p = .009) and liver enzyme levels. There was no correlation between liver fibrosis and the Fontan palliation type. AST to platelet count ratio and FIB-4, which are non-invasive fibrosis markers, presumed absence of fibrosis in approximately 90% of patients. Conclusions In the evaluation of early liver fibrosis after the Fontan procedure, abnormal findings of 2D SWE and ELF scores were observed before abnormal ultrasound and liver enzyme results. Therefore, these indicators may be helpful for the diagnosis of early liver fibrosis, and further longitudinal study might be needed.

Background Published algorithms for accessory pathway localization in Wolff-Parkinson-White (WPW) syndrome are inaccurate in pediatric patients, especially for septal pathways. Objective We aimed to develop a new algorithm that is sensitive for septal pathways and more applicable in pediatric patients. Methods In 120 patients (mean age: 11.7 ± 3.9 years) who underwent catheter ablation for WPW syndrome, the candidate criteria for new algorithm were searched by comparing electrocardiography parameters and accessory pathway locations. A new algorithm was designed to increase the sensitivity for septal pathways. For validation, 142 patients (mean age: 15.8 ± 3.7 years) were additionally evaluated. New and published algorithms were applied to electrocardiography of 262 patients and the results were compared. Results The new algorithm achieved its best discrimination by combining several parameters together in each step: (1) QRS polarity in V1 and QRS shape in lead I for left/right discrimination, and (2) delta wave polarity in V1, QRS transition in precordial leads, and delta wave polarity in lead III for septal pathway screening. The new algorithm showed higher sensitivity for septal pathways (95.7%) than 7 published algorithms (average: 62.1%), with satisfactory positive predictive value (77.9%). Delta wave polarity in V1 among septal pathways and QRS axis among right anteroseptal pathway showed age-related trend; this could be the reason for the lower accuracy in localizing septal pathways in children. Conclusion The inaccuracy of published algorithms in pediatric patients is due to the age-related trend in the electrocardiography of septal pathways. The new algorithm was superior for localizing septal pathways in pediatric patients.

Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure. However, in pediatric and congenital heart disease (CHD) patients, current adult indications cannot be directly applied because of heterogeneity in anatomy and diagnosis. Therefore, CRT responses and clinical outcomes in these patients were investigated to derive possible candidates for CRT.This study retrospectively analyzed 16 pediatric and CHD patients who underwent CRT implantation at a single center in early (0.7±0.2 year) and late (4.7±0.3 years) follow-up period after CRT.The median age at CRT implantation was 2.5 (0.3-37.2) years, and median follow-up duration was 6.3 (0.1-13.6) years. Thirteen had non-transvenous CRT. Two had congenital complete atrioventricular (AV) block with previous right ventricular pacing, 5 had dilated cardiomyopathy (DCM) with left bundle branch block, and 9 had CHD. The mean ejection fraction of the systemic ventricle increased from 28.1±10.0% to 44.3±21.0% (p=0.003) in early and 51.8±16.3% (p=0.012) in late outcome. The mean functional class improved from 3.1±0.9 to 1.8±1.1 after CRT (p=0.003). Twelve patients (75%) showed improvement in ventricular function or functional class after CRT. Proportion of responders differed between patients without CHD (2/2 patients with complete AV block and 5/5 with DCM, 100%) and those with CHD (5/9, 56%), although statistical significance was not reached (p=0.088).CRT improved ventricular function and functional status according to the underlying condition in pediatric and CHD patients. However, further large and longer-term studies are needed to establish the guideline for the patient selection of CRT in these patients.

This study aims to investigate the knowledge structure and research trends in child and adolescent health literacy research over the past 30 years by using network text analysis.The study was conducted in four steps: 1) collecting abstracts, 2) keyword extraction and preprocessing, 3) creation of co-occurrence matrix, and 4) text network analysis.As a result of the centrality analysis, the upper-ranked core keywords were "health care," "health behavior," "prevention," "treatment," and "health promotion." In contrast to earlier times, "barrier," "caregiver," "school setting," and "QOL" have recently emerged as core keywords.Over the past 30 years, child and adolescent health literacy has been importantly addressed in both clinical and public health approaches. The results of the current study provide references for future research in child and adolescent health literacy.This study suggests the need for additional research on school-based practices that can improve health literacy and for identifying validated and reliable multidimensional health literacy assessment instruments.

Background Radiofrequency catheter ablation (RFCA) has been accepted as an efficient therapy for tachycardia, and substantial improvement in the outcomes of RFCA in pediatric patients has been seen. However, there is not enough data on the clinical outcomes of RFCA for ventricular tachycardia (VT) in pediatric patients. The objective of this study was to elucidate the efficacy and safety of RFCA for VT in pediatric patients. Methods We performed a retrospective study involving 35 consecutive pediatric VT ablation procedures in 28 patients at a single institution. Results The median age at ablation was 14.0 years (range 6.9–19.2 years). There were 24 patients with a structurally normal heart and four patients with congenital heart disease (CHD). The left ventricular posteroseptal area was the most common site of VT origin (22/28, 78.6%). However, there was an unusual case of VT which involved a papillary muscle as its origin. Acute success was achieved in 30 (85.7%) of 35 procedures. The recurrence rate after successful RFCA was 14.2% (5/35) at a median follow-up of 6.7 years (range 1.0–16.7 years). There were five procedural failures due to the inability to induce VT for complete mapping. Ultimately, long-term success was achieved in 27 patients (96.4%) after repeated procedures and no major complications occurred. Long-term success was associated with VT inducibility (p = Conclusions Difficulty in inducing VT for precise mapping was a significant obstacle to successful RFCA. RFCA was identified as safe and effective therapy to eliminate VT in the selected pediatric VT patients.

Though ventricular assist devices (VADs) are an important treatment option for acute heart failure, an extracorporeal membrane oxygenator (ECMO) is usually used in pediatric patients for several reasons. However, a temporary centrifugal pump-based Bi-VAD might have clinical advantages versus ECMO or implantable VADs. From January 2000 to July 2018, we retrospectively reviewed 36 pediatric patients who required mechanical circulatory support (MCS) for acute heart failure. Cases with postoperative MCS were excluded. Since 2016, we have tried to immediately add a right VAD rather than ECMO, when the patients begin to present features of right heart failure after left VAD support started in cases that the patients’ respiratory function did not require an oxygenator. Original diagnoses included dilated cardiomyopathy (n = 18), myocarditis (n = 11), and others (n = 7). Eleven patients were supported by Bi-VAD, and 25 patients were supported by ECMO; of these. Four patients were successfully weaned from VAD, and 10 patients were weaned from ECMO. Eleven patients underwent heart transplantation. Overall, we have 15 (41.7%) early mortalities. There were no significant differences in early mortality, morbidity, and weaning rate between the Bi-VAD group and the ECMO group. During the support, patients with Bi-VADs significantly required fewer platelets and showed less hemolysis than ECMO patients. Patients with myocarditis were successfully weaned from Bi-VAD support and bridged to transplantation thereafter. A temporary centrifugal pump-based Bi-VAD was clinically comparable to ECMO for pediatric patients with acceptable pulmonary function.

Background As a result of advances in pediatric care and diagnostic testing, there is a growing population of adults with congenital heart disease (ACHD). The purpose of this study was to better define the epidemiology and changes in the trend of hospitalizations for ACHD in Korean society. Methods We reviewed outpatient and inpatient data from 2005 to 2017 to identify patient ≥18 years of age admitted for acute care with a congenital heart disease (CHD) diagnosis in the pediatric cardiology division. We tried to analyze changes of hospitalization trend for ACHD. Results The ratio of outpatients with ACHD increased 286.5%, from 11.1% (1748/15,682) in 2005 to 31.8% (7795/24,532) in 2017. The number of ACHD hospitalizations increased 360.7%, from 8.9% (37/414) in 2005 to 32.1% (226/705) in 2017. The average patient age increased from 24.3 years in 2005 to 27.4 in 2017. The main diagnosis for admission of ACHD is heart failure, arrhythmia and Fontan-related complications. The annual ICU admission percentage was around 5% and mean length of intensive care unit (ICU) stay was 8.4 ± 14.6 days. Mean personal hospital charges by admission of ACHD increased to around two times from 2005 to 2017. (from $2578.1 to $3697.0). Total annual hospital charges by ACHD markedly increased ten times (from $95,389.7 to $831,834.2). Conclusions The number of hospital cares for ACHD dramatically increased more than five times from 2005 to 2017. We need preparations for efficient healthcare for adults with CHD such as a multi-dimensional approach, effective communication, and professional training.

This study compared the physicochemical characteristics of different grape varieties for wine making, and contributed to the selection of suitable varieties to impart the desirable characteristics of wine demanded by consumers. It is well known that to produce wine containing above 11% (v/v) alcohol, the amount of soluble solids in grape juice is required to be at least 20 °Brix. Of the different varieties used in this study, Black Sun, Chhungpung × Buffalo, Gaeryangmerou, MBA and Merou × Buffalo were all above 20 °Brix and found to be suitable for making wine without external sugar addition. Considering the total acidity, Chhungpung × Buffalo and Doonuri varieties were below 0.4% (w/v) and required blending with Gaeryangmerou or Wangmerou, which have high total acidity. Total polyphenol, total anthocyanin, and tannin contents were highest in Gaeryangmerou, at 6,615.23 mg/L, 3,122.09 mg/L and 2,742.89 mg/L, respectively. Hence, Gaeryangmerou is good for producing wines with high polyphenol content and blending with low polyphenol grapes. Organic acids are reportedly involved in stabilization, color and pH in wine production. In the current study, four organic acids were detected, in the order tartaric acid, malic acid, citric acid and acetic acid. Tartaric acid comes from grape material, and converts to tartaric precipitation during wine aging. Therefore, wines fermented with Chhungpung × Buffalo, MA55 or Wangmerou varieties, which contain high levels of tartaric acid, are able to remove tartaric precipitation by cooling during the aging process.

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This study explored the relationship between problematic smartphone use and depressive symptoms, peer relationships, and functional somatic symptoms with a representative sample of Korean male and female adolescents using serial multiple mediation models. The results identified the mediating effect of depressive symptoms and peer relationships for males in the association between problematic smartphone use and FSS. The serial mediating effect of the two mediators was also verified in the model for males. However, in the model for females, only depressive symptoms mediated the relationship between problematic smartphone use and FSS. The findings suggest that parents and professionals should assess adolescents with problematic smartphone use for the risk of FSS when depressive symptoms develop. Schools should also provide programs to build positive peer relationships to reduce FSS.

Protein-losing enteropathy (PLE) is a devastating complication after the Fontan operation. This study aimed to investigate the clinical characteristics, treatment response, and outcomes of Fontan-associated PLE.We reviewed the medical records of 38 patients with Fontan-associated PLE from 1992 to 2018 in 2 institutions in Korea.PLE occurred in 4.6% of the total 832 patients after the Fontan operation. After a mean period of 7.7 years after Fontan operation, PLE was diagnosed at a mean age of 11.6 years. The mean follow-up period was 8.9 years. The survival rates were 81.6% at 5 years and 76.5% at 10 years. In the multivariate analysis, New York Heart Association Functional classification III or IV (p=0.002), low aortic oxygen saturation (90%) (p=0.003), and ventricular dysfunction (p=0.032) at the time of PLE diagnosis were found as predictors of mortality. PLE was resolved in 10 of the 38 patients after treatment. Among medical managements, an initial heparin response was associated with survival (p=0.043). Heparin treatment resulted in resolution in 4 patients. We found no evidence on pulmonary vasodilator therapy alone. PLE was also resolved after surgical Fontan fenestration (2/6), aortopulmonary collateral ligation (1/1), and transplantation (1/1).The survival rate of patients with Fontan-associated PLE has improved with the advancement of conservative care. Although there is no definitive method, some treatments led to the resolution of PLE in one-fourth of the patients. Further investigations are needed to develop the best prevention and therapeutic strategies for PLE.

The available tools to assess the communication skills of oncology nurses are limited, and the ComOn Coaching scale may be appropriate for this purpose. The aim of this study was to evaluate the psychometric properties of the Korean version of the ComOn Coaching scale from a patient-centered perspective.The participants were 296 oncology nurses and 42 nursing students. To assess construct, convergent, criterion, and known-group validities and the reliability of the ComOn Coaching scale, the Patient Care Communication Scale, the Korean version of the Watson Caritas Patient Score, and Cancer Survivor Integrated Supportive Care Competence were used. Exploratory and confirmatory factor analyses were conducted. Pearson correlation coefficients and Cronbach's alpha values were calculated. Differential item functions were analyzed.Three factors were extracted from 12 items, and the cumulative variance was 58.8% of the total variance. The three extracted factors were based on the contents of the original scale: Factor 1, Structure of conversation; Factor 2, Building rapport; and Factor 3, Verbal communications skills. Confirmatory factor analysis verified the construct validity of the instrument [χThe Korean ComOn Coaching scale may be a useful self-checking tool for the communication skills of oncology nurses. Repeated use of the Korean ComOn Coaching scale can provide practical information for developing a communication skills program for these professionals and testing its outcomes in the clinical setting.

Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young individuals, largely due to ventricular arrhythmias, which may be associated with electrical disturbances from pathologic myocardial changes.The purpose of this study was to investigate electromechanical mismatches in patients with HCM and the relationship between electromechanical mismatches and life-threatening events (LTEs).We performed a retrospective review of patients (age 1-80 years) diagnosed with HCM. Electromechanical mismatch was evaluated using the electromechanical window (EMW), defined as the interval between the Q wave and aortic valve closure minus the QT interval.We enrolled 458 patients (mean age 52.4 ± 18.8 years). When the EMW of patients with HCM was compared to that of age-/sex-matched normal controls, EMW was more negative in patients with HCM than in normal controls (-51 ± 35 ms vs 7 ± 19 ms; P.001). LTEs occurred in 25 patients (5.5%). EMW was more negative in patients with LTEs than in those without (-77 ± 33 ms vs -42 ± 31 ms; P.001). The cutoff value of EMW to identify patients with LTEs was -54 ms, and the c-index of EMW was 0.726. EMW less than -54 ms, unexplained syncope, pediatric onset, and extreme left ventricular hypertrophy were significant risk factors for LTEs on multivariate analysis.EMW was more negative in patients with HCM than in healthy individuals, and profound EMW negativity was an independent risk factor for LTEs. EMW can be useful for risk stratification of SCD in patients with HCM.

A 4-year-old boy presented with intractable atrial tachycardia and heart failure. Antiarrhythmic drugs, such as digoxin, beta-blockers, and amiodarone were ineffective. Although we attempted multiple radiofrequency catheter ablations, the atrial tachycardia arising from left atrial appendage frequently recurred. Finally, we decided to perform atrial appendectomy using the thoracoscopic approach. Immediately after the appendectomy, the atrial tachycardia was terminated and restored to sinus rhythm. Left ventricular ejection fraction increased from 33 to 60% within 1 week. He had no arrhythmia during the subsequent 9-month follow-up period. Minimally invasive thoracoscopic surgery can be applied even in a small child who has focal atrial tachycardia originating from an atrial appendage.

Because Fontan circulation does not have a subpulmonary ventricle, the preload is limited. In Fontan circulation with extracardiac conduit, the size of conduit could be an important factor in determining the preload. We compared exercise capacity with each conduit size and tried to search for optimal conduit size in Fontan circulation. We reviewed the medical record of 677 patients with Fontan circulation. Patients who had other type Fontan circulation (Kawashima, atriopulmonary, lateral tunnel), SpO2

Pyruvate dehydrogenase kinase 4 (PDK4) activation is associated with metabolic diseases including hyperglycemia, insulin resistance, allergies, and cancer. Structural modifications of hit anthraquinone led to the identification of a new series of allosteric PDK4 inhibitors. Among this series, compound 8c showed promising in vitro activity with an IC50 value of 84 nM. Good metabolic stability, pharmacokinetic profiles, and possible metabolites were suggested. Compound 8c improved glucose tolerance in diet-induced obese mice and ameliorated allergic reactions in a passive cutaneous anaphylaxis mouse model. Additionally, compound 8c exhibited anticancer activity by controlling cell proliferation, transformation, and apoptosis. From the molecular docking studies, compound 8c displayed optimal fitting in the lipoamide binding site (allosteric) with a full fitness, providing a new scaffold for drug development toward PDK4 inhibitors.